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Published Online: 12 February 2011

A Diffusion Tensor Imaging Study on the White Matter Skeleton in Individuals with Sports-Related Concussion

Publication: Journal of Neurotrauma
Volume 28, Issue Number 2

Abstract

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.

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cover image Journal of Neurotrauma
Journal of Neurotrauma
Volume 28Issue Number 2February 2011
Pages: 189 - 201
PubMed: 21083414

History

Published online: 12 February 2011
Published in print: February 2011
Published ahead of print: 27 January 2011
Published ahead of production: 17 November 2010

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Valerie A. Cubon
Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey.
Margot Putukian
University Health Services, Princeton University, Princeton, New Jersey.
Cynthia Boyer
Brain Injury Services, Bancroft NeuroHealth, Cherry Hill, New Jersey.
Annegret Dettwiler
Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey.

Notes

Address correspondence to:Annegret Dettwiler, Ph.D.Princeton Neuroscience InstitutePrinceton UniversityGreen HallPrinceton, NJ 08544E-mail: [email protected]

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No competing financial interests exist.

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