title: A potential biomarker in sports-related concussion: brain functional connectivity alteration of the default-mode network measured with longitudinal resting-state fMRI over thirty days.
abstract: Current diagnosis and monitoring of sports-related concussion rely on clinical signs and symptoms, and balance, vestibular, and neuropsychological examinations. Conventional brain imaging often does not reveal abnormalities. We sought to assess if the longitudinal change of functional and structural connectivity of the default-mode network (DMN) can serve as a potential biomarker. Eight concussed Division I collegiate football student-athletes in season (one participated twice) and 11 control subjects participated in this study. ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) was administered over the course of recovery. High-resolution three dimensional T1-weighted, T2*-weighted diffusion-tensor images and resting-state functional magnetic resonance imaging (rs-fMRI) scans were collected from each subject within 24 h, 7±1 d and 30±1 d after concussion. Both network based and whole-brain based functional correlation analyses on DMN were performed. ImPACT findings demonstrated significant cognitive impairment across multiple categories and a significant increase of symptom severity on Day 1 following a concussion but full recovery by 6.0±2.4 d. While the structural connectivity within DMN and gross anatomy appeared unchanged, a significantly reduced functional connectivity within DMN from Day 1 to Day 7 was found in the concussed group in this small pilot study. This reduction was seen in eight of our nine concussion cases. Compared with the control group, there appears a general trend of increased DMN functional connectivity on Day 1, a significant drop on Day 7, and partial recovery on Day 30. The results of this pilot study suggest that the functional connectivity of DMN measured with longitudinal rs-fMRI can serve as a potential biomarker to monitor the dynamically changing brain function after sports-related concussion, even in patients who have shown clinical improvement.
authors.affiliation: 1 Department of Radiology, Michigan State University , East Lansing, Michigan.
authors.forename: David C
authors.initials: DC
authors.lastname: Zhu
authors.forename: Tracey
authors.initials: T
authors.lastname: Covassin
authors.forename: Sally
authors.initials: S
authors.lastname: Nogle
authors.forename: Scarlett
authors.initials: S
authors.lastname: Doyle
authors.forename: Doozie
authors.initials: D
authors.lastname: Russell
authors.forename: Randolph L
authors.initials: RL
authors.lastname: Pearson
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Monroe
authors.forename: Christine M
authors.initials: CM
authors.lastname: Liszewski
authors.forename: J Kevin
authors.initials: JK
authors.lastname: DeMarco
authors.forename: David I
authors.initials: DI
authors.lastname: Kaufman
mesh_terms: D001930:Brain Injuries / Q000175:diagnosis* / Q000503:physiopathology*; D038524:Diffusion Magnetic Resonance Imaging; D005538:Football / Q000293:injuries*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D009434:Neural Pathways / Q000503:physiopathology; D010865:Pilot Projects; D055815:Young Adult
keywords: default-mode network; diffusion-tensor imaging; mild traumatic brain injury; resting-state fMRI; sports-related concussion