Data_Sheet_1_Pathological Insights From Quantitative Susceptibility Mapping and Diffusion Tensor Imaging in Ice Hockey Players Pre and Post-concussion.DOCX

<p>Myelin sensitive MRI techniques, such as diffusion tensor imaging and myelin water imaging, have previously been used to reveal changes in myelin after sports-related concussions. What is not clear from these studies, however, is how myelin is affected: whether it becomes degraded and possibly removed, or whether the myelin sheath loosens and becomes “decompacted”. Previously, our team revealed myelin specific changes in ice hockey players 2 weeks post-concussion using myelin water imaging. In that study, 45 subjects underwent a pre-season baseline scan, 11 of which sustained a concussion during play and received follow-up scans: eight were scanned within 3 days, 10 were scanned at 14 days, and nine were scanned at 60 days. In the current retrospective analysis, we used quantitative susceptibility mapping, along with the diffusion tensor imaging measures axial diffusivity and radial diffusivity, to investigate this myelin disruption. If sports-related concussive hits lead to myelin fragmentation in regions of lowered MWF, this should result in a measurable increase in magnetic susceptibility, due to the anisotropic myelin fragmenting into isotropic myelin debris, and the diamagnetic myelin tissue being removed, while no such changes should be expected if the myelin sheath simply loosens and becomes decompacted. An increase in radial diffusivity would likewise reveal myelin fragmentation, as myelin sheaths block water diffusion out of the axon, with little to no changes expected for myelin sheath loosening. Statistical analysis of the same voxels-of-interest that were found to have reduced myelin water fraction 2 weeks post-concussion, revealed no statistically significant changes in magnetic susceptibility, axial diffusivity, or radial diffusivity at any time-point post-concussion. This suggests that myelin water fraction changes are likely due to a loosening of the myelin sheath structure, as opposed to fragmentation and removal of myelin debris.</p

Relative myelin water fraction change post-injury.

<p>Change scores for myelin water fraction, relative to baseline, plotted against time for each subject with a mild traumatic brain injury in all significant voxels A) across the whole brain; B) in the splenium of the corpus callosum (a structure most commonly affected in mild TBI). Dots represent data points for each injured athlete (mean ± standard error plotted in grey). Note: time zero refers to baseline.</p

Brain areas with significantly reduced myelin water fraction.

<p>Areas of significantly reduced myelin water fraction in athletes with concussion at two weeks post-injury, superimposed on a standard brain. These areas include the splenium of the corpus callosum, right posterior thalamic radiation, left superior corona radiata, left superior longitudinal fasciculus, and left posterior limb of the internal capsule.</p

Representative myelin water fraction maps.

<p>Myelin water fraction maps from a concussed athlete at baseline (left) and two weeks post-injury (right). Myelin water fraction is measured as the T2 signal from 0–40 ms divided by the total T2 signal. A region of the corpus callosum with a visible reduction in MWF post-injury is highlighted by the red arrow.</p

Demographic Characteristics for All Athletes.

<p>Demographic Characteristics for All Athletes.</p