Abstract
The effect of exposing the developing brain of a high school football player to subconcussive impacts during a single season is unknown. The purpose of this pilot study was to use diffusion tensor imaging to assess white matter changes during a single high school football season, and to correlate these changes with impacts measured by helmet accelerometer data and neurocognitive test scores collected during the same period. Seventeen male athletes (mean age, 16 ± 0.73 years) underwent MR imaging before and after the season. Changes in fractional anisotropy across the white matter skeleton were assessed with Tract-Based Spatial Statistics and ROI analysis. The mean number of impacts over a 10-g threshold sustained was 414 ± 291. Voxelwise analysis failed to show significant changes in fractional anisotropy across the season or a correlation with impact frequency, after correcting for multiple comparisons. ROI analysis showed significant (P < .05, corrected) decreases in fractional anisotropy in the fornix-stria terminalis and cingulum hippocampus, which were related to impact frequency. The effects were strongest in the fornix-stria terminalis, where decreases in fractional anisotropy correlated with worsening visual memory. Our findings suggest that subclinical neurotrauma related to participation in American football may result in white matter injury and that alterations in white matter tracts within the limbic system may be detectable after only 1 season of play at the high school level.
Highlights
MethodsSeventeen male athletes (mean age, 16 Ϯ 0.73 years) underwent MR imaging before and after the season
BACKGROUND AND PURPOSEThe effect of exposing the developing brain of a high school football player to subconcussive impacts during a single season is unknown
The effects were strongest in the fornix-stria terminalis, where decreases in fractional anisotropy correlated with worsening visual memory
Summary
Seventeen male athletes (mean age, 16 Ϯ 0.73 years) underwent MR imaging before and after the season. Changes in fractional anisotropy across the white matter skeleton were assessed with Tract-Based Spatial Statistics and ROI analysis. Subjects This was a prospective, longitudinal pilot study to investigate the effects of cumulative head impacts during 1 high school football season. An initial MR imaging study was performed for each subject before the start of fall contact practice (average, 4.6 Ϯ 5.0 days before the first contact practice). Within 4 weeks of the end of the season (average, 14.5 Ϯ 8.5 days after the final game), the subjects returned for the postseason MR imaging using the same protocol. Any subjects who experienced a diagnosed concussion were asked to undergo an additional MR imaging within 48 hours of the injury in addition to the pre- and postseason scans.
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