Researchers use advanced imaging studies (e.g., diffusion tensor imaging, resting-state functional magnetic resonance imaging) to assess structural and functional changes following a concussion. This can help clinicians and researchers understand if there are long-term problems after a concussion and discover potential therapeutic interventions. Unfortunately, it is challenging to interpret the complex structural and functional brain changes that occur after a concussion. Therefore, the authors used advanced analyses to examine changes in brain structure (diffuse tensor imaging) and function (resting-stage functional magnetic resonance imaging) together in 52 healthy female varsity rugby players (~20 years of age) over a five-year period (71 in season data sets, 60 off-season data sets). The authors also compared these non-concussed rugby players to 21 athletes with concussion acutely (24 to 72 h) and longitudinally (3- and 6-months) post-concussion. Athletes with a concussion completed the SCAT 3 and reported their history of concussion. The authors found that the number of signs and symptoms and a history of concussion were associated with brain structure alterations. The authors also showed that brain structure (white matter microstructure) had negative outcomes (poorer neuronal connectivity) in-season compared to offseason. Furthermore, athletes with an acute concussion had different imaging findings than the off-season and 6-months post-injury.
Linked MRI signatures of the brain’s acute and persistent response to concussion in female varsity rugby players
Manning KY, Llera A, Dekaban GA, Bartha R, Barreira C, Brown A, Fischer L, Jevremovic T, Blackney K, Doherty TJ, Fraser DD, Holmes J, Beckmann CF, Menon RS. Neuroimage Clin.2018 Dec 3. pii: S2213-1582(18)30375-9.
Take Home Message: Athletes in rugby have altered white matter structural and functional connectivity after a concussion and in season. Some changes may persist up to 6 months post-injury.
This was an interesting study because the authors found evidence that concussed brains experience acute neuroinflammatory issues that recover quickly. Unfortunately, these brains have lingering microstructural and functional connectivity changes up to 6 months after injury. These imaging techniques may enable people to better monitor athletes and learn more about the pathological changes that occur in brain tissue following head impacts. Rugby is a sport where athletes may receive multiple head impacts; therefore, it was interesting to see that many of the negative alterations depicted on the imaging studies occurred during the in season and not just acutely post-concussion. These findings suggest that even non-concussed athletes could be negatively affected by subconcussive impacts. These brain tissue changes were in cerebral regions that communicate between brain hemispheres and the body as well as handle higher-level thinking and functioning. These changes were worse in-season compared to off-season. This may highlight the importance of allowing our athletes to have an off-season from impacts to allow recovery. Currently, medical professionals need to be aware that brain structure and connectivity is altered even after clinical symptoms resolve. We need to educate athletes, parents, and coaches that the brain takes time to heal and ensure best practices are being implemented for safe active recovery for return to activity.
Questions for Discussion: If affordable, would you send your concussed athletes to receive imaging to help check his/her progress? If the brain microstructure is being affected even after 6 months do you think further monitoring post-concussion be implemented?
Written by: Jane McDevitt
Reviewed by: Jeffrey Driban