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评估血氧水平依赖信号变异性作为运动相关性脑震荡脑损伤的生物标志物。

Assessing blood oxygen level-dependent signal variability as a biomarker of brain injury in sport-related concussion.

作者信息

Anderson Evan D, Talukdar Tanveer, Goodwin Grace, Di Pietro Valentina, Yakoub Kamal M, Zwilling Christopher E, Davies David, Belli Antonio, Barbey Aron K

机构信息

Decision Neuroscience Laboratory, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA.

Air Force Research Laboratory, Wright-Patterson AFB, OH 45433, USA.

出版信息

Brain Commun. 2023 Aug 16;5(4):fcad215. doi: 10.1093/braincomms/fcad215. eCollection 2023.

Abstract

Mild traumatic brain injury is a complex neurological disorder of significant concern among athletes who play contact sports. Athletes who sustain sport-related concussion typically undergo physical examination and neurocognitive evaluation to determine injury severity and return-to-play status. However, traumatic disruption to neurometabolic processes can occur with minimal detectable anatomic pathology or neurocognitive alteration, increasing the risk that athletes may be cleared for return-to-play during a vulnerable period and receive a repetitive injury. This underscores the need for sensitive functional neuroimaging methods to detect altered cerebral physiology in concussed athletes. The present study compared the efficacy of Immediate Post-concussion Assessment and Cognitive Testing composite scores and whole-brain measures of blood oxygen level-dependent signal variability for classifying concussion status and predicting concussion symptomatology in healthy, concussed and repetitively concussed athletes, assessing blood oxygen level-dependent signal variability as a potential diagnostic tool for characterizing functional alterations to cerebral physiology and assisting in the detection of sport-related concussion. We observed significant differences in regional blood oxygen level-dependent signal variability measures for concussed athletes but did not observe significant differences in Immediate Post-concussion Assessment and Cognitive Testing scores of concussed athletes. We further demonstrate that incorporating measures of functional brain alteration alongside Immediate Post-concussion Assessment and Cognitive Testing scores enhances the sensitivity and specificity of supervised random forest machine learning methods when classifying and predicting concussion status and post-concussion symptoms, suggesting that alterations to cerebrovascular status characterize unique variance that may aid in the detection of sport-related concussion and repetitive mild traumatic brain injury. These results indicate that altered blood oxygen level-dependent variability holds promise as a novel neurobiological marker for detecting alterations in cerebral perfusion and neuronal functioning in sport-related concussion, motivating future research to establish and validate clinical assessment protocols that can incorporate advanced neuroimaging methods to characterize altered cerebral physiology following mild traumatic brain injury.

摘要

轻度创伤性脑损伤是一种复杂的神经疾病,在从事接触性运动的运动员中备受关注。遭受与运动相关脑震荡的运动员通常会接受体格检查和神经认知评估,以确定损伤的严重程度和恢复比赛的状态。然而,在可检测到的解剖病理学或神经认知改变最小的情况下,神经代谢过程也可能发生创伤性破坏,这增加了运动员在脆弱期被批准恢复比赛并再次受伤的风险。这凸显了需要敏感的功能神经成像方法来检测脑震荡运动员大脑生理的改变。本研究比较了脑震荡后即刻评估和认知测试综合评分以及全脑血氧水平依赖信号变异性测量在健康、脑震荡和反复脑震荡运动员中对脑震荡状态进行分类和预测脑震荡症状的功效,将血氧水平依赖信号变异性评估为一种潜在的诊断工具,用于表征大脑生理的功能改变并协助检测与运动相关的脑震荡。我们观察到脑震荡运动员在区域血氧水平依赖信号变异性测量上存在显著差异,但在脑震荡运动员的脑震荡后即刻评估和认知测试分数上未观察到显著差异。我们进一步证明,在脑震荡后即刻评估和认知测试分数之外纳入功能性脑改变的测量,在对脑震荡状态和脑震荡后症状进行分类和预测时,可提高监督随机森林机器学习方法的敏感性和特异性,这表明脑血管状态的改变表征了独特的变异,可能有助于检测与运动相关的脑震荡和反复轻度创伤性脑损伤。这些结果表明,血氧水平依赖变异性的改变有望作为一种新的神经生物学标志物,用于检测与运动相关脑震荡中脑灌注和神经元功能的改变,促使未来开展研究以建立和验证能够纳入先进神经成像方法来表征轻度创伤性脑损伤后脑生理改变的临床评估方案。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3a42/10465085/09b2c35e6af8/fcad215_ga1.jpg

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