A Diffusion Tensor Imaging Study on the White Matter Skeleton in Individuals with Sports-Related Concussion
A Diffusion Tensor Imaging Study on the White Matter Skeleton in Individuals with Sports-Related Concussion
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DOI：
10.1089/neu.2010.1430
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发表时间：
2011-02-01
影响因子：
4.2
通讯作者：
Dettwiler, Annegret
中科院分区：
文献类型：
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作者：
Cubon, Valerie A.;Putukian, Margot;Dettwiler, Annegret
认识和管理脑震荡的影响是非常具有挑战性的，考虑到离散的脑震荡。大多数患有运动相关脑震荡的个体在格拉斯哥昏迷量表上的评分不会低于15分，但会出现短暂的神经功能障碍的快速发作，在传统的磁共振成像（MRI）和计算机断层扫描（CT）上没有显示出结构变化。决定是否重返赛场是医生面临的最困难的责任之一，到目前为止，这一决定主要基于神经系统检查、症状检查表和神经心理学（NP）测试。弥散张量成像（DTI）可能是一个更客观的工具，以评估脑震荡后的严重程度和功能恢复。我们评估了运动相关性脑震荡而无意识丧失的大学运动员的白色纤维束完整性，这些运动员在受伤后经历了至少1个月的持续症状。使用基于束的空间统计学（TBSS）评价WM骨骼的各向异性分数（FA）和平均扩散率（MD）显示，在左半球的几个WM纤维束中，脑震荡受试者的MD显著增加，包括下/上级纵束和额枕束的部分，内囊的晶状体后部分，以及后丘脑和声辐射。平均FA和MD的定性比较表明，随着损伤严重程度的增加（从运动相关的脑震荡到严重的创伤性脑损伤），MD可能在检测轻度损伤时更敏感，而FA捕获更严重的损伤。总之，TBSS分析用于评估WM骨骼的弥漫性轴索损伤似乎足够敏感，以检测运动相关脑震荡的结构变化。
Recognizing and managing the effects of cerebral concussion is very challenging, given the discrete symptomatology. Most individuals with sports-related concussion will not score below 15 on the Glasgow Coma Scale, but will present with rapid onset of short-lived neurological impairment, demonstrating no structural changes on traditional magnetic resonance imaging (MRI) and computed tomography (CT) scans. The return-to-play decision is one of the most difficult responsibilities facing the physician, and so far this decision has been primarily based on neurological examination, symptom checklists, and neuropsychological (NP) testing. Diffusion tensor imaging (DTI) may be a more objective tool to assess the severity and recovery of function after concussion. We assessed white matter (WM) fiber tract integrity in varsity level college athletes with sports-related concussion without loss of consciousness, who experienced protracted symptoms for at least 1 month after injury. Evaluation of fractional anisotropy (FA) and mean diffusivity (MD) of the WM skeleton using tract-based spatial statistics (TBSS) revealed a large cluster of significantly increased MD for concussed subjects in several WM fiber tracts in the left hemisphere, including parts of the inferior/superior longitudinal and fronto-occipital fasciculi, the retrolenticular part of the internal capsule, and posterior thalamic and acoustic radiations. Qualitative comparison of average FA and MD suggests that with increasing level of injury severity (ranging from sports-related concussion to severe traumatic brain injury), MD might be more sensitive at detecting mild injury, whereas FA captures more severe injuries. In conclusion, the TBSS analysis used to evaluate diffuse axonal injury of the WM skeleton seems sensitive enough to detect structural changes in sports-related concussion.