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J Neurotrauma. 2019 Oct 15;36(20):2831-2849. doi: 10.1089/neu.2019.6398. Epub 2019 Jun 27.

Diffusion Tensor Imaging in Athletes Sustaining Repetitive Head Impacts: A Systematic Review of Prospective Studies.

Author information

1
The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
2
Department of Medical Education, Riverside Methodist Hospital, Columbus, Ohio.
3
Duke University School of Medicine, Durham, North Carolina.
4
Department of Emergency Medicine, University of Rochester School of Medicine, Rochester, New York.
5
Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
6
Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
7
College of Medicine, University of Cincinnati, Cincinnati, Ohio.
8
Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
9
Harvard Medical School, Boston, Massachusetts.
10
School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana.
11
Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana.
12
Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio.
13
The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts.

Abstract

Competitive sport participation, in contact and collision sports, exposes athletes to repetitive head impacts. Although these impacts do not always result in overt symptomology or a diagnosed "concussion," evidence indicates that cumulative repetitive impacts affect brain pathophysiology. The purpose of this study was to perform a systematic review of prospective, longitudinal trials evaluating repetitive head impact exposure on white matter (WM) microstructure in collision and contact sport athletes to inform clinical care and treatment strategies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to determine studies that met predetermined inclusion and exclusion criteria. Initially, 2498 abstracts were identified, and 20 studies were critically evaluated herein. The majority of studies demonstrated significant longitudinal changes in anisotropy and/or diffusivity metrics that were associated with the quantity and/or the magnitude of head impact exposure, highlighting the utility of diffusion tensor imaging (DTI) for measuring changes in WM microstructure. Our review also comments on study methodology and describes how age, sex, sport, and time between sport cessation and DTI measures contribute to divergent findings within the literature. Suggestions for future research are also provided to overcome previous study limitations and maximize our understanding of the role of repetitive head impact exposure on WM integrity and long-term neurological sequela.

KEYWORDS:

DTI; athletes; repetitive subconcussive impacts

PMID:
31062655
DOI:
10.1089/neu.2019.6398

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