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Sex differences in white matter alterations following repetitive subconcussive head impacts in collegiate ice hockey players.
Neuroimage Clin. 2018; 17:642-649.NC

Abstract

Objective

Repetitive subconcussive head impacts (RSHI) may lead to structural, functional, and metabolic alterations of the brain. While differences between males and females have already been suggested following a concussion, whether there are sex differences following exposure to RSHI remains unknown. The aim of this study was to identify and to characterize sex differences following exposure to RSHI.

Methods

Twenty-five collegiate ice hockey players (14 males and 11 females, 20.6 ± 2.0 years), all part of the Hockey Concussion Education Project (HCEP), underwent diffusion-weighted magnetic resonance imaging (dMRI) before and after the Canadian Interuniversity Sports (CIS) ice hockey season 2011-2012 and did not experience a concussion during the season. Whole-brain tract-based spatial statistics (TBSS) were used to compare pre- and postseason imaging in both sexes for fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). Pre- and postseason neurocognitive performance were assessed by the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT).

Results

Significant differences between the sexes were primarily located within the superior longitudinal fasciculus (SLF), the internal capsule (IC), and the corona radiata (CR) of the right hemisphere (RH). In significant voxel clusters (p < 0.05), decreases in FA (absolute difference pre- vs. postseason: 0.0268) and increases in MD (0.0002), AD (0.00008), and RD (0.00005) were observed in females whereas males showed no significant changes. There was no significant correlation between the change in diffusion scalar measures over the course of the season and neurocognitive performance as evidenced from postseason ImPACT scores.

Conclusions

The results of this study suggest sex differences in structural alterations following exposure to RSHI. Future studies need to investigate further the underlying mechanisms and association with exposure and clinical outcomes.

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Authors+Show Affiliations

Sollmann N
Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. Electronic address: Nico.Sollmann@tum.de.
Echlin PS
Elliott Sports Medicine Clinic, Burlington, ON, Canada. Electronic address: Psechlin@gmail.com.
Schultz V
Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany. Electronic address: VivianSchultz@gmx.de.
Viher PV
Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Translational Research Center, University Hospital of Psychiatry, Bern, Switzerland. Electronic address: Petra.Viher@puk.unibe.ch.
Lyall AE
Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: Alyall@bwh.harvard.edu.
Tripodis Y
Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA; Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA. Electronic address: Yorghos@bu.edu.
Kaufmann D
Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany; Department of Radiology, Charité Universitätsmedizin, Berlin, Germany. Electronic address: David.Kaufmann@charite.de.
Hartl E
Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurology, Epilepsy Center, Ludwig-Maximilians-Universität, Munich, Germany. Electronic address: Elisabeth.Hartl@med.uni-muenchen.de.
Kinzel P
Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany. Electronic address: Pkinzel@bwh.harvard.edu.
Forwell LA
3M Centre, The University of Western Ontario, London, ON, Canada. Electronic address: Lforwell@uwo.ca.
Johnson AM
School of Health Studies, The University of Western Ontario, London, ON, Canada. Electronic address: Ajohnson@uwo.ca.
Skopelja EN
Ruth Lilly Medical Library, Indiana University, Indianapolis, IN, USA. Electronic address: Eskopelj@iu.edu.
Lepage C
Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; School of Psychology, University of Ottawa, Ottawa, ON, Canada. Electronic address: Clepage@uottawa.ca.
Bouix S
Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: Sylvain@bwh.harvard.edu.
Pasternak O
Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: Ofer@bwh.harvard.edu.
Lin AP
Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: Aplin@bwh.harvard.edu.
Shenton ME
Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; VA Boston Healthcare System, Brockton Division, Brockton, MA, USA. Electronic address: Shenton@bwh.harvard.edu.
Koerte IK
Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: Ikoerte@bwh.harvard.edu.

MeSH

Brain ConcussionDiffusion Tensor ImagingFemaleHockeyHumansImage Interpretation, Computer-AssistedMaleSex CharacteristicsWhite MatterYoung Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29204342

Citation

Sollmann, Nico, et al. "Sex Differences in White Matter Alterations Following Repetitive Subconcussive Head Impacts in Collegiate Ice Hockey Players." NeuroImage. Clinical, vol. 17, 2018, pp. 642-649.
Sollmann N, Echlin PS, Schultz V, et al. Sex differences in white matter alterations following repetitive subconcussive head impacts in collegiate ice hockey players. Neuroimage Clin. 2018;17:642-649.
Sollmann, N., Echlin, P. S., Schultz, V., Viher, P. V., Lyall, A. E., Tripodis, Y., Kaufmann, D., Hartl, E., Kinzel, P., Forwell, L. A., Johnson, A. M., Skopelja, E. N., Lepage, C., Bouix, S., Pasternak, O., Lin, A. P., Shenton, M. E., & Koerte, I. K. (2018). Sex differences in white matter alterations following repetitive subconcussive head impacts in collegiate ice hockey players. NeuroImage. Clinical, 17, 642-649. https://doi.org/10.1016/j.nicl.2017.11.020
Sollmann N, et al. Sex Differences in White Matter Alterations Following Repetitive Subconcussive Head Impacts in Collegiate Ice Hockey Players. Neuroimage Clin. 2018;17:642-649. PubMed PMID: 29204342.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sex differences in white matter alterations following repetitive subconcussive head impacts in collegiate ice hockey players. AU - Sollmann,Nico, AU - Echlin,Paul S, AU - Schultz,Vivian, AU - Viher,Petra V, AU - Lyall,Amanda E, AU - Tripodis,Yorghos, AU - Kaufmann,David, AU - Hartl,Elisabeth, AU - Kinzel,Philipp, AU - Forwell,Lorie A, AU - Johnson,Andrew M, AU - Skopelja,Elaine N, AU - Lepage,Christian, AU - Bouix,Sylvain, AU - Pasternak,Ofer, AU - Lin,Alexander P, AU - Shenton,Martha E, AU - Koerte,Inga K, Y1 - 2017/11/21/ PY - 2017/07/29/received PY - 2017/11/08/revised PY - 2017/11/18/accepted PY - 2017/12/6/entrez PY - 2017/12/6/pubmed PY - 2018/8/1/medline KW - AD, axial diffusivity KW - CIS, Canadian Interuniversity Sports KW - CR, corona radiata KW - Diffusion tensor imaging KW - EC, external capsule KW - FA, fractional anisotropy KW - HCEP, Hockey Concussion Education Project KW - IC, internal capsule KW - Ice hockey KW - ImPACT, Immediate Post-Concussion Assessment and Cognitive Test KW - LH, left hemisphere KW - MD, mean diffusivity KW - MRI, magnetic resonance imaging KW - NCAA, National Collegiate Athletic Association KW - RD, radial diffusivity KW - RH, right hemisphere KW - RSHI, repetitive subconcussive head impacts KW - Repetitive subconcussive head impacts KW - SD, standard deviation KW - SLF, superior longitudinal fasciculus KW - Sex difference KW - TBI, traumatic brain injury KW - TBSS, tract-based spatial statistics KW - Traumatic brain injury KW - WM, white matter KW - White matter KW - dMRI, diffusion magnetic resonance imaging KW - rs, Spearman's rank correlation coefficient SP - 642 EP - 649 JF - NeuroImage. Clinical JO - Neuroimage Clin VL - 17 N2 - Objective: Repetitive subconcussive head impacts (RSHI) may lead to structural, functional, and metabolic alterations of the brain. While differences between males and females have already been suggested following a concussion, whether there are sex differences following exposure to RSHI remains unknown. The aim of this study was to identify and to characterize sex differences following exposure to RSHI. Methods: Twenty-five collegiate ice hockey players (14 males and 11 females, 20.6 ± 2.0 years), all part of the Hockey Concussion Education Project (HCEP), underwent diffusion-weighted magnetic resonance imaging (dMRI) before and after the Canadian Interuniversity Sports (CIS) ice hockey season 2011-2012 and did not experience a concussion during the season. Whole-brain tract-based spatial statistics (TBSS) were used to compare pre- and postseason imaging in both sexes for fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). Pre- and postseason neurocognitive performance were assessed by the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). Results: Significant differences between the sexes were primarily located within the superior longitudinal fasciculus (SLF), the internal capsule (IC), and the corona radiata (CR) of the right hemisphere (RH). In significant voxel clusters (p < 0.05), decreases in FA (absolute difference pre- vs. postseason: 0.0268) and increases in MD (0.0002), AD (0.00008), and RD (0.00005) were observed in females whereas males showed no significant changes. There was no significant correlation between the change in diffusion scalar measures over the course of the season and neurocognitive performance as evidenced from postseason ImPACT scores. Conclusions: The results of this study suggest sex differences in structural alterations following exposure to RSHI. Future studies need to investigate further the underlying mechanisms and association with exposure and clinical outcomes. SN - 2213-1582 UR - https://www.unboundmedicine.com/medline/citation/29204342/Sex_differences_in_white_matter_alterations_following_repetitive_subconcussive_head_impacts_in_collegiate_ice_hockey_players_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-1582(17)30300-5 DB - PRIME DP - Unbound Medicine ER -