Preliminary evidence from a prospective DTI study suggests a posterior-to-anterior pattern of recovery in college athletes with sports-related concussion

Abstract

Objectives: We compared the integrity of white matter (WM) microstructure to the course of recovery in athletes who sustained one sports-related concussion (SRC), assessing individual longitudinal changes in WM fiber tracts following SRC using pre- and post-injury measurements. Materials and Methods: Baseline diffusion tensor imaging (DTI) scans and neuropsychological tests were collected on 53 varsity contact-sport college athletes. Participants (n = 13) who subsequently sustained an SRC underwent DTI scans and neuropsychological testing at 2 days, 2 weeks, and 2 months following injury. Results: Relying on tract-based spatial statistics (TBSS) analyses, we found that radial diffusivity (RD) and mean diffusivity (MD) were significantly increased at 2 days post-injury compared to the same-subject baseline (corrected p < 0.02). These alterations were visible in anterior/posterior WM regions spanning both hemispheres, demonstrating a diffuse pattern of injury after concussion. Implicated WM fiber tracts at 2 days include the following: right superior/inferior longitudinal fasciculus; right/left inferior fronto-occipital fasciculus; right corticospinal tract; right acoustic radiation; right/left anterior thalamic radiations; right/left uncinate fasciculus; and forceps major/minor. At 2 weeks post-injury, persistently elevated RD and MD were observed solely in prefrontal portions of WM fiber tracts (using same-subject contrasts). No significant differences were found for FA in any of the post-injury comparisons to baseline. Plots of individual subject RD and MD in prefrontal WM demonstrated homogenous increases from baseline to just after SRC; thereafter, trajectories became more variable. Most subjects’ diffusivity values remained elevated at 2 months post-injury relative to their own baseline. Over the 2-month period after SRC, recovery of WM fiber tracts appeared to follow a posterior-to-anterior trend, paralleling the posterior–anterior pattern of WM maturation previously identified in the normal population. Conclusion: These results suggest greater vulnerability of prefrontal regions to SRC, underline the importance of an individualized approach to concussion management, and show promise for using RD and MD for imaging-based diagnosis of SRC.