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Longitudinal white-matter abnormalities in sports-related concussion: A diffusion MRI study.
Neurology. 2020 08 18; 95(7):e781-e792.Neur

Abstract

OBJECTIVE

To study longitudinal recovery trajectories of white matter after sports-related concussion (SRC) by performing diffusion tensor imaging (DTI) on collegiate athletes who sustained SRC.

METHODS

Collegiate athletes (n = 219, 82 concussed athletes, 68 contact-sport controls, and 69 non-contact-sport controls) were included from the Concussion Assessment, Research and Education Consortium. The participants completed clinical assessments and DTI at 4 time points: 24 to 48 hours after injury, asymptomatic state, 7 days after return-to-play, and 6 months after injury. Tract-based spatial statistics was used to investigate group differences in DTI metrics and to identify white-matter areas with persistent abnormalities. Generalized linear mixed models were used to study longitudinal changes and associations between outcome measures and DTI metrics. Cox proportional hazards model was used to study effects of white-matter abnormalities on recovery time.

RESULTS

In the white matter of concussed athletes, DTI-derived mean diffusivity was significantly higher than in the controls at 24 to 48 hours after injury and beyond the point when the concussed athletes became asymptomatic. While the extent of affected white matter decreased over time, part of the corpus callosum had persistent group differences across all the time points. Furthermore, greater elevation of mean diffusivity at acute concussion was associated with worse clinical outcome measures (i.e., Brief Symptom Inventory scores and symptom severity scores) and prolonged recovery time. No significant differences in DTI metrics were observed between the contact-sport and non-contact-sport controls.

CONCLUSIONS

Changes in white matter were evident after SRC at 6 months after injury but were not observed in contact-sport exposure. Furthermore, the persistent white-matter abnormalities were associated with clinical outcomes and delayed recovery time.

Authors+Show Affiliations

From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor. yucwu@iu.edu.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.From the Departments of Radiology and Imaging Sciences (Y.-C.W., N.M.H.E., Q.W., S.M.M., A.J.S.), Psychiatry (Z.L., T.W.M.), and Biostatistics (L.D.R.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health, Indiana University, Bloomington; Nanoscope Technology LLC (S.M.M.), Bedford, TX; Departments of Radiology (K.M.K., A.S.N., Y.W.) and Neurosurgery (T.B.M., M.A.M.), Medical College of Wisconsin, Milwaukee; The Mind Research Network (A.R.M.), Albuquerque, NM; Department of Neurosurgery (C.C.G.), David Geffen School of Medicine at the University of California Los Angeles; Division of Pediatric Neurology (C.C.G.), Mattel Children's Hospital-UCLA; Departments of Family Medicine and Orthopedics (J.P.D.), Division of Sports Medicine, University of California Los Angeles; Primary Care Sports Medicine (J.P.D.), Hospital for Special Surgery, New York, NY; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center (K.M.G., J.P.M.), Department of Exercise and Sport Science, University of North Carolina, Chapel Hill; School of Biomedical Engineering and Sciences (S.M.L.), Wake-Forest and Virginia Tech University, Virginia Tech Carilion Research Institute, Roanoke; School of Biomedical Engineering and Sciences (S.M.D.), Wake-Forest and Virginia Tech University, Blacksburg; and NeuroTrauma Research Laboratory (S.P.B.), Michigan Concussion Center, University of Michigan, Ann Arbor.

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

32641518

Citation

Wu, Yu-Chien, et al. "Longitudinal White-matter Abnormalities in Sports-related Concussion: a Diffusion MRI Study." Neurology, vol. 95, no. 7, 2020, pp. e781-e792.
Wu YC, Harezlak J, Elsaid NMH, et al. Longitudinal white-matter abnormalities in sports-related concussion: A diffusion MRI study. Neurology. 2020;95(7):e781-e792.
Wu, Y. C., Harezlak, J., Elsaid, N. M. H., Lin, Z., Wen, Q., Mustafi, S. M., Riggen, L. D., Koch, K. M., Nencka, A. S., Meier, T. B., Mayer, A. R., Wang, Y., Giza, C. C., DiFiori, J. P., Guskiewicz, K. M., Mihalik, J. P., LaConte, S. M., Duma, S. M., Broglio, S. P., ... McAllister, T. W. (2020). Longitudinal white-matter abnormalities in sports-related concussion: A diffusion MRI study. Neurology, 95(7), e781-e792. https://doi.org/10.1212/WNL.0000000000009930
Wu YC, et al. Longitudinal White-matter Abnormalities in Sports-related Concussion: a Diffusion MRI Study. Neurology. 2020 08 18;95(7):e781-e792. PubMed PMID: 32641518.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Longitudinal white-matter abnormalities in sports-related concussion: A diffusion MRI study. AU - Wu,Yu-Chien, AU - Harezlak,Jaroslaw, AU - Elsaid,Nahla M H, AU - Lin,Zikai, AU - Wen,Qiuting, AU - Mustafi,Sourajit M, AU - Riggen,Larry D, AU - Koch,Kevin M, AU - Nencka,Andrew S, AU - Meier,Timothy B, AU - Mayer,Andrew R, AU - Wang,Yang, AU - Giza,Christopher C, AU - DiFiori,John P, AU - Guskiewicz,Kevin M, AU - Mihalik,Jason P, AU - LaConte,Stephen M, AU - Duma,Stefan M, AU - Broglio,Steven P, AU - Saykin,Andrew J, AU - McCrea,Michael A, AU - McAllister,Thomas W, Y1 - 2020/07/08/ PY - 2019/03/11/received PY - 2020/02/07/accepted PY - 2020/7/10/pubmed PY - 2020/10/21/medline PY - 2020/7/10/entrez SP - e781 EP - e792 JF - Neurology JO - Neurology VL - 95 IS - 7 N2 - OBJECTIVE: To study longitudinal recovery trajectories of white matter after sports-related concussion (SRC) by performing diffusion tensor imaging (DTI) on collegiate athletes who sustained SRC. METHODS: Collegiate athletes (n = 219, 82 concussed athletes, 68 contact-sport controls, and 69 non-contact-sport controls) were included from the Concussion Assessment, Research and Education Consortium. The participants completed clinical assessments and DTI at 4 time points: 24 to 48 hours after injury, asymptomatic state, 7 days after return-to-play, and 6 months after injury. Tract-based spatial statistics was used to investigate group differences in DTI metrics and to identify white-matter areas with persistent abnormalities. Generalized linear mixed models were used to study longitudinal changes and associations between outcome measures and DTI metrics. Cox proportional hazards model was used to study effects of white-matter abnormalities on recovery time. RESULTS: In the white matter of concussed athletes, DTI-derived mean diffusivity was significantly higher than in the controls at 24 to 48 hours after injury and beyond the point when the concussed athletes became asymptomatic. While the extent of affected white matter decreased over time, part of the corpus callosum had persistent group differences across all the time points. Furthermore, greater elevation of mean diffusivity at acute concussion was associated with worse clinical outcome measures (i.e., Brief Symptom Inventory scores and symptom severity scores) and prolonged recovery time. No significant differences in DTI metrics were observed between the contact-sport and non-contact-sport controls. CONCLUSIONS: Changes in white matter were evident after SRC at 6 months after injury but were not observed in contact-sport exposure. Furthermore, the persistent white-matter abnormalities were associated with clinical outcomes and delayed recovery time. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/32641518/Longitudinal_white_matter_abnormalities_in_sports_related_concussion:_A_diffusion_MRI_study_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=32641518 DB - PRIME DP - Unbound Medicine ER -