Associations Between Brain Metabolites Measured With MR Spectroscopy and Head Impacts in High School American Football Athletes.

IF 4.3 3区材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC ACS Applied Electronic Materials Pub Date : 2024-08-23 DOI:10.1002/jmri.29581

Zexuan Liu, Jonathan A Dudley, Jed A Diekfuss, Nadine Ahmed, Alex D Edmondson, Kim M Cecil, Weihong Yuan, Taylor M Zuleger, Alexis B Slutsky-Ganesh, Kim D Barber Foss, Gregory D Myer, Candace C Fleischer

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Abstract

Background: While changes in brain metabolites after injury have been reported, relationships between metabolite changes and head impacts are less characterized.

Purpose: To investigate alterations in neurochemistry in high school athletes as a function of head impacts, concussion, and the use of a jugular vein compression (JVC) collar.

Study type: Prospective controlled trial.

Subjects: A total of 284 male American football players, divided into JVC collar and noncollar groups; 215 included in final analysis (age = 15.9 ± 1.0 years; 114 in collar group).

Field strength/sequence: 3 Tesla/T₁-weighted gradient echo, ¹H point resolved spectroscopy, acquired between August and November 2018.

Assessment: Head impacts were quantified using accelerometers. Concussion was diagnosed by medical professionals for each team. Pre- to postseason differences in total N-acetylaspartate (tNAA), total choline (tCho), myo-inositol (myoI), and glutamate + glutamine (Glx), in primary motor cortex (M1) and anterior cingulate cortex (ACC), relative to total creatine (tCr), were determined.

Statistical tests: Group-wise comparisons were performed using Wilcoxon signed-rank, Friedman's, and Mann-Whitney U tests. Relationships between ∆metabolite/tCr and mean g-force were analyzed using linear regressions accounting for concussion and JVC collar. Significance was set at P ≤ 0.05.

Results: In participants without concussion, a significant decrease in tCho/tCr (0.233 ± 1.40 × 10^-3 to 0.227 ± 1.47 × 10^-7) and increase in Glx/tCr (1.60 ± 8.75 × 10^-3 to 1.63 ± 1.08 × 10^-2) in ACC were observed pre- to postseason. The relationship between ∆tCho/tCr in M1 and ACC and mean g-force from >80 g to >140 g differed significantly between participants with and without concussion (M1 β ranged from 3.9 × 10^-3 to 2.1 × 10^-3; ACC β ranged from 2.7 × 10^-3 to 2.1 × 10^-3). Posthoc analyses revealed increased tCho/tCr in M1 was positively associated with mean g-force >100 g (β = 3.6 × 10^-3) and >110 g (β = 2.9 × 10^-3) in participants with concussion. Significant associations between $∆ myoI / tCr$ in ACC and mean g-force >110 g (β = -1.1 × 10^-3) and >120 g (β = -1.1 × 10^-3) were observed in the collar group only.

Data conclusion: Diagnosed concussion and the use of a JVC collar result in distinct neurochemical trends after repeated head impacts.

Level of evidence: 2 TECHNICAL EFFICACY: Stage 3.

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用核磁共振光谱仪测量的脑代谢物与高中美式橄榄球运动员头部受到的撞击之间的关系。

背景：目的：研究高中运动员神经化学的改变与头部撞击、脑震荡和颈静脉压迫（JVC）项圈的使用之间的关系：研究类型：前瞻性对照试验：共 284 名男性美式足球运动员，分为 JVC 颈圈组和非颈圈组；最终分析包括 215 人（年龄 = 15.9 ± 1.0 岁；颈圈组 114 人）：3特斯拉/T1加权梯度回波，1H点分辨光谱，2018年8月至11月期间采集：使用加速度计对头部撞击进行量化。脑震荡由每支球队的专业医务人员诊断。确定初级运动皮层（M1）和前扣带回皮层（ACC）中相对于总肌酸（tCr）的总N-乙酰天冬氨酸（tNAA）、总胆碱（tCho）、肌醇（myo-inositol）和谷氨酸+谷氨酰胺（Glx）在赛季前和赛季后的差异：使用 Wilcoxon 符号秩检验、Friedman 检验和 Mann-Whitney U 检验进行组间比较。使用线性回归分析了 ∆metabolite/tCr 和平均 g 力之间的关系，并考虑了脑震荡和 JVC 颈圈。显著性设定为 P≤ 0.05：在没有脑震荡的参与者中，观察到 ACC 的 tCho/tCr 从赛季前到赛季后显著下降（0.233 ± 1.40 × 10-3 到 0.227 ± 1.47 × 10-7），Glx/tCr 从赛季前到赛季后显著上升（1.60 ± 8.75 × 10-3 到 1.63 ± 1.08 × 10-2）。M1和ACC的∆tCho/tCr与从>80 g到>140 g的平均g力之间的关系在有脑震荡和无脑震荡的参与者之间存在显著差异（M1 β从3.9 × 10-3到2.1 × 10-3；ACC β从2.7 × 10-3到2.1 × 10-3）。事后分析显示，在脑震荡参与者中，M1 的 tCho/tCr 增加与平均 g 力 >100 g（β = 3.6 × 10-3）和 >110 g（β = 2.9 × 10-3）呈正相关。仅在衣领组观察到ACC中的∆ myoI / tCr $$ \Delta \mathrm{myoI}/\mathrm{tCr} $$ 与平均g力>110 g (β = -1.1 × 10-3)和>120 g (β = -1.1 × 10-3)之间存在显著关联：证据等级：2 技术效果：第 3 阶段。

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