Longitudinal Alterations of Cerebral Blood Flow in High-Contact Sports
Mahta Karimpoor PhD
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorMarios Georgiadis PhD
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorMoss Y. Zhao PhD
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorMaged Goubran PhD
Department of Medical Biophysics, University of Toronto, Toronto, Canada
Physical Sciences Platform & Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
Search for more papers by this authorHossein Moein Taghavi BA
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorBrian D. Mills PhD
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorDean Tran
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorNicole Mouchawar BS
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorSohrab Sami MA
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorMax Wintermark MD
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorGerald Grant MD, FACS
Department of Neurosurgery, Stanford University, Stanford, CA
Search for more papers by this authorDavid B. Camarillo PhD
Department of Bioengineering, Stanford University, Stanford, CA
Search for more papers by this authorMichael E. Moseley PhD
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorGreg Zaharchuk MD, PhD
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorCorresponding Author
Michael M. Zeineh MD, PhD
Department of Radiology, Stanford University, Stanford, CA
Address correspondence to Dr Zeineh, Department of Radiology, Stanford University, Stanford, CA, 94035. E-mail: [email protected]
Search for more papers by this authorMahta Karimpoor PhD
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorMarios Georgiadis PhD
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorMoss Y. Zhao PhD
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorMaged Goubran PhD
Department of Medical Biophysics, University of Toronto, Toronto, Canada
Physical Sciences Platform & Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
Search for more papers by this authorHossein Moein Taghavi BA
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorBrian D. Mills PhD
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorDean Tran
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorNicole Mouchawar BS
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorSohrab Sami MA
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorMax Wintermark MD
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorGerald Grant MD, FACS
Department of Neurosurgery, Stanford University, Stanford, CA
Search for more papers by this authorDavid B. Camarillo PhD
Department of Bioengineering, Stanford University, Stanford, CA
Search for more papers by this authorMichael E. Moseley PhD
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorGreg Zaharchuk MD, PhD
Department of Radiology, Stanford University, Stanford, CA
Search for more papers by this authorCorresponding Author
Michael M. Zeineh MD, PhD
Department of Radiology, Stanford University, Stanford, CA
Address correspondence to Dr Zeineh, Department of Radiology, Stanford University, Stanford, CA, 94035. E-mail: [email protected]
Search for more papers by this authorAbstract
Objective
Repetitive head trauma is common in high-contact sports. Cerebral blood flow (CBF) can measure changes in brain perfusion that could indicate injury. Longitudinal studies with a control group are necessary to account for interindividual and developmental effects. We investigated whether exposure to head impacts causes longitudinal CBF changes.
Methods
We prospectively studied 63 American football (high-contact cohort) and 34 volleyball (low-contact controls) male collegiate athletes, tracking CBF using 3D pseudocontinuous arterial spin labeling magnetic resonance imaging for up to 4 years. Regional relative CBF (rCBF, normalized to cerebellar CBF) was computed after co-registering to T1-weighted images. A linear mixed effects model assessed the relationship of rCBF to sport, time, and their interaction. Within football players, we modeled rCBF against position-based head impact risk and baseline Standardized Concussion Assessment Tool score. Additionally, we evaluated early (1–5 days) and delayed (3–6 months) post-concussion rCBF changes (in-study concussion).
Results
Supratentorial gray matter rCBF declined in football compared with volleyball (sport-time interaction p = 0.012), with a strong effect in the parietal lobe (p = 0.002). Football players with higher position-based impact-risk had lower occipital rCBF over time (interaction p = 0.005), whereas players with lower baseline Standardized Concussion Assessment Tool score (worse performance) had relatively decreased rCBF in the cingulate-insula over time (interaction effect p = 0.007). Both cohorts showed a left–right rCBF asymmetry that decreased over time. Football players with an in-study concussion showed an early increase in occipital lobe rCBF (p = 0.0166).
Interpretation
These results suggest head impacts may result in an early increase in rCBF, but cumulatively a long-term decrease in rCBF. ANN NEUROL 2023;94:457–469
Potential Conflicts of Interest
Dr Zeineh receives research funding from General Electric Healthcare.
Open Research
Data Availability Statement
All data associated with this study are available in the main text or the supplementary materials. All the imaging data can be shared upon request with a proposal and under a data transfer agreement.
Supporting Information
| Filename | Description |
|---|---|
| ana26718-sup-0001-supinfo.docxWord 2007 document , 21.9 KB | Data S1. Supporting Information. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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