Surgical Planning Laboratory - Brigham & Women's Hospital - Boston, Massachusetts USA - a teaching affiliate of Harvard Medical School

Surgical Planning Laboratory

The Publication Database hosted by SPL

All Publications | Upload | Advanced Search | Gallery View | Download Statistics | Help | Import | Log in

Hockey Concussion Education Project, Part 2. Microstructural White Matter Alterations in Acutely Concussed Ice Hockey Players: A Longitudinal Free-water MRI Study

Institution:
Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Publication Date:
Apr-2014
Journal:
J Neurosurg
Volume Number:
120
Issue Number:
4
Pages:
873-81
Citation:
J Neurosurg. 2014 Apr;120(4):873-81.
PubMed ID:
24490785
PMCID:
PMC4386884
Appears in Collections:
PNL, NAC, SLICER
Sponsors:
P41 EB015902/EB/NIBIB NIH HHS/United States
P41 RR013218/RR/NCRR NIH HHS/United States
R01 MH074794/MH/NIMH NIH HHS/United States
Generated Citation:
Pasternak O., Koerte I.K., Bouix S., Fredman E., Sasaki T., Mayinger M., Helmer K.G., Johnson A.M., Holmes J.D., Forwell L.A., Skopelja E.N., Shenton M.E., Echlin P.S. Hockey Concussion Education Project, Part 2. Microstructural White Matter Alterations in Acutely Concussed Ice Hockey Players: A Longitudinal Free-water MRI Study. J Neurosurg. 2014 Apr;120(4):873-81. PMID: 24490785. PMCID: PMC4386884.
Downloaded: 589 times. [view map]
Paper: Download, View online
Export citation:
Google Scholar: link

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.

Additional Material
1 File (52.212kB)
Pasternak-JNeurosurg2014-fig1.jpg (52.212kB)