Diffusion Imaging Reveals Sex Differences in the White Matter Following Sports-Related Concussion

Abstract

Sports-related concussion (SRC) is a serious health concern. However, the temporal profile of neuropathophysiological changes after SRC and how these relate to biological sex are still poorly understood. This preliminary study investigated whether diffusion-weighted magnetic resonance imaging (dMRI) was sensitive to neuropathophysiological changes following SRC; whether these changes were sex-specific; and whether they persisted beyond the resolution of self-reported symptoms. Recently concussed athletes (n = 14), and age- and education-matched nonconcussed control athletes (n = 16), underwent MRI 24–48-h postinjury and again at 2-week postinjury (i.e., when cleared to return-to-play). Male athletes reported more symptoms and greater symptom severity compared with females. dMRI revealed white matter differences between athletes with SRC and their nonconcussed counterparts at 48-h postinjury. These differences were still present at 2-week postinjury, despite SRC athletes being cleared to return to play and may indicate increased cerebral vulnerability beyond the resolution of subjective symptoms. Furthermore, we identified sex-specific differences, with male SRC athletes having significantly greater white matter disruption compared with female SRC athletes. These results have important implications for the management of concussion, including guiding return-to-play decisions, and further improve our understanding regarding the role of sex in SRC outcomes.

Impaired glymphatic function in the early stages of disease in a TDP-43 mouse model of amyotrophic lateral sclerosis

“…DWI methods can detect microstructural changes to the white matter in the absence of any macroscopic changes on conventional structural images [ 22 , 23 ]. Using multi-tissue constrained spherical deconvolution, we estimated a fibre orientation distribution for each voxel.…”

“…DWI has demonstrated potential as a sensitive biomarker for neurodegeneration, identifying microstructural changes to the white matter in the absence of any macroscopic changes on conventional radiological images [ 22 , 23 ]. We assessed the fixel-derived metric FDC using both exploratory whole-brain and a priori analyses.…”

Sub-acute Changes on MRI Measures of Cerebral Blood Flow and Venous Oxygen Saturation in Concussed Australian Rules Footballers

“…There is widespread concern regarding the impact of repeated SRCs. Evidence from both animal [ 24 ] and human [ 5 , 11 , 18 , 19 ] neuroimaging studies suggests that clinical recovery, i.e. the absence of symptoms, may precede physiological recovery.…”

“…A number of promising biomarkers have been developed with the aim of objectively determining recovery. Magnetic resonance imaging (MRI) techniques including magnetic resonance spectroscopy [ 4 ] and diffusion weighted imaging [ 5 – 8 ] have been used to investigate a range of often subtle physiological cascades that follow SRC. Quantitative susceptibility mapping (QSM) is a comparatively new technique that utilizes MR phase images to map tissue susceptibility ( χ ) [ 9 ].…”

Decrease in Plasma miR-27a and miR-221 After Concussion in Australian Football Players

“… 1 , 2 These symptoms often resolve within weeks, 1 , 3 however, there is growing evidence that neurobiological abnormalities persist beyond the resolution of symptoms. 4 - 6 Furthermore, 10% to 30% of SRC patients go on to suffer from persistent post-concussion symptoms (PPCS), 2 and SRC has been linked to the later development of neurodegenerative conditions, such as chronic traumatic encephalopathy. 7 Notably, there appears to be an increased risk of long-term neurological consequences in those who experience repetitive mTBIs, 8 , 9 with evidence suggesting this may be due to the repetitive injuries occurring within a period of vulnerability after the initial SRC.…”