Diffusion Tensor Imaging in Contact and Non-Contact University-Level Sport Athletes

Lefebvre, Geneviève; Guay, Samuel; Chamard, Émilie; Theaud, Guillaume; Guise, Élaine de; Bacon, Benoît A.; Descoteaux, Maxime; Beaumont, Louis De; Théoret, Hugo

doi:10.1089/neu.2020.7170

Cited by 10 publications

(23 citation statements)

References 91 publications

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“…In our longitudinal multi-season investigation with multicompartment modeling, we observed decreased tract-specific diffusivity and dispersion perpendicular to the primary pathway over time in low-contact sports (volleyball), whereas in high-contact athletes (football) these changes were attenuated. This finding is consistent with existing literature suggesting decreased tract-specific diffusivity, including RD 27 , MD 5 , and ODI 28 in non- or low-contact compared to high-contact sports; particularly in the corpus callosum where we also observed decreasing MD, RD and increasing AWF. In addition, we observed increased FA longitudinally in volleyball compared to football, consistent with findings in studies including non-contact sports vs. a rugby cohort 29,30 .…”

Section: Discussionsupporting

confidence: 93%

“…This finding is consistent with existing literature suggesting decreased tract-specific diffusivity, including RD 27 , MD 5 , and ODI 28 in non- or low-contact compared to high-contact sports; particularly in the corpus callosum where we also observed decreasing MD, RD and increasing AWF. In addition, we observed increased FA longitudinally in volleyball compared to football, consistent with findings in studies including non-contact sports vs. a rugby cohort 29,30 . WMTI and kurtosis metrics can be sensitive markers of WM injury following head impacts 31–33 as they enable the quantification of non-Gaussian water diffusion, and might be sensitive to effects such as inflammatory responses 34 ; thus, employing them in addition to DTI and NODDI metrics enhances our ability to decipher underlying microstructural mechanisms.…”

Section: Discussionsupporting

confidence: 93%

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Microstructural alterations in tract development in college football: a longitudinal diffusion MRI study

Goubran

Mills

Georgiadis

et al. 2022

Preprint

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Background and Objectives: Repeated concussive and sub-concussive impacts in high-contact sports can affect microstructure of the brain, which can be studied using diffusion MRI. Most prior imaging studies, however, employ a cross-sectional design, do not include low-contact players as controls, or use traditional diffusion tensor imaging without investigating novel tract-specific microstructural metrics. Methods: We examined brain microstructure in 63 high-contact (American football) and 34 low-contact (volleyball) collegiate athletes with up to 4 years of follow-up (315 total scans) using advanced diffusion MRI, a comprehensive set of multi-compartment models, and automated fiber quantification tools. We investigated diffusion metrics along the length of tracts using nested linear mixed-effects models to ascertain the acute and chronic effects of sub-concussive and concussive impacts, as well as associations between diffusion changes with clinical, behavioral, and sports-related measures. Results: Significant longitudinal increases in fractional anisotropy and axonal water fraction were detected in volleyball players, but not in football players, along with decreases in radial and mean diffusivity as well as orientation dispersion index (all findings absolute T-statistic > 3.5, p < .0001). This pattern was present in the callosum forceps minor, left superior longitudinal fasciculus, left thalamic radiation, and right cingulum hippocampus. Longitudinal group differences were more prominent and observed in a larger number of tracts in concussed (previously or in-study) football players (p < .0001), while smaller effects were noted in un-concussed players. An analysis of immediate-post concussion scans in football players demonstrated a transient localized increase in axial diffusivity, mean and radial kurtosis in the left uncinate and right cingulum hippocampus (p < .0001). Finally, football players with high position-based sub-concussive risk demonstrated increased orientation dispersion index over time (p < .0001). Discussion: The observed longitudinal changes in our volleyball cohort likely reflect normal development in this age range, while the relative attenuation of these effects seen in football, and especially concussed athletes, could possibly reveal diminished myelination, altered axonal calibers, or depressed pruning processes leading to a static, non-decreasing axonal dispersion. This prospective longitudinal study demonstrates significantly divergent tract-specific trajectories of brain microstructure, possibly reflecting a concussive and/or repeated sub-concussive impact-related alteration of normal white matter development in football athletes.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Microstructural alterations in tract development in college football: a longitudinal diffusion MRI study

Goubran

Mills

Georgiadis

et al. 2022

Preprint

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“…23 While the validity of this test has not been performed in a sporting population, it has previously been used to assess the processing speed of athletes in several studies. [24][25][26] Trail Making Test (TMT). Complex attention and cognitive flexibility were assessed using the TMT.…”

Section: Symbol Digit Modality Test (Sdmt)mentioning

confidence: 99%

Investigating the role of age and maturation on the association between tennis experience and cognitive function in junior beginner to intermediate-level tennis players

Turner

Ishihara

Beranek

et al. 2022

International Journal of Sports Science & Coaching

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Sport engagement, including tennis, and physical activity have been shown to have a positive influence on cognition in children. However, age has also been found to have a strong association with cognition in youth athletes. This study examines the threshold hypothesis by investigating the moderating role of age and maturation on the association between tennis experience and cognitive measures in Australian and German junior beginner to intermediate-level tennis players. The demographic information, which includes years of tennis experience, and anthropometrics (e.g. height and weight) was collected for 48 junior tennis players. A comprehensive cognitive testing battery was then completed to assess cognitive performance, with a principle component analysis used to determine an overall cognitive performance score. Multiple regression analyses were then performed to test the relationship between tennis experience and cognitive performance as well as the moderating effects of age and maturation. The results of this study indicate that the age and maturation rather than the exposure to tennis training are related to cognitive performance. Additionally, the positive relations of tennis experience to cognitive performance were stronger in younger participants, specifically those younger than 12 years old. Therefore, tennis may not provide a stimulus large enough for further cognitive improvement once players have developed a high level of cognitive performance. While age and biological maturity will largely dictate cognitive performance in adolescents, tennis experience may play some role in the cognitive performance of children (specifically <12 years of age).

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“…Of note, each of the studies included in this review was rated by the QUADAS-2 as having at least some risk of bias. More specifically, the main issues within each of the four domains of the QUADAS-2 were as follows: (a) Patient Selection, "Consideration of sex or gender differences is missing" (11 of 17 studies) (Bazarian et al, 2014;Brett et al, 2021;Champagne et al, 2019;Churchill et al, 2017;Holcomb et al, 2021;Koerte et al, 2012a;Kuzminski et al, 2018;Lefebvre et al, 2021;Mayinger et al, 2018;Saghafi et al, 2018;Slobounov et al, 2017), or sample was too small (i.e., ≤ 15 individuals), or control group was missing (11 of 17 studies) (Bahrami et al, 2016;Brett et al, 2021;Champagne et al, 2019;Holcomb et al, 2021;Kawata et al, 2020;Koerte et al, 2012b;Kuzminski et al, 2018;Lipton et al, 2013;Mayinger et al, 2018;Saghafi et al, 2018;Slobounov et al, 2017); (b) Index Test, "No or sparse information is provided regarding the evaluation of the quality of the imaging data" (10 of 17 studies) (Bahrami et al, 2016;Bazarian et al, 2014;Champagne et al, 2019;Churchill et al, 2017;Holcomb et al, 2021;Kawata et al, 2020;Koerte et al, 2012a;Lipton et al, 2013;Slobounov et al, 2017;Strauss et al, 2021); (c) Reference Standard, "Objective quantification of RHI is missing" (10 of 17 studies) (Brett et al, 2021;Churchill et al, 2017;…”

Section: Study Qualitymentioning

confidence: 99%

“…Of the 17 studies included, 11 had a longitudinal study design (Bahrami et al, 2016;Bazarian et al, 2014;Brett et al, 2021;Champagne et al, 2019;Holcomb et al, 2021;Koerte et al, 2012b;Kuzminski et al, 2018;Mayinger et al, 2018;Saghafi et al, 2018;Slobounov et al, 2017;Strauss et al, 2021), and six had a cross sectional study design (Churchill et al, 2017;de Souza et al, 2020;Kawata et al, 2020;Koerte et al, 2012a;Lefebvre et al, 2021;Lipton et al, 2013). Most studies related their testing time points to the start and end of a competitive sport season.…”

Section: Study Characteristicsmentioning

confidence: 99%

Diffusion Imaging of Sport-related Repetitive Head Impacts—A Systematic Review

et al. 2022

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Repetitive head impacts (RHI) are commonly observed in athletes participating in contact sports such as American football, ice hockey, and soccer. RHI usually do not result in acute symptoms and are therefore often referred to as subclinical or “subconcussive” head impacts. Epidemiological studies report an association between exposure to RHI and an increased risk for the development of neurodegenerative diseases. Diffusion magnetic resonance imaging (dMRI) has emerged as particularly promising for the detection of subtle alterations in brain microstructure following exposure to sport-related RHI. The purpose of this study was to perform a systematic review of studies investigating the effects of exposure to RHI on brain microstructure using dMRI. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to determine studies that met inclusion and exclusion criteria across three databases. Seventeen studies were identified and critically evaluated. Results from these studies suggest an association between white matter alterations and RHI exposure in youth and young adult athletes. The most consistent finding across studies was lower or decreased fractional anisotropy (FA), a measure of the directionality of the diffusion of water molecules, associated with greater exposure to sport-related RHI. Whether decreased FA is associated with functional outcome (e.g., cognition) in those exposed to RHI is yet to be determined. This review further identified areas of importance for future research to increase the diagnostic and prognostic value of dMRI in RHI and to improve our understanding of the effects of RHI on brain physiology and microstructure.

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Diffusion Tensor Imaging in Contact and Non-Contact University-Level Sport Athletes

Cited by 10 publications

References 91 publications

Microstructural alterations in tract development in college football: a longitudinal diffusion MRI study

Microstructural alterations in tract development in college football: a longitudinal diffusion MRI study

Investigating the role of age and maturation on the association between tennis experience and cognitive function in junior beginner to intermediate-level tennis players

Diffusion Imaging of Sport-related Repetitive Head Impacts—A Systematic Review

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