Abstract
Preliminary studies suggest that sports-related concussion (SRC) is associated with alterations in cerebral blood flow (CBF) regulation. Here, we use advanced magnetic resonance imaging (MRI) techniques to measure CBF and cerebrovascular responsiveness (CVR) in individual SRC patients and healthy control subjects. 15 SRC patients (mean age = 16.3, range 14-20 years) and 27 healthy control subjects (mean age = 17.6, range 13-21 years) underwent anatomical MRI, pseudo-continuous arterial spin labeling (pCASL) MRI and model-based prospective end-tidal targeting (MPET) of CO2 during blood oxygenation level-dependent (BOLD) MRI. Group differences in global mean resting CBF were examined. Voxel-by-voxel group and individual differences in regional CVR were examined using statistical parametric mapping (SPM). Leave-one-out receiver operating characteristic curve analysis was used to evaluate the utility of brain MRI CO2 stress testing biomarkers to correctly discriminate between SRC patients and healthy control subjects. All studies were tolerated with no complications. Traumatic structural findings were identified in one SRC patient. No significant group differences in global mean resting CBF were observed. There were no significant differences in the CO2 stimulus and O2 targeting during BOLD MRI. Significant group and patient-specific differences in CVR were observed with SRC patients demonstrating a predominant pattern of increased CVR. Leave-one-out ROC analysis for voxels demonstrating a significant increase in CVR was found to reliably discriminate between SRC patients and healthy control subjects (AUC of 0.879, p = 0.0001). The optimal cutoff for increased CVR declarative for SRC was 1,899 voxels resulting in a sensitivity of 0.867 and a specificity of 0.778 for this specific ROC analysis. There was no correlation between abnormal voxel counts and Postconcussion Symptom Scale scores among SRC patients. Acute and subacute SRCs are associated with alterations in CVR that can be reliably detected by brain MRI CO2 stress testing in individual patients.
Highlights
Expert consensus has historically viewed sports-related concussion (SRC) as an injury resulting in clinical features that arise from transient disturbances in brain functioning occurring in the absence of structural brain injury [1]
Among the processes implicated in the pathogenesis of acute concussion and traumatic brain injury (TBI) are disturbances in cerebrovascular physiology that result in a mismatch between the metabolic demands of the injured brain and the delivery of cerebral blood flow (CBF) [9,10,11,12,13]
Using model-based prospective end-tidal targeting (MPET) of CO2 during blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI), we have previously demonstrated patient-specific qualitative and quantitative regional alterations in cerebrovascular reactivity or responsiveness (CVR) among adolescent postconcussion syndrome patients while global mean resting CBF remained within normal limits [18]
Summary
Expert consensus has historically viewed sports-related concussion (SRC) as an injury resulting in clinical features that arise from transient disturbances in brain functioning occurring in the absence of structural brain injury [1]. Using model-based prospective end-tidal targeting (MPET) of CO2 during blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI), we have previously demonstrated patient-specific qualitative and quantitative regional alterations in CVR among adolescent postconcussion syndrome patients while global mean resting CBF remained within normal limits [18]. These results suggest that the cerebrovascular disturbances that characterize acute SRC can persist into the chronic phases of injury, available studies that have aimed to evaluate alterations in CVR using various techniques among acute and subacute SRC patients have yielded inconsistent results [19,20,21]. We use advanced magnetic resonance imaging (MRI) techniques to measure CBF and cerebrovascular responsiveness (CVR) in individual SRC patients and healthy control subjects
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
