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Preliminary evidence from a prospective DTI study suggests a posterior-to-anterior pattern of recovery in college athletes with sports-related concussion.
Brain Behav 2018; 8(12):e01165BB

Abstract

OBJECTIVES

We compared the integrity of white matter (WM) microstructure to the course of recovery in athletes who sustained one sports-related concussion (SRC), assessing individual longitudinal changes in WM fiber tracts following SRC using pre- and post-injury measurements.

MATERIALS AND METHODS

Baseline diffusion tensor imaging (DTI) scans and neuropsychological tests were collected on 53 varsity contact-sport college athletes. Participants (n = 13) who subsequently sustained an SRC underwent DTI scans and neuropsychological testing at 2 days, 2 weeks, and 2 months following injury.

RESULTS

Relying on tract-based spatial statistics (TBSS) analyses, we found that radial diffusivity (RD) and mean diffusivity (MD) were significantly increased at 2 days post-injury compared to the same-subject baseline (corrected p < 0.02). These alterations were visible in anterior/posterior WM regions spanning both hemispheres, demonstrating a diffuse pattern of injury after concussion. Implicated WM fiber tracts at 2 days include the following: right superior/inferior longitudinal fasciculus; right/left inferior fronto-occipital fasciculus; right corticospinal tract; right acoustic radiation; right/left anterior thalamic radiations; right/left uncinate fasciculus; and forceps major/minor. At 2 weeks post-injury, persistently elevated RD and MD were observed solely in prefrontal portions of WM fiber tracts (using same-subject contrasts). No significant differences were found for FA in any of the post-injury comparisons to baseline. Plots of individual subject RD and MD in prefrontal WM demonstrated homogenous increases from baseline to just after SRC; thereafter, trajectories became more variable. Most subjects' diffusivity values remained elevated at 2 months post-injury relative to their own baseline. Over the 2-month period after SRC, recovery of WM fiber tracts appeared to follow a posterior-to-anterior trend, paralleling the posterior-anterior pattern of WM maturation previously identified in the normal population.

CONCLUSION

These results suggest greater vulnerability of prefrontal regions to SRC, underline the importance of an individualized approach to concussion management, and show promise for using RD and MD for imaging-based diagnosis of SRC.

Authors+Show Affiliations

Department of Chemistry and Biochemistry, Kent State University at Trumbull, Warren, Ohio.Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey.Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey.Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30566282

Citation

Cubon, Valerie A., et al. "Preliminary Evidence From a Prospective DTI Study Suggests a Posterior-to-anterior Pattern of Recovery in College Athletes With Sports-related Concussion." Brain and Behavior, vol. 8, no. 12, 2018, pp. e01165.
Cubon VA, Murugavel M, Holmes KW, et al. Preliminary evidence from a prospective DTI study suggests a posterior-to-anterior pattern of recovery in college athletes with sports-related concussion. Brain Behav. 2018;8(12):e01165.
Cubon, V. A., Murugavel, M., Holmes, K. W., & Dettwiler, A. (2018). Preliminary evidence from a prospective DTI study suggests a posterior-to-anterior pattern of recovery in college athletes with sports-related concussion. Brain and Behavior, 8(12), pp. e01165. doi:10.1002/brb3.1165.
Cubon VA, et al. Preliminary Evidence From a Prospective DTI Study Suggests a Posterior-to-anterior Pattern of Recovery in College Athletes With Sports-related Concussion. Brain Behav. 2018;8(12):e01165. PubMed PMID: 30566282.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preliminary evidence from a prospective DTI study suggests a posterior-to-anterior pattern of recovery in college athletes with sports-related concussion. AU - Cubon,Valerie A, AU - Murugavel,Murali, AU - Holmes,Katharine W, AU - Dettwiler,Annegret, Y1 - 2018/11/22/ PY - 2017/12/28/received PY - 2018/09/04/revised PY - 2018/10/24/accepted PY - 2018/12/20/pubmed PY - 2019/7/23/medline PY - 2018/12/20/entrez KW - diffusion tensor imaging KW - mTBI KW - mean diffusivity KW - radial diffusivity KW - sports-related concussion SP - e01165 EP - e01165 JF - Brain and behavior JO - Brain Behav VL - 8 IS - 12 N2 - OBJECTIVES: We compared the integrity of white matter (WM) microstructure to the course of recovery in athletes who sustained one sports-related concussion (SRC), assessing individual longitudinal changes in WM fiber tracts following SRC using pre- and post-injury measurements. MATERIALS AND METHODS: Baseline diffusion tensor imaging (DTI) scans and neuropsychological tests were collected on 53 varsity contact-sport college athletes. Participants (n = 13) who subsequently sustained an SRC underwent DTI scans and neuropsychological testing at 2 days, 2 weeks, and 2 months following injury. RESULTS: Relying on tract-based spatial statistics (TBSS) analyses, we found that radial diffusivity (RD) and mean diffusivity (MD) were significantly increased at 2 days post-injury compared to the same-subject baseline (corrected p < 0.02). These alterations were visible in anterior/posterior WM regions spanning both hemispheres, demonstrating a diffuse pattern of injury after concussion. Implicated WM fiber tracts at 2 days include the following: right superior/inferior longitudinal fasciculus; right/left inferior fronto-occipital fasciculus; right corticospinal tract; right acoustic radiation; right/left anterior thalamic radiations; right/left uncinate fasciculus; and forceps major/minor. At 2 weeks post-injury, persistently elevated RD and MD were observed solely in prefrontal portions of WM fiber tracts (using same-subject contrasts). No significant differences were found for FA in any of the post-injury comparisons to baseline. Plots of individual subject RD and MD in prefrontal WM demonstrated homogenous increases from baseline to just after SRC; thereafter, trajectories became more variable. Most subjects' diffusivity values remained elevated at 2 months post-injury relative to their own baseline. Over the 2-month period after SRC, recovery of WM fiber tracts appeared to follow a posterior-to-anterior trend, paralleling the posterior-anterior pattern of WM maturation previously identified in the normal population. CONCLUSION: These results suggest greater vulnerability of prefrontal regions to SRC, underline the importance of an individualized approach to concussion management, and show promise for using RD and MD for imaging-based diagnosis of SRC. SN - 2162-3279 UR - https://www.unboundmedicine.com/medline/citation/30566282/Preliminary_evidence_from_a_prospective_DTI_study_suggests_a_posterior_to_anterior_pattern_of_recovery_in_college_athletes_with_sports_related_concussion_ L2 - https://doi.org/10.1002/brb3.1165 DB - PRIME DP - Unbound Medicine ER -