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Hockey Concussion Education Project, Part 1. Susceptibility-weighted imaging study in male and female ice hockey players over a single season.
J Neurosurg 2014; 120(4):864-72JN

Abstract

OBJECT

Concussion, or mild traumatic brain injury (mTBI), is a commonly occurring sports-related injury, especially in contact sports such as hockey. Cerebral microbleeds (CMBs), which appear as small, hypointense lesions on T₂*-weighted images, can result from TBI. The authors use susceptibility-weighted imaging (SWI) to automatically detect small hypointensities that may be subtle signs of chronic and acute damage due to both subconcussive and concussive injury. The goal was to investigate how the burden of these hypointensities changes over time, over a playing season, and postconcussion, in comparison with subjects who did not suffer a medically observed and diagnosed concussion.

METHODS

Images were obtained in 45 university-level adult male and female ice hockey players before and after a single Canadian Interuniversity Sports season. In addition, 11 subjects (5 men and 6 women) underwent imaging at 72 hours, 2 weeks, and 2 months after concussion. To identify subtle changes in brain tissue and potential CMBs, nonvessel clusters of hypointensities on SWI were automatically identified, and a hypointensity burden index was calculated for all subjects at the beginning of the season (BOS), the end of the season (EOS), and at postconcussion time points (where applicable).

RESULTS

A statistically significant increase in the hypointensity burden, relative to the BOS, was observed for male subjects with concussions at the 2-week postconcussion time point. A smaller, nonsignificant rise in the burden for female subjects with concussions was also observed within the same time period. There were no significant changes in burden for nonconcussed subjects of either sex between the BOS and EOS time points. However, there was a statistically significant difference in the burden between male and female subjects in the nonconcussed group at both the BOS and EOS time points, with males having a higher burden.

CONCLUSIONS

This method extends the utility of SWI from the enhancement and detection of larger (> 5 mm) CMBs, which are often observed in more severe cases of TBI, to cases involving smaller lesions in which visual detection of injury is difficult. The hypointensity burden metric proposed here shows statistically significant changes over time in the male subjects. A smaller, nonsignificant increase in the burden metric was observed in the female subjects.

Authors+Show Affiliations

Massachusetts General Hospital/Massachusetts Institute of Technology/Harvard Medical School/No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

24490839

Citation

Helmer, Karl G., et al. "Hockey Concussion Education Project, Part 1. Susceptibility-weighted Imaging Study in Male and Female Ice Hockey Players Over a Single Season." Journal of Neurosurgery, vol. 120, no. 4, 2014, pp. 864-72.
Helmer KG, Pasternak O, Fredman E, et al. Hockey Concussion Education Project, Part 1. Susceptibility-weighted imaging study in male and female ice hockey players over a single season. J Neurosurg. 2014;120(4):864-72.
Helmer, K. G., Pasternak, O., Fredman, E., Preciado, R. I., Koerte, I. K., Sasaki, T., ... Echlin, P. S. (2014). Hockey Concussion Education Project, Part 1. Susceptibility-weighted imaging study in male and female ice hockey players over a single season. Journal of Neurosurgery, 120(4), pp. 864-72. doi:10.3171/2013.12.JNS132093.
Helmer KG, et al. Hockey Concussion Education Project, Part 1. Susceptibility-weighted Imaging Study in Male and Female Ice Hockey Players Over a Single Season. J Neurosurg. 2014;120(4):864-72. PubMed PMID: 24490839.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hockey Concussion Education Project, Part 1. Susceptibility-weighted imaging study in male and female ice hockey players over a single season. AU - Helmer,Karl G, AU - Pasternak,Ofer, AU - Fredman,Eli, AU - Preciado,Ronny I, AU - Koerte,Inga K, AU - Sasaki,Takeshi, AU - Mayinger,Michael, AU - Johnson,Andrew M, AU - Holmes,Jeffrey D, AU - Forwell,Lorie A, AU - Skopelja,Elaine N, AU - Shenton,Martha E, AU - Echlin,Paul S, Y1 - 2014/02/04/ PY - 2014/2/5/entrez PY - 2014/2/5/pubmed PY - 2014/6/10/medline SP - 864 EP - 72 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 120 IS - 4 N2 - OBJECT: Concussion, or mild traumatic brain injury (mTBI), is a commonly occurring sports-related injury, especially in contact sports such as hockey. Cerebral microbleeds (CMBs), which appear as small, hypointense lesions on T₂*-weighted images, can result from TBI. The authors use susceptibility-weighted imaging (SWI) to automatically detect small hypointensities that may be subtle signs of chronic and acute damage due to both subconcussive and concussive injury. The goal was to investigate how the burden of these hypointensities changes over time, over a playing season, and postconcussion, in comparison with subjects who did not suffer a medically observed and diagnosed concussion. METHODS: Images were obtained in 45 university-level adult male and female ice hockey players before and after a single Canadian Interuniversity Sports season. In addition, 11 subjects (5 men and 6 women) underwent imaging at 72 hours, 2 weeks, and 2 months after concussion. To identify subtle changes in brain tissue and potential CMBs, nonvessel clusters of hypointensities on SWI were automatically identified, and a hypointensity burden index was calculated for all subjects at the beginning of the season (BOS), the end of the season (EOS), and at postconcussion time points (where applicable). RESULTS: A statistically significant increase in the hypointensity burden, relative to the BOS, was observed for male subjects with concussions at the 2-week postconcussion time point. A smaller, nonsignificant rise in the burden for female subjects with concussions was also observed within the same time period. There were no significant changes in burden for nonconcussed subjects of either sex between the BOS and EOS time points. However, there was a statistically significant difference in the burden between male and female subjects in the nonconcussed group at both the BOS and EOS time points, with males having a higher burden. CONCLUSIONS: This method extends the utility of SWI from the enhancement and detection of larger (> 5 mm) CMBs, which are often observed in more severe cases of TBI, to cases involving smaller lesions in which visual detection of injury is difficult. The hypointensity burden metric proposed here shows statistically significant changes over time in the male subjects. A smaller, nonsignificant increase in the burden metric was observed in the female subjects. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/24490839/Hockey_Concussion_Education_Project_Part_1__Susceptibility_weighted_imaging_study_in_male_and_female_ice_hockey_players_over_a_single_season_ L2 - https://thejns.org/doi/10.3171/2013.12.JNS132093 DB - PRIME DP - Unbound Medicine ER -