Wright David K, O'Brien Terence J, Shultz Sandy R
Department of Neuroscience, The Alfred Centre, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, 3052, Australia.
Sports Med Open. 2022 Apr 1;8(1):45. doi: 10.1186/s40798-022-00435-w.
Sports-related concussion (SRC) is common in collision sport athletes. There is growing evidence that repetitive SRC can have serious neurological consequences, particularly when the repetitive injuries occur when the brain has yet to fully recover from the initial injury. Hence, there is a need to identify biomarkers that are capable of determining SRC recovery so that they can guide clinical decisions pertaining to return-to-play. Cerebral venous oxygen saturation (SvO) and cerebral blood flow (CBF) can be measured using magnetic resonance imaging (MRI) and may provide insights into changing energy demands and recovery following SRC.
In this study we therefore investigated SvO and CBF in a cohort of concussed amateur Australian Football athletes (i.e., Australia's most participated collision sport). Male and female Australian footballers (n = 13) underwent MRI after being cleared to return to play following a mandatory 13-day recovery period and were compared to a group of control Australian footballers (n = 16) with no recent history of SRC (i.e., > 3 months since last SRC). Despite the concussed Australian footballers being cleared to return to play at the time of MRI, we found evidence of significantly increased susceptibility in the global white matter (p = 0.020) and a trend (F = 2.404, p = 0.071) for reduced relative CBF (relCBF) compared to the control group. Further, there was evidence of an interaction between sex and injury in straight sinus susceptibility values (F = 3.858, p = 0.061) which were decreased in female SRC athletes (p = 0.053). Of note, there were significant negative correlations between straight sinus susceptibility and relCBF suggesting impaired metabolic function after SRC.
These findings support the use of quantitative susceptibility mapping (QSM) and relCBF as sensitive indicators of SRC, and raise further concerns related to SRC guidelines that allow for return-to-play in less than two weeks.
与运动相关的脑震荡（SRC）在碰撞类运动的运动员中很常见。越来越多的证据表明，重复性SRC会产生严重的神经后果，尤其是当重复性损伤发生在大脑尚未从初始损伤中完全恢复时。因此，需要识别能够确定SRC恢复情况的生物标志物，以便指导有关重返比赛的临床决策。脑静脉血氧饱和度（SvO）和脑血流量（CBF）可以通过磁共振成像（MRI）进行测量，并可能为了解SRC后能量需求的变化和恢复情况提供线索。
因此，在本研究中，我们调查了一组脑震荡的澳大利亚业余足球运动员（即澳大利亚参与度最高的碰撞类运动）的SvO和CBF。在经过13天的强制恢复期并被批准重返比赛后，男性和女性澳大利亚足球运动员（n = 13）接受了MRI检查，并与一组近期无SRC病史（即自上次SRC以来超过3个月）的对照澳大利亚足球运动员（n = 16）进行了比较。尽管脑震荡的澳大利亚足球运动员在进行MRI检查时被批准重返比赛，但我们发现，与对照组相比，全球白质的易感性显著增加（p = 0.020），相对CBF（relCBF）有降低的趋势（F = 2.404，p = 0.071）。此外，在直窦易感性值方面存在性别与损伤之间的相互作用的证据（F = 3.858，p = 0.061），女性SRC运动员的直窦易感性值降低（p = 0.053）。值得注意的是，直窦易感性与relCBF之间存在显著的负相关，表明SRC后代谢功能受损。
这些发现支持将定量易感性图谱（QSM）和relCBF用作SRC的敏感指标，并进一步引发了对允许在不到两周内重返比赛的SRC指南的担忧。
