Cerebral Microhemorrhages Detected by Susceptibility-Weighted Imaging in Amateur Boxers

Hasıloğlu, Zehra Işık; Albayram, Sait; Selçuk, Hakan; Ceyhan, Erman; Delil, Şakir; Arkan, B.; Baskoy, L.

doi:10.3174/ajnr.a2250

Cited by 54 publications

(41 citation statements)

References 16 publications

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“…High rates of CSP have been reported in neuropathologically confirmed cases of CTE 2,32 as well as in living contact sports athletes with a history of exposure to repetitive head impacts (CSP in 43%), 25 and in boxers in particular (CSP in 57%). 33 High rates of CSP have also been reported in post-mortem studies (CSP in 69% of cadavers with history of head trauma) 34 and in vivo studies of persons with exposure to brain trauma (67% of those with CSP had history of head trauma). 35 CSP was found in 54% of victims of fatal road accidents compared with 38% in a control group.…”

Section: Discussionmentioning

confidence: 91%

Cavum Septi Pellucidi in Symptomatic Former Professional Football Players

Koerte

Hufschmidt

Muehlmann

et al. 2016

Journal of Neurotrauma

112

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Post-mortem studies reveal a high rate of cavum septi pellucidi (CSP) in chronic traumatic encephalopathy (CTE). It remains, however, to be determined whether or not the presence of CSP may be a potential in vivo imaging marker in populations at high risk to develop CTE. The aim of this study was to evaluate CSP in former professional American football players presenting with cognitive and behavioral symptoms compared with noncontact sports athletes. Seventytwo symptomatic former professional football players (mean age 54.53 years, standard deviation [SD] 7.97) as well as 14 former professional noncontact sports athletes (mean age 57.14 years, SD 7.35) underwent high-resolution structural 3T magnetic resonance imaging. Two raters independently evaluated the CSP, and interrater reliability was calculated. Within National Football League players, an association of CSP measures with cognitive and behavioral functioning was evaluated using a multivariate mixed effects model. The measurements of the two raters were highly correlated (CSP length: rho = 0.98; Intraclass Correlation Coefficient [ICC] 0.99; p < 0.0001; septum length: rho = 0.93; ICC 0.96; p < 0.0001). For presence versus absence of CSP, there was high agreement (Cohen kappa = 0.83, p < 0.0001). A higher rate of CSP, a greater length of CSP, as well as a greater ratio of CSP length to septum length was found in symptomatic former professional football players compared with athlete controls. In addition, a greater length of CSP was associated with decreased performance on a list learning task (Neuropsychological Assessment Battery List A Immediate Recall, p = 0.04) and decreased test scores on a measure of estimate verbal intelligence (Wide Range Achievement Test Fourth Edition Reading Test, p = 0.02). Given the high prevalence of CSP in neuropathologically confirmed CTE in addition to the results of this study, CSP may serve as a potential early in vivo imaging marker to identify those at high risk for CTE. Future research is needed to investigate the pathomechanism underlying the development of CSP after repetitive head impacts, and its potential association with neuropathologically confirmed CTE.

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Section: Discussionmentioning

confidence: 91%

Cavum Septi Pellucidi in Symptomatic Former Professional Football Players

Koerte

Hufschmidt

Muehlmann

et al. 2016

Journal of Neurotrauma

112

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“…A case report of a patient with a history of mTBI, who died later of unrelated causes, reported evidence of previous hemorrhage in the form of hemosiderin-laden macrophages in the frontal and temporal lobes on histopathological examination. 31 Recent studies utilizing newer imaging techniques, including susceptibility weighted imaging (SWI), [32][33][34][35] likewise demonstrated that in a subset of mTBI patients, small hemorrhages occur. SWI combines the phase and magnitude of T2* gradient echo imaging (GRE) to accentuate net susceptibility effects and, therefore, to enhance detection of macroscopic field inhomogeneities such as from focal deposits of hemosiderin (Fig.…”

Section: Heme Ironmentioning

confidence: 99%

The Presence and Role of Iron in Mild Traumatic Brain Injury: An Imaging Perspective

Nisenbaum

Novikov²,

Lui³

2014

Journal of Neurotrauma

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Mild traumatic brain injury (mTBI), although often presenting without the gross structural abnormalities seen in more severe forms of brain trauma, can nonetheless result in lingering cognitive and behavioral problems along with subtle alterations in brain structure and function. Repeated injuries are associated with brain atrophy and dementia in the form of chronic traumatic encephalopathy (CTE). The mechanisms underlying these dysfunctions are poorly understood. There is a growing body of evidence that brain iron is abnormal after TBI, and brain iron has also been implicated in a host of neurodegenerative disorders. The purpose of this article is to review evidence about the function of iron in the pathophysiology of mTBI and the role that advanced imaging modalities can play in further elucidating said function. MRI techniques sensitive to field inhomogeneities provide supporting evidence for both deep gray matter non-heme iron accumulation as well as focal microhemorrhage resulting from mTBI. In addition, there is evidence that iron may contribute to pathology after mTBI through a number of mechanisms, including generation of reactive oxygen species (ROS), exacerbation of oxidative stress from other sources, and encouragement of tau phosphorylation and the formation of neurofibrillary tangles. Finally, recent animal studies suggest that iron may serve as a therapeutic target in mitigating the effects of mTBI. However, research on the presence and role of iron in mTBI and CTE is still relatively sparse, and further work is necessary to elucidate issues such as the sources of increased iron and the chain of secondary injury.

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“…Hemorrhagic lesions are more commonly identified in moderate and severe TBI (45), though with increasing sensitivity of newer techniques, there is evidence that microhemorrhages occur in mTBI more commonly than had been previously suspected. Susceptibility-weighted imaging combines magnitude and phase information by using a gradient-echo sequence (85,86) and demonstrates superior sensitivity for paramagnetic deoxygenated blood products after TBI (87)(88)(89)(90)(91). Detection of these microhemorrhages in mTBI is important as the presence of hemorrhage correlates findings (73).…”

Section: State Of the Art: Mr Imaging Applications In Mild Traumatic mentioning

confidence: 99%

MR Imaging Applications in Mild Traumatic Brain Injury: An Imaging Update

Wu¹,

Kirov²,

Gonen³

et al. 2016

Radiology

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Mild traumatic brain injury (mTBI), also commonly referred to as concussion, affects millions of Americans annually. Although computed tomography is the first-line imaging technique for all traumatic brain injury, it is incapable of providing long-term prognostic information in mTBI. In the past decade, the amount of research related to magnetic resonance (MR) imaging of mTBI has grown exponentially, partly due to development of novel analytical methods, which are applied to a variety of MR techniques. Here, evidence of subtle brain changes in mTBI as revealed by these techniques, which are not demonstrable by conventional imaging, will be reviewed. These changes can be considered in three main categories of brain structure, function, and metabolism. Macrostructural and microstructural changes have been revealed with threedimensional MR imaging, susceptibility-weighted imaging, diffusion-weighted imaging, and higher order diffusion imaging. Functional abnormalities have been described with both task-mediated and resting-state blood oxygen leveldependent functional MR imaging. Metabolic changes suggesting neuronal injury have been demonstrated with MR spectroscopy. These findings improve understanding of the true impact of mTBI and its pathogenesis. Further investigation may eventually lead to improved diagnosis, prognosis, and management of this common and costly condition.q RSNA, 2016

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Cerebral Microhemorrhages Detected by Susceptibility-Weighted Imaging in Amateur Boxers

Cited by 54 publications

References 16 publications

Cavum Septi Pellucidi in Symptomatic Former Professional Football Players

Cavum Septi Pellucidi in Symptomatic Former Professional Football Players

The Presence and Role of Iron in Mild Traumatic Brain Injury: An Imaging Perspective

MR Imaging Applications in Mild Traumatic Brain Injury: An Imaging Update

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