MRI-defined White Matter Microstructural Alteration Associated with Soccer Heading Is More Extensive in Women than Men

Abstract

Purpose To examine the role of sex in abnormal white matter microstructure after soccer heading as identified by using the diffusion-tensor imaging (DTI) metric fractional anisotropy (FA). Materials and Methods In this prospective cross-sectional study, 98 individuals who were enrolled in a larger prospective study of amateur soccer players (from 2013 to 2016) were matched 1:1 for age and history of soccer heading in the prior 12 months. Among the subjects, 49 men (mean age, 25.7 years; range, 18-50 years) and 49 women (mean age, 25.8 years; range, 18-50 years) with median total soccer headings per year of 487 and 469, respectively, underwent 3.0-T DTI. Images were registered to the Johns Hopkins University template. A voxelwise linear regression was fitted for FA with terms for the number of headings during the previous 12 months and its interaction with sex after controlling for the following potential confounders: age, years of education, number of lifetime concussions, and handedness. In the resulting statistical maps, P < .01 indicated a statistically significant difference, with a threshold cluster size larger than 100 mm. Results Among men, three regions were identified in which greater heading exposure was associated with lower FA; eight such regions were identified among women (>100 contiguous voxels, P < .01). In seven of the eight regions identified in women, the association between heading and FA was stronger in women than in men. There was no significant difference of heading with FA between the sexes for any region in which heading was associated with FA among men (P > .01, <100 contiguous voxels). Conclusion With similar exposure to heading, women exhibit more widespread evidence of microstructural white matter alteration than do men, suggesting preliminary support for a biologic divergence of brain response to repetitive trauma. © RSNA, 2018 Online supplemental material is available for this article.

BDNF Val66Met Positive Players Demonstrate Diffusion Tensor Imaging Consistent With Impaired Myelination Associated With High Levels of Soccer Heading: Indication of a Potential Gene-Environment Interaction Mechanism

“…Number of lifetime concussions was not determined as a significant confounder in the models; however, Met (+) players demonstrated a borderline trend toward a greater number of lifetime concussions; a fact that may have contributed to our results. Likewise, we have previously reported gender differences in DTI outcomes from soccer heading (14). Though we adjusted for gender in our analyses, we were not powered to detect a heading * gender * BDNF Val 66 Met interaction; which limits our ability to address the combined effect of the Met allele and gender on white matter abnormalities from soccer heading.…”

“…HeadCount-12mo. Questionnaire: HeadCount-12mo is a questionnaire that estimates their total number heads in the prior 12-months [refer to Levitch et al 9and Rubin et al (14) for a detailed explanation of Head Count-12mo]. In brief, participants are asked a series of questions pertaining to their soccer play during practice and competition in indoor and outdoor settings: (1) the number of months per year active in each setting; (2) the average number of competitive soccer games per week; (3) the average number of headers per game; (4) the average number of practices per week; (5) the average number of headers per practice.…”

“…Diffusion Tensor Imaging (DTI) is an MRI modality capable of detecting changes to the white matter microstructure following Traumatic Brain Injuries (TBIs) (13). There is now evidence to suggest that subconcussive head injury is associated with aberrations in brain tissue microstrutcture (8,(14)(15)(16). Radial Diffusivity (RD) is a DTI marker which reflects myelination wherein high RD is associated with myelin loss following injury and low RD is associated with myelination (17).…”

Omega-3-Fettsäuren im Sport – Mängel erkennen und beheben

“…B. beim Boxen oder American Football erhebliche Ausmaße annehmen und das weitere Schicksal der Sportler bestimmen können [49]. Auch nach Kopfbällen, weniger nach Tackling, im Fußball hat man inzwischen im Kernspin Hirnschäden gefunden, die bei Frauen ausgeprägter waren als bei Männern [50]. In entsprechenden Leitlinien wird noch nicht auf EPA und DHA eingegangen [51].…”

Heading the ball in football: what do we tell our patients and why so long to action?

“…For example, in 2002 the inquest into the English footballer Jeff Astle who died aged 59 with early-onset dementia found that repeated heading of a heavy leather football had contributed to his illness. However, supported by improved epidemiological studies 2,3 and more accurate imaging techniques that can identify sub-clinical brain cell injury, an evidence base is emerging that confirms this relationship and in particular identifies children 4 and women 5 to be at particular risk.…”