Mito Remika, Parker Donna M, Abbott David F, Makdissi Michael, Pedersen Mangor, Jackson Graeme D
Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3084, Australia.
Florey Department of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC 3052, Australia.
Brain Commun. 2022 Aug 17;4(4):fcac208. doi: 10.1093/braincomms/fcac208. eCollection 2022.
Sports-related concussion, a form of mild traumatic brain injury, is characterized by transient disturbances of brain function. There is increasing evidence that functional brain changes may be driven by subtle abnormalities in white matter microstructure, and diffusion MRI has been instrumental in demonstrating these white matter abnormalities . However, the reported location and direction of the observed white matter changes in mild traumatic brain injury are variable, likely attributable to the inherent limitations of the white matter models used. This cross-sectional study applies an advanced and robust technique known as fixel-based analysis to investigate fibre tract-specific abnormalities in professional Australian Football League players with a recent mild traumatic brain injury. We used the fixel-based analysis framework to identify common abnormalities found in specific fibre tracts in participants with an acute injury (≤12 days after injury; = 14). We then assessed whether similar changes exist in subacute injury (>12 days and <3 months after injury; = 15). The control group was 29 neurologically healthy control participants. We assessed microstructural differences in fibre density and fibre bundle morphology and performed whole-brain fixel-based analysis to compare groups. Subsequent tract-of-interest analyses were performed within five selected white matter tracts to investigate the relationship between the observed tract-specific abnormalities and days since injury and the relationship between these tract-specific changes with cognitive abnormalities. Our whole-brain analyses revealed significant increases in fibre density and bundle cross-section in the acute mild traumatic brain injury group when compared with controls. The acute mild traumatic brain injury group showed even more extensive differences when compared with the subacute injury group than with controls. The fibre structures affected in acute concussion included the corpus callosum, left prefrontal and left parahippocampal white matter. The fibre density and cross-sectional increases were independent of time since injury in the acute injury group, and were not associated with cognitive deficits. Overall, this study demonstrates that acute mild traumatic brain injury is characterized by specific white matter abnormalities, which are compatible with tract-specific cytotoxic oedema. These potential oedematous changes were absent in our subacute mild traumatic brain injury participants, suggesting that they may normalize within 12 days after injury, although subtle abnormalities may persist in the subacute stage. Future longitudinal studies are needed to elucidate individualized recovery after brain injury.
与运动相关的脑震荡是轻度创伤性脑损伤的一种形式,其特征是脑功能的短暂紊乱。越来越多的证据表明,脑功能变化可能由白质微观结构的细微异常所驱动,而扩散磁共振成像在显示这些白质异常方面发挥了重要作用。然而,在轻度创伤性脑损伤中,所报道的白质变化的位置和方向是可变的,这可能归因于所使用的白质模型的固有局限性。这项横断面研究应用了一种先进且稳健的技术,即基于固定点的分析,来研究近期有轻度创伤性脑损伤的澳大利亚职业橄榄球联盟球员的纤维束特异性异常。我们使用基于固定点的分析框架来识别急性损伤参与者(受伤后≤12天;n = 14)特定纤维束中发现的常见异常。然后,我们评估了亚急性损伤(受伤后>12天且<3个月;n = 15)中是否存在类似变化。对照组为29名神经健康的对照参与者。我们评估了纤维密度和纤维束形态的微观结构差异,并进行了全脑基于固定点的分析以比较各组。随后在五个选定的白质束内进行感兴趣束分析,以研究观察到的束特异性异常与受伤天数之间的关系,以及这些束特异性变化与认知异常之间的关系。我们的全脑分析显示,与对照组相比,急性轻度创伤性脑损伤组的纤维密度和束横截面积显著增加。与亚急性损伤组相比,急性轻度创伤性脑损伤组与对照组相比显示出更广泛的差异。急性脑震荡中受影响的纤维结构包括胼胝体、左侧前额叶和左侧海马旁白质。急性损伤组中纤维密度和横截面积的增加与受伤时间无关,且与认知缺陷无关。总体而言,这项研究表明,急性轻度创伤性脑损伤的特征是特定的白质异常,这与束特异性细胞毒性水肿相符。在我们的亚急性轻度创伤性脑损伤参与者中不存在这些潜在的水肿变化,这表明它们可能在受伤后12天内恢复正常,尽管在亚急性阶段可能仍存在细微异常。未来需要进行纵向研究以阐明脑损伤后的个体恢复情况。