Abstract
Neuroimaging has been used to describe the pathophysiology of sport-related concussion during early injury, with effects that may persist beyond medical clearance to return-to-play (RTP). However, studies are typically cross-sectional, comparing groups of concussed and uninjured athletes. It is important to determine whether these findings are consistent with longitudinal change at the individual level, relative to their own pre-injury baseline. A cohort of N = 123 university-level athletes were scanned with magnetic resonance imaging (MRI). Of this group, N = 12 acquired a concussion and were re-scanned at early symptomatic injury and at RTP. A sub-group of N = 44 uninjured athletes were also re-imaged, providing a normative reference group. Among concussed athletes, abnormalities were identified for white matter fractional anisotropy and mean diffusivity, along with grey matter cerebral blood flow, using both cross-sectional (CS) and longitudinal (LNG) approaches. The spatial patterns of abnormality for CS and LNG were distinct, with median fractional overlap below 0.10 and significant differences in the percentage of abnormal voxels. However, the analysis methods did not differ in the amount of change from symptomatic injury to RTP and in the direction of observed abnormalities. These results highlight the impact of using pre-injury baseline data when evaluating concussion-related brain abnormalities at the individual level.
Highlights
Neuroimaging has been used to describe the pathophysiology of sport-related concussion during early injury, with effects that may persist beyond medical clearance to return-to-play (RTP)
12 athletes (10% of the cohort) sustained a concussion over the course of the study. They were re-imaged at both symptomatic phase of injury (SYM) (4 [3, 6] days post-concussion) and return to play (RTP) (38 [17, 97] days post-concussion), with N = for Diffusion tensor imaging (DTI) and N = for arterial spin labelling (ASL) and N = for DTI and N = for ASL (RTP)
In this multi-modal magnetic resonance imaging (MRI) study, concussion-related brain abnormalities were examined at the individual subject level, as this remains an understudied area of research
Summary
Neuroimaging has been used to describe the pathophysiology of sport-related concussion during early injury, with effects that may persist beyond medical clearance to return-to-play (RTP). The analysis methods did not differ in the amount of change from symptomatic injury to RTP and in the direction of observed abnormalities These results highlight the impact of using pre-injury baseline data when evaluating concussion-related brain abnormalities at the individual level. While there is a growing literature base examining concussion effects at the individual level[23,24], including emerging results with pre-injury baseline data[25,26,27], this remains an under-studied area of research It is as of yet unclear whether concussion-related abnormalities identified in longitudinal analysis relative to baseline imaging are distinct from those identified in cross-sectional comparisons to uninjured cohorts
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