A Diffusion Tensor Imaging Study on the White Matter Skeleton in Individuals with Sports-Related Concussion

Cubon, Valerie A.; Putukian, Margot; Boyer, Cynthia; Dettwiler, Annegret

doi:10.1089/neu.2010.1430

Cited by 277 publications

(225 citation statements)

References 70 publications

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“…The John Hopkins University ( JHU) ICBM-DTI-81 WM and JHU WM tractography atlases [49][50][51] included in FSL version 4.1.9 were used to determine the anatomical regions referenced. Interestingly, these regions are almost identical to those reported earlier 12 in the contralateral hemisphere. In addition, a trend ( p < 0.05, one sided, FWE, TFCE, two clusters for a total of 348 voxels in MNI space; FMRIB58_FA_1mm) was observed in the FA measure with both clusters overlaying approximately 58% of the aforementioned significant RD cluster, but with the result trending in the opposite direction.…”

Section: Resultssupporting

confidence: 88%

“…31 In college athletes exhibiting prolonged symptoms after SRC, increased MD has been reported in parts of the left inferior/superior longitudinal and fronto-occipital fasciculi, the retrolenticular part of the internal capsule, and posterior thalamic and acoustic radiations. 12 Persistent microstructural alterations in deep WM have been shown in female contact sports athletes at 7 months postinjury 6 ; all participants were symptom free at this point of their recovery, suggesting that, in female athletes, structural recovery may lag behind behaviorally assessed recovery by up to 7 months postinjury. Finally, changes in WM microstructure were observed in a cohort of contact sports athletes with subconcussive blows to the head (26-399 hits), whereas no such changes were identified in 6 control participants.…”

Section: Introductionmentioning

confidence: 84%

“…Diffusion-weighted images (single-shot spin echo pulse sequence with parameters adapted from our earlier publication 12 ) were acquired with a 16-channel, phase-array coil (Siemens, Erlangen, Germany) on a whole-body 3T Siemens Skyra scanner: repetition time (TR) = 12,100 ms; echo time (TE) = 96 ms; 70 axial slices; voxel size, 1.88 · 1.88 mm 2 in plane; slice thickness = 1.9 mm; field of view (FOV) = 256 mm; 64 gradient directions, b-value, 1000 s/mm 2 ; 8 volumes with no diffusion weighting (b = 0); and 2 runs, yielding a total scan time of 26 min 52 sec. In order to facilitate image volume registration to the Montreal Neurological Institute (MNI) space, a high-resolution T1-weighted MPRAGE image was additionally acquired at the start of each imaging session: TR = 1900 ms; TE = 2.13 ms; 192 sagittal slices; 0.90 · 0.94 · 0.94 mm 3 voxel resolution; flip angle = 9 degrees; FOV = 240 mm; and a total anatomical scan time of 4 min 26 sec.…”

Section: Imaging Protocolmentioning

confidence: 99%

“…[6][7][8][9] Similarly, in a functional MRI study, hyperactivation of the dorsolateral prefrontal cortex was found to persist beyond 2 months postinjury in athletes whose symptoms subsided at 2 weeks after injury. 10 DTI studies demonstrating structural changes from repetitive concussive head impacts have been reported in ice hockey players over the course of a single season, 11 in athletes with prolonged symptoms, 12 as well as in adolescents exhibiting close-to-normal scores on the Sports Concussion Assessment Tool (SCAT2) 13 at 2 months postinjury. 14 Compared to standard MRI, DTI offers a more sensitive assessment of focal ischemic lesions and diffuse axonal damage.…”

Section: Introductionmentioning

confidence: 99%

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A Longitudinal Diffusion Tensor Imaging Study Assessing White Matter Fiber Tracts after Sports-Related Concussion

Murugavel

Cubon

Putukian

et al. 2014

Journal of Neurotrauma

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106

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The extent of structural injury in sports-related concussion (SRC) is central to the course of recovery, long-term effects, and the decision to return to play. In the present longitudinal study, we used diffusion tensor imaging (DTI) to assess white matter (WM) fiber tract integrity within 2 days, 2 weeks, and 2 months of concussive injury. Participants were righthanded male varsity contact-sport athletes (20.2 -1.0 years of age) with a medically diagnosed SRC (no loss of consciousness). They were compared to right-handed male varsity non-contact-sport athletes serving as controls (19.9 -1.7 years). We found significantly increased radial diffusivity (RD) in concussed athletes (n = 12; paired t-test, tract-based spatial statistics; p < 0.025) at 2 days, when compared to the 2-week postinjury time point. The increase was found in a cluster of right hemisphere voxels, spanning the posterior limb of the internal capsule (IC), the retrolenticular part of the IC, the inferior longitudinal fasciculus, the inferior fronto-occipital fasciculus (sagittal stratum), and the anterior thalamic radiation. Post-hoc, univariate, between-group (controls vs. concussed), mixed-effects analysis of the cluster showed significantly higher RD at 2 days ( p = 0.002), as compared to the controls, with a trend in the same direction at 2 months ( p = 0.11). Results for fractional anisotropy (FA) in the same cluster showed a similar, but inverted, pattern; FA was decreased at 2 days and at 2 months postinjury, when compared to healthy controls. At 2 weeks postinjury, no statistical differences between concussed and control athletes were found with regard to either RD or FA. These results support the hypothesis of increased RD and reduced FA within 72 h postinjury, followed by recovery that may extend beyond 2 weeks. RD appears to be a sensitive measure of concussive injury.

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Section: Resultssupporting

confidence: 88%

Section: Introductionmentioning

confidence: 84%

Section: Imaging Protocolmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Longitudinal Diffusion Tensor Imaging Study Assessing White Matter Fiber Tracts after Sports-Related Concussion

Murugavel

Cubon

Putukian

et al. 2014

Journal of Neurotrauma

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106

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“…DWI is an MRI technique that is sensitive to the diffusion of water molecules as they move and interact within the brain. Diffusion tensor imaging (DTI) is the most commonly applied DWI method, and initial studies have reported changes on DTI measures (e.g., fractional anisotropy, FA) in the clinical mTBI setting 19, 20, 21, 22. Furthermore, new DWI acquisition and analysis methods (e.g., track‐weighted imaging, TWI) are being developed that may also be sensitive to mTBIs,23, 24, 25 but remain to be comprehensively studied in this context.…”

Section: Introductionmentioning

confidence: 99%

Diffusion MRI abnormalities in adolescent rats given repeated mild traumatic brain injury

Wortman

Meconi

Neale

et al. 2018

Ann Clin Transl Neurol

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ObjectiveMild traumatic brain injury (mTBI) is a serious health concern in the adolescent population. Repeated mTBI may result in more pronounced deficits, and has been associated with long‐term neurological consequences including neurodegeneration. As such, there is a critical need for the development of objective mTBI biomarkers to help guide medical management. Diffusion‐weighted imaging (DWI) is an advanced magnetic resonance imaging (MRI) technique that may detect brain abnormalities after mTBI. Diffusion tensor imaging (DTI) is the most commonly applied DWI method, and initial studies have reported DTI changes in mTBI patients. Furthermore, new DWI methods (e.g., track‐weighted imaging; TWI) are being developed that may also be sensitive to mTBIs, but remain to be comprehensively studied.MethodsThis study utilized the Awake Closed Head Injury (ACHI) model of mTBI to investigate changes in DTI and TWI following repeated mTBI in adolescent male and female rats. A total of four ACHI impacts, two/day over two consecutive days, were delivered beginning on postnatal day 25. At 1 day and 7 days postinjury, rats were euthanized and brains were collected for DWI analyses.ResultsRats given repeated mTBI displayed changes in fractional anisotropy and radial diffusivity (i.e., DTI measures), as well as track density (i.e., TWI).InterpretationThese findings are consistent with initial DTI findings in mTBI patients, suggest that TWI may complement DTI, support the utility of DWI measures as biomarkers in mTBI, and further validate the ACHI rat model of mTBI.

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White Matter Alterations in Military Service Members With Remote Mild Traumatic Brain Injury

Kim,

Ollinger,

Song

et al. 2024

JAMA Netw Open

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ImportanceMild traumatic brain injury (mTBI) is the signature injury experienced by military service members and is associated with poor neuropsychiatric outcomes. Yet, there is a lack of reliable clinical tools for mTBI diagnosis and prognosis.ObjectiveTo examine the white matter microstructure and neuropsychiatric outcomes of service members with a remote history of mTBI (ie, mTBI that occurred over 2 years ago) using diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI).Design, Setting, and ParticipantsThis case-control study examined 98 male service members enrolled in a study at the National Intrepid Center of Excellence. Eligible participants were active duty status or able to enroll in the Defense Enrollment Eligibility Reporting system, ages 18 to 60 years, and had a remote history of mTBI; controls were matched by age.ExposuresRemote history of mTBI.Main Outcomes and MeasuresWhite matter microstructure was assessed using a region-of-interest approach of skeletonized diffusion images, including DTI (fractional anisotropy, mean diffusivity, radial diffusivity and axial diffusivity) and NODDI (orientation dispersion index [ODI], isotropic volume fraction, intra-cellular volume fraction). Neuropsychiatric outcomes associated with posttraumatic stress disorder (PTSD) and postconcussion syndrome were assessed.ResultsA total of 65 male patients with a remote history of mTBI (mean [SD] age, 40.5 [5.0] years) and 33 age-matched male controls (mean [SD] age, 38.9 [5.6] years) were included in analysis. Compared with the control cohort, the 65 service members with mTBI presented with significantly more severe PTSD-like symptoms (mean [SD] PTSD CheckList-Civilian [PCL-C] version scores: control, 19.0 [3.8] vs mTBI, 41.2 [11.6]; P &lt; .001). DTI and NODDI metrics were altered in the mTBI group compared with the control, including intra-cellular volume fraction of the right cortico-spinal tract (β = −0.029, Cohen d = 0.66; P &lt; .001), ODI of the left posterior thalamic radiation (β = −0.006, Cohen d = 0.55; P &lt; .001), and ODI of the left uncinate fasciculus (β = 0.013, Cohen d = 0.61; P &lt; .001). In service members with mTBI, fractional anisotropy of the left uncinate fasciculus was associated with postconcussion syndrome (β = 5.4 × 10−3; P = .003), isotropic volume fraction of the genu of the corpus callosum with PCL-C (β = 4.3 × 10−4; P = .01), and ODI of the left fornix and stria terminalis with PCL-C avoidance scores (β = 1.2 × 10−3; P = .02).Conclusions and RelevanceIn this case-control study of military-related mTBI, the results suggest that advanced magnetic resonance imaging techniques using NODDI can reveal white matter microstructural alterations associated with neuropsychiatric symptoms in the chronic phase of mTBI. Diffusion trends observed throughout widespread white matter regions-of-interest may reflect mechanisms of neurodegeneration as well as postinjury tissue scarring and reorganization.

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A Diffusion Tensor Imaging Study on the White Matter Skeleton in Individuals with Sports-Related Concussion

Cited by 277 publications

References 70 publications

A Longitudinal Diffusion Tensor Imaging Study Assessing White Matter Fiber Tracts after Sports-Related Concussion

A Longitudinal Diffusion Tensor Imaging Study Assessing White Matter Fiber Tracts after Sports-Related Concussion

Diffusion MRI abnormalities in adolescent rats given repeated mild traumatic brain injury

White Matter Alterations in Military Service Members With Remote Mild Traumatic Brain Injury

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