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2014 ; 120
(4
): 873-81
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English Wikipedia
Hockey Concussion Education Project, Part 2 Microstructural white matter
alterations in acutely concussed ice hockey players: a longitudinal free-water
MRI study
#MMPMID24490785
Pasternak O
; Koerte IK
; Bouix S
; Fredman E
; Sasaki T
; Mayinger M
; Helmer KG
; Johnson AM
; Holmes JD
; Forwell LA
; Skopelja EN
; Shenton ME
; Echlin PS
J Neurosurg
2014[Apr]; 120
(4
): 873-81
PMID24490785
show ga
OBJECT: Concussion is a common injury in ice hockey and a health problem for the
general population. Traumatic axonal injury has been associated with concussions
(also referred to as mild traumatic brain injuries), yet the pathological course
that leads from injury to recovery or to long-term sequelae is still not known.
This study investigated the longitudinal course of concussion by comparing
diffusion MRI (dMRI) scans of the brains of ice hockey players before and after a
concussion. METHODS: The 2011-2012 Hockey Concussion Education Project followed
45 university-level ice hockey players (both male and female) during a single
Canadian Interuniversity Sports season. Of these, 38 players had usable dMRI
scans obtained in the preseason. During the season, 11 players suffered a
concussion, and 7 of these 11 players had usable dMRI scans that were taken
within 72 hours of injury. To analyze the data, the authors performed free-water
imaging, which reflects an increase in specificity over other dMRI analysis
methods by identifying alterations that occur in the extracellular space compared
with those that occur in proximity to cellular tissue in the white matter. They
used an individualized approach to identify alterations that are spatially
heterogeneous, as is expected in concussions. RESULTS: Paired comparison of the
concussed players before and after injury revealed a statistically significant (p
< 0.05) common pattern of reduced free-water volume and reduced axial and radial
diffusivities following elimination of free-water. These free-water-corrected
measures are less affected by partial volumes containing extracellular water and
are therefore more specific to processes that occur within the brain tissue.
Fractional anisotropy was significantly increased, but this change was no longer
significant following the free-water elimination. CONCLUSIONS: Concussion during
ice hockey games results in microstructural alterations that are detectable using
dMRI. The alterations that the authors found suggest decreased extracellular
space and decreased diffusivities in white matter tissue. This finding might be
explained by swelling and/or by increased cellularity of glia cells. Even though
these findings in and of themselves cannot determine whether the observed
microstructural alterations are related to long-term pathology or persistent
symptoms, they are important nonetheless because they establish a clearer picture
of how the brain responds to concussion.