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<meta name="DC.Title" content="Investigating Brain White Matter in Football Players with and without Concussion Using a Biophysical Model from Multishell Diffusion MRI" />
<meta name="DC.Identifier" content="10.3174/ajnr.A7522" />
<meta name="DC.Date" content="2022-06-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2022 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: There have been growing concerns around potential risks related to sports-related concussion and contact sport exposure to repetitive head impacts in young athletes. Here we investigate WM microstructural differences between collegiate football players with and without sports-related concussion.

MATERIALS AND METHODS: The study included 78 collegiate athletes (24 football players with sports-related concussion, 26 football players with repetitive head impacts, and 28 non-contact-sport control athletes), available through the Federal Interagency Traumatic Brain Injury Research registry. Diffusion metrics of diffusion tensor/kurtosis imaging and WM tract integrity were calculated. Tract-Based Spatial Statistics and post hoc ROI analyses were performed to test group differences.

RESULTS: Significantly increased axial kurtosis in those with sports-related concussion compared with controls was observed diffusely across the whole-brain WM, and some focal areas demonstrated significantly higher mean kurtosis and extra-axonal axial diffusivity in sports-related concussion. The extent of significantly different WM regions decreased across time points and remained present primarily in the corpus callosum. Similar differences in axial kurtosis were found between the repetitive head impact and control groups. Other significant differences were seen at unrestricted return-to-play with lower radial kurtosis and intra-axonal diffusivity in those with sports-related concussion compared with the controls, mainly restricted to the posterior callosum.

CONCLUSIONS: This study highlights the fact that there are differences in diffusion microstructure measures that are present not only between football players with sports-related injuries and controls, but that there are also measurable differences between football players with repetitive head impacts and controls. This work reinforces previous work showing that the corpus callosum is specifically implicated in sports-related concussion and also suggests this to be true for repetitive head impacts.

AK
:   axial kurtosis
AWF
:   axonal water fraction
CC
:   corpus callosum
Daxon
:   intra-axonal diffusivity
De,‖
:   extra-axonal axial diffusivity
De,⊥
:   extra-axonal radial diffusivity
DKI
:   diffusional kurtosis imaging
FA
:   fractional anisotropy
HC
:   healthy controls
MD
:   mean diffusivity
MK
:   mean kurtosis
RHI
:   repetitive head impact
RK
:   radial kurtosis
SCAT3
:   Sport Concussion Assessment Tool 3
SRC
:   sports-related concussion
TBSS
:   Tract-Based Spatial Statistics
WMTI
:   white matter tract integrity" />
<meta name="DC.Contributor" content="S. Chung" />
<meta name="DC.Contributor" content="J. Chen" />
<meta name="DC.Contributor" content="T. Li" />
<meta name="DC.Contributor" content="Y. Wang" />
<meta name="DC.Contributor" content="Y.W. Lui" />
<meta name="article:published_time" content="2022-06-01" />
<meta name="article:section" content="Adult Brain" />
<meta name="citation_title" content="Investigating Brain White Matter in Football Players with and without Concussion Using a Biophysical Model from Multishell Diffusion MRI" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;There have been growing concerns around potential risks related to sports-related concussion and contact sport exposure to repetitive head impacts in young athletes. Here we investigate WM microstructural differences between collegiate football players with and without sports-related concussion.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;The study included 78 collegiate athletes (24 football players with sports-related concussion, 26 football players with repetitive head impacts, and 28 non-contact-sport control athletes), available through the Federal Interagency Traumatic Brain Injury Research registry. Diffusion metrics of diffusion tensor/kurtosis imaging and WM tract integrity were calculated. Tract-Based Spatial Statistics and post hoc ROI analyses were performed to test group differences.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Significantly increased axial kurtosis in those with sports-related concussion compared with controls was observed diffusely across the whole-brain WM, and some focal areas demonstrated significantly higher mean kurtosis and extra-axonal axial diffusivity in sports-related concussion. The extent of significantly different WM regions decreased across time points and remained present primarily in the corpus callosum. Similar differences in axial kurtosis were found between the repetitive head impact and control groups. Other significant differences were seen at unrestricted return-to-play with lower radial kurtosis and intra-axonal diffusivity in those with sports-related concussion compared with the controls, mainly restricted to the posterior callosum.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;This study highlights the fact that there are differences in diffusion microstructure measures that are present not only between football players with sports-related injuries and controls, but that there are also measurable differences between football players with repetitive head impacts and controls. This work reinforces previous work showing that the corpus callosum is specifically implicated in sports-related concussion and also suggests this to be true for repetitive head impacts.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_publication_date" content="2022/06/01" />
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<meta name="citation_issn" content="0195-6108" />
<meta name="citation_issn" content="1936-959X" />
<meta name="citation_doi" content="10.3174/ajnr.A7522" />
<meta name="citation_pmid" content="35589140" />
<meta name="citation_volume" content="43" />
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<meta name="citation_article_type" content="Research Article" />
<meta name="citation_section" content="Adult Brain" />
<meta name="citation_firstpage" content="823" />
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<meta name="citation_author" content="S. Chung" />
<meta name="citation_author_institution" content="aFrom the Department of Radiology (S.C., Y.W.L.), Center for Advanced Imaging Innovation and Research, New York University Grossman School of Medicine, New York, New York" />
<meta name="citation_author_institution" content="bDepartment of Radiology (S.C.), Bernard and Irene Schwartz Center for Biomedical Imaging, New York University Grossman School of Medicine, New York, New York" />
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<meta name="citation_author" content="J. Chen" />
<meta name="citation_author_institution" content="cDepartment of Electrical and Computer Engineering (J.C., T.L., Y.W.), New York University Tandon School of Engineering, Brooklyn, New York" />
<meta name="citation_author_orcid" content="https://orcid.org/0000-0003-4784-4588" />
<meta name="citation_author" content="T. Li" />
<meta name="citation_author_institution" content="cDepartment of Electrical and Computer Engineering (J.C., T.L., Y.W.), New York University Tandon School of Engineering, Brooklyn, New York" />
<meta name="citation_author_orcid" content="https://orcid.org/0000-0001-9893-4562" />
<meta name="citation_author" content="Y. Wang" />
<meta name="citation_author_institution" content="cDepartment of Electrical and Computer Engineering (J.C., T.L., Y.W.), New York University Tandon School of Engineering, Brooklyn, New York" />
<meta name="citation_author_orcid" content="https://orcid.org/0000-0003-3199-3802" />
<meta name="citation_author" content="Y.W. Lui" />
<meta name="citation_author_institution" content="aFrom the Department of Radiology (S.C., Y.W.L.), Center for Advanced Imaging Innovation and Research, New York University Grossman School of Medicine, New York, New York" />
<meta name="citation_author_institution" content="bDepartment of Radiology (S.C.), Bernard and Irene Schwartz Center for Biomedical Imaging, New York University Grossman School of Medicine, New York, New York" />
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<meta name="twitter:title" content="Investigating Brain White Matter in Football Players with and without Concussion Using a Biophysical Model from Multishell Diffusion MRI" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: There have been growing concerns around potential risks related to sports-related concussion and contact sport exposure to repetitive head impacts in young athletes. Here we investigate WM microstructural differences between collegiate football players with and without sports-related concussion.

MATERIALS AND METHODS: The study included 78 collegiate athletes (24 football players with sports-related concussion, 26 football players with repetitive head impacts, and 28 non-contact-sport control athletes), available through the Federal Interagency Traumatic Brain Injury Research registry. Diffusion metrics of diffusion tensor/kurtosis imaging and WM tract integrity were calculated. Tract-Based Spatial Statistics and post hoc ROI analyses were performed to test group differences.

RESULTS: Significantly increased axial kurtosis in those with sports-related concussion compared with controls was observed diffusely across the whole-brain WM, and some focal areas demonstrated significantly higher mean kurtosis and extra-axonal axial diffusivity in sports-related concussion. The extent of significantly different WM regions decreased across time points and remained present primarily in the corpus callosum. Similar differences in axial kurtosis were found between the repetitive head impact and control groups. Other significant differences were seen at unrestricted return-to-play with lower radial kurtosis and intra-axonal diffusivity in those with sports-related concussion compared with the controls, mainly restricted to the posterior callosum.

CONCLUSIONS: This study highlights the fact that there are differences in diffusion microstructure measures that are present not only between football players with sports-related injuries and controls, but that there are also measurable differences between football players with repetitive head impacts and controls. This work reinforces previous work showing that the corpus callosum is specifically implicated in sports-related concussion and also suggests this to be true for repetitive head impacts.

AK
:   axial kurtosis
AWF
:   axonal water fraction
CC
:   corpus callosum
Daxon
:   intra-axonal diffusivity
De,‖
:   extra-axonal axial diffusivity
De,⊥
:   extra-axonal radial diffusivity
DKI
:   diffusional kurtosis imaging
FA
:   fractional anisotropy
HC
:   healthy controls
MD
:   mean diffusivity
MK
:   mean kurtosis
RHI
:   repetitive head impact
RK
:   radial kurtosis
SCAT3
:   Sport Concussion Assessment Tool 3
SRC
:   sports-related concussion
TBSS
:   Tract-Based Spatial Statistics
WMTI
:   white matter tract integrity" />
<meta name="og-title" property="og:title" content="Investigating Brain White Matter in Football Players with and without Concussion Using a Biophysical Model from Multishell Diffusion MRI" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/43/6/823" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: There have been growing concerns around potential risks related to sports-related concussion and contact sport exposure to repetitive head impacts in young athletes. Here we investigate WM microstructural differences between collegiate football players with and without sports-related concussion.

MATERIALS AND METHODS: The study included 78 collegiate athletes (24 football players with sports-related concussion, 26 football players with repetitive head impacts, and 28 non-contact-sport control athletes), available through the Federal Interagency Traumatic Brain Injury Research registry. Diffusion metrics of diffusion tensor/kurtosis imaging and WM tract integrity were calculated. Tract-Based Spatial Statistics and post hoc ROI analyses were performed to test group differences.

RESULTS: Significantly increased axial kurtosis in those with sports-related concussion compared with controls was observed diffusely across the whole-brain WM, and some focal areas demonstrated significantly higher mean kurtosis and extra-axonal axial diffusivity in sports-related concussion. The extent of significantly different WM regions decreased across time points and remained present primarily in the corpus callosum. Similar differences in axial kurtosis were found between the repetitive head impact and control groups. Other significant differences were seen at unrestricted return-to-play with lower radial kurtosis and intra-axonal diffusivity in those with sports-related concussion compared with the controls, mainly restricted to the posterior callosum.

CONCLUSIONS: This study highlights the fact that there are differences in diffusion microstructure measures that are present not only between football players with sports-related injuries and controls, but that there are also measurable differences between football players with repetitive head impacts and controls. This work reinforces previous work showing that the corpus callosum is specifically implicated in sports-related concussion and also suggests this to be true for repetitive head impacts.

AK
:   axial kurtosis
AWF
:   axonal water fraction
CC
:   corpus callosum
Daxon
:   intra-axonal diffusivity
De,‖
:   extra-axonal axial diffusivity
De,⊥
:   extra-axonal radial diffusivity
DKI
:   diffusional kurtosis imaging
FA
:   fractional anisotropy
HC
:   healthy controls
MD
:   mean diffusivity
MK
:   mean kurtosis
RHI
:   repetitive head impact
RK
:   radial kurtosis
SCAT3
:   Sport Concussion Assessment Tool 3
SRC
:   sports-related concussion
TBSS
:   Tract-Based Spatial Statistics
WMTI
:   white matter tract integrity" />
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      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Adult Brain</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Investigating Brain White Matter in Football Players with and without Concussion Using a Biophysical Model from Multishell Diffusion MRI</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">S. Chung</span>, <span class="highwire-citation-author" data-delta="1">J. Chen</span>, <span class="highwire-citation-author" data-delta="2">T. Li</span>, <span class="highwire-citation-author" data-delta="3">Y. Wang</span> and <span class="highwire-citation-author" data-delta="4">Y.W. Lui</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">June 2022,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">43 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">823-828; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A7522 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-97358--6764179725" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">S. Chung </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (S.C., Y.W.L.), Center for Advanced Imaging Innovation and Research, New York University Grossman School of Medicine, New York, New York</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Radiology (S.C.), Bernard and Irene Schwartz Center for Biomedical Imaging, New York University Grossman School of Medicine, New York, New York</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BChung%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chung%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.%2BChung%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-1132-900X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Chung</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">J. Chen </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Electrical and Computer Engineering (J.C., T.L., Y.W.), New York University Tandon School of Engineering, Brooklyn, New York</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BChen%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chen%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BChen%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-4784-4588" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Chen</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">T. Li </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Electrical and Computer Engineering (J.C., T.L., Y.W.), New York University Tandon School of Engineering, Brooklyn, New York</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.%2BLi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Li%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AT.%2BLi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-9893-4562" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T. Li</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Y. Wang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Electrical and Computer Engineering (J.C., T.L., Y.W.), New York University Tandon School of Engineering, Brooklyn, New York</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Y.%2BWang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wang%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AY.%2BWang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-3199-3802" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Y. 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Lui </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology (S.C., Y.W.L.), Center for Advanced Imaging Innovation and Research, New York University Grossman School of Medicine, New York, New York</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Radiology (S.C.), Bernard and Irene Schwartz Center for Biomedical Imaging, New York University Grossman School of Medicine, New York, New York</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Y.W.%2BLui%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lui%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AY.W.%2BLui%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-9984-9164" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Y.W. 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