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MRI technique shows unique signatures of concussion in rugby players

*** Zie hieronder de Nederlandse versie (See the Dutch version below) Using MRI to study the brains of young female athletes has helped researchers develop an objective way to monitor a concussion injury. By using a technique that combines both structural and functional MRI information, Western University researchers were able to identify three unique signatures […]

 December 19, 2018

 December 19, 2018

*** Zie hieronder de Nederlandse versie (See the Dutch version below)

Using MRI to study the brains of young female athletes has helped researchers develop an objective way to monitor a concussion injury. By using a technique that combines both structural and functional MRI information, Western University researchers were able to identify three unique signatures – one that shows acute brain changes after an athlete has suffered a concussion, another that can identify persistent brain changes six months after the concussion, and a third that shows evidence of concussion history.

“Diagnosis of concussion is subjective right now,” said Ravi Menon, PhD, Professor at Western’s Schulich School of Medicine & Dentistry, and senior author on the study. “There is a long checklist that trained physicians can look at, and while it is pretty good at diagnosing the initial concussion, it is not sensitive to the longer-term brain changes and making decisions about when someone is okay to return to play.”

The study included 52 female athletes from the women’s varsity rugby team at Western during a regular season of play, including 21 who suffered a concussion. In collaboration with researchers from the Donders Institute in the Netherlands, the research team used a technique that combined multiple imaging measures to be able to look at structural and functional information at the same time. The result was a much more sensitive and complete picture of concussion injury.

“Typically imaging studies examine one metric at a time,” said Kathryn Manning, PhD, first author on the study who undertook this work while completing her PhD at Western. “By combining the imaging measures in this way, we were able to reliably monitor an individual athlete before and longitudinally after their concussion.”

“This study highlights the important contributions advanced imaging techniques can make in helping clinicians understand what happens biologically in the brain when players become concussed – and these improvements translate into better clinical decisions,” said Christian Beckmann, DPhil, Professor of Statistics in Imaging Neuroscience at the Donders Institute and the Radboud University Medical Centre Nijmegen in the Netherlands.

The authors point out that there is growing evidence of persistent changes in the brain that last well beyond clinical recovery and clearance to return to play. This study confirmed those findings showing clear brain changes in both structure and function that persisted six-months after injury. They also showed that these persistent brain changes related to concussion history, even in healthy athletes.

“We were able to show evidence of prior concussion history through this method,” said Menon who is also a scientist at Robarts Research Institute and the director of the Western Centre for Functional and Metabolic Mapping. “This component correlates directly with the number of previous concussions that an athlete has had. This hasn’t been shown before.”

Menon says the imaging studies were done on a 3T MRI which is the standard of care in most hospitals and clinics, making this method easily translatable clinically.

The study was funded by Schulich Medicine & Dentistry, Brain Canada, Western’s BrainsCAN, and NSERC.

MEDIA CONTACT: Crystal Mackay, Media Relations Officer, Schulich School of Medicine & Dentistry, Western University, t. 519.661.2111 ext. 80387, c. 519.933.5944, crystal.mackay@schulich.uwo.ca @CrystalMackay

ABOUT WESTERN
Western University delivers an academic experience second to none. Since 1878, The Western Experience has combined academic excellence with life-long opportunities for intellectual, social and cultural growth in order to better serve our communities. Our research excellence expands knowledge and drives discovery with real-world application. Western attracts individuals with a broad worldview, seeking to study, influence and lead in the international community.

ABOUT THE SCHULICH SCHOOL OF MEDICINE & DENTISTRY
The Schulich School of Medicine & Dentistry at Western University is one of Canada’s preeminent medical and dental schools. Established in 1881, it was one of the founding schools of Western University and is known for being the birthplace of family medicine in Canada. For more than 130 years, the School has demonstrated a commitment to academic excellence and a passion for scientific discovery.

**Version from Radboud University in Dutch:

MRI-scans onthullen typerend profiel van hersenschudding

Onderzoek van het Radboudumc en de Western University Canada onder ruim vijftig rugbyspeelsters toont een afwijkend patroon aan in de hersenen na een acute hersenschudding. De MRI-scans tonen zelfs na een half jaar nog een duidelijk verschil. Op basis van de scans is het ook mogelijk om een geschiedenis van eerder doorgemaakte hersenschuddingen vast te stellen, schrijven de onderzoekers in NeuroImage Clinical.

Hersenschudding komt regelmatig voor bij contactsporten zoals voetbal en rugby. Symptomen van een hersenschudding, zoals hoofdpijn, concentratie- en geheugenproblemen, duizeligheid, verwardheid en misselijkheid verdwijnen meestal weer snel. Het is moeilijk om vast te stellen of er na het herstel toch onderliggende, blijvende veranderingen in de hersenen zijn opgetreden. Hoogleraar Christian Beckmann en onderzoeker Alberto Llera, verbonden aan het Radboudumc en het Donders Center for Cognitive Neuroimaging, hebben daar met collega’s van de Western University in Canada nu onderzoek naar gedaan.

Rugbyspeelsters

Gedurende een seizoen volgden de onderzoekers ruim vijftig rugbyspeelsters van het universiteitsteam van Western University, waarvan eenentwintig speelsters een hersenschudding opliepen. Bij deze groep werden extra MRI-scans gemaakt drie dagen, drie maanden en zes maanden na de hersenschudding.

Beckmann: “Met diverse MRI-technieken brachten we de anatomische en functionele karakteristieken van de hersenen in kaart. Dat gaf niet alleen een heel gevoelig en compleet beeld van de hersenen op verschillende tijdstippen, maar we zagen ook kenmerkende patronen bij de speelsters met een hersenschudding.”

Blijvende veranderingen

Om die resultaten boven tafel te krijgen werd onder andere gekeken naar de zeer fijnmazige structuur van de witte stof en de functionele verbindingen tussen diverse hersengebieden. Alberto Llera: “Analyses maken dan niet alleen de acute reactie van de hersenen zichtbaar, maar we zien ook dat er blijvende veranderingen optreden na het klinische herstel. Op basis van dergelijke veranderingen kunnen we zelfs de geschiedenis van hersenschuddingen bij iemand in beeld brengen.”

Beter begrip

“Ons onderzoek onderstreept het belang van geavanceerde beeldvormende technieken om te begrijpen wat er in de hersenen allemaal gebeurt na een hersenschudding”, zegt Beckmann. “Dat levert waardevolle informatie op, die de arts kan gebruiken om zijn behandeling nog beter vorm te geven.”

Publicatie in NeuroImage: Clinical – Linked MRI signatures of the brain’s acute and persistent response to concussion in female varsity rugby players; Kathryn Y. Manning, Alberto Llera, Gregory A. Dekaban, Robert Bartha, Christy Barreira, Arthur Brown, Lisa Fischer, Tatiana Jevremovic, Kevin Blackney, Timothy J. Doherty, Douglas D. Fraser, Jeff Holmes, Christian F. Beckmann, Ravi S. Menon

Het Dondersinstituut heeft een samenwerkingsverband met Western University. In dat verband deed Kathryn Y. Manning (eerste auteur van deze publicatie) tijdelijk onderzoek bij de groep van Christian Beckmann. Deze publicatie is een resultaat van die samenwerking.

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