title: Increased diffusion in the brain of professional boxers: a preclinical sign of traumatic brain injury?
abstract: OBJECTIVE
  Professional boxing is associated with chronic, repetitive head blows that may cause brain injuries. Diffusion-weighted imaging is sensitive to microscopic changes and may be a useful tool to quantify the microstructural integrity of the brain. In this study, we sought to quantify microscopic alterations associated with chronic traumatic brain injury in professional boxers.
  
  
  METHODS
  MR and diffusion-weighted imaging were performed in 24 boxers and in 14 age- and sex-matched control subjects with no history of head trauma. Using distribution analysis, the average diffusion constant of the entire brain (BD(av)) and diffusion distribution width (sigma) were calculated for each subject; findings in professional boxers were compared with those of control subjects. In the boxer group, correlations between diffusion changes and boxing history and diffusion changes and MR imaging findings were assessed.
  
  
  RESULTS
  The measured diffusion values in the boxer group were significantly higher than those measured in the control group (BD(av), P <.0001; sigma, P <.01). In the boxer group, a robust correlation was found between increased BD(av) and frequency of hospitalization for boxing injuries (r = 0.654, P <.05). The most common MR finding in the boxer group was volume loss inappropriate to age followed by cavum septum pellucidum, subcortical white matter disease, and periventricular white matter disease.
  
  
  CONCLUSIONS
  Boxers had higher diffusion constants than those in control subjects. Our data suggest that microstructural damage of the brain associated with chronic traumatic brain injury may elevate whole-brain diffusion. This global elevation can exist even when routine MR findings are normal.
authors.affiliation: Department of Radiology, Weill Medical College of Cornell University, New York, NY 10021, USA.
authors.forename: Lijuan
authors.initials: L
authors.lastname: Zhang
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Ravdin
authors.forename: Norman
authors.initials: N
authors.lastname: Relkin
authors.forename: Robert D
authors.initials: RD
authors.lastname: Zimmerman
authors.forename: Barry
authors.initials: B
authors.lastname: Jordan
authors.forename: William E
authors.initials: WE
authors.lastname: Lathan
authors.forename: Aziz M
authors.initials: AM
authors.lastname: Uluğ
mesh_terms: D000328:Adult; D001265:Athletic Injuries / Q000175:diagnosis*; D001284:Atrophy; D001914:Boxing / Q000293:injuries*; D001921:Brain / Q000473:pathology; D020208:Brain Injury, Chronic / Q000175:diagnosis*; D038524:Diffusion Magnetic Resonance Imaging; D004292:Dominance, Cerebral / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012016:Reference Values