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Citation
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Legarreta AD, Monk SH, Kirby PW, Brett BL, Yengo-Kahn AM, Bhatia A, Solomon GS, Zuckerman SL. World Neurosurg. 2018; 120: e365-e379. |
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Affiliation
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Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN USA. Electronic address: scott.zuckerman@vumc.org. |
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Abstract
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BACKGROUND: Lasting neuroimaging changes after participation in American football is a growing public health concern. The clinical relevance of the imaging findings to date remains unknown.
METHODS: A systematic review was performed with the following inclusion criteria: football players, brain imaging ≥2 years from prior concussion or retirement, and sample size ≥5. Studies were assessed for: 1) methodology (control selection, type I error, and recall bias), 2) imaging outcomes, and 3) number of significant statistical comparisons.
RESULTS: Sixteen studies (all cross-sectional studies) met inclusion criteria. Highest level of play included high school (1), college (3), and professional (12). Thirteen of the 16 studies made a total 456 comparisons of brain activity, of which 171 were statistically significant (38%). Nine of 16 studies (56%) had appropriate controls, and five of 16 studies (31%) appropriately accounted for type I error. To obtain player concussion history, all studies (16/16) had recall bias or unclear methodology. Imaging outcome measures included structural MRI (29.2%), diffusion tensor imaging (DTI) (25%), radioactive tracer uptake on PET (16.7%), patterns of connectivity on functional MRI (fMRI) (12.5%), transcranial magnetic stimulation (TMS) (8.3%), arterial spin labeling (ASL) MRI (4.2%), and metabolic changes on 1H-MR spectroscopy (4.2%).
CONCLUSIONS: Long-term neuroimaging findings in American football players are heterogeneous in both methodology and findings. Understanding the clinical importance of statistically significant findings is complicated by methodological limitations and study design. Further research is required to correlate imaging findings with clinical outcomes.
Copyright © 2018 Elsevier Inc. All rights reserved.
Language: en |