Longitudinal alteration of cortical thickness and volume in high-impact sports
Brian D. Mills,
Maged Goubran,
Sherveen N. Parivash,
Emily L. Dennis,
Paymon Rezaii,
Carolyn Akers,
Wei Bian,
Lex A. Mitchell,
Brian Boldt,
David Douglas,
Sohrab Sami,
Nicole Mouchawar,
Eugene W. Wilson,
Phil DiGiacomo,
Mansi Parekh,
Huy Do,
Jaime Lopez,
Jarrett Rosenberg,
David Camarillo,
Gerald Grant,
Max Wintermark,
Michael Zeineh
Affiliations
Brian D. Mills
Department of Radiology, Stanford University, Stanford, CA, 94035, USA
Maged Goubran
Department of Radiology, Stanford University, Stanford, CA, 94035, USA; Department of Medical Biophysics, University of Toronto, Canada; Hurvitz Brain Sciences Program and Physical Sciences Platform, Sunnybrook Research Institute, University of Toronto, Canada
Sherveen N. Parivash
Department of Radiology, Stanford University, Stanford, CA, 94035, USA
Emily L. Dennis
Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
Paymon Rezaii
Department of Neurosurgery, Stanford University, Stanford, CA, 94035, USA
Carolyn Akers
Department of Radiology, Stanford University, Stanford, CA, 94035, USA
Wei Bian
Department of Radiology, Stanford University, Stanford, CA, 94035, USA
Lex A. Mitchell
Department of Radiology, Stanford University, Stanford, CA, 94035, USA
Brian Boldt
Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA; Department of Radiology, Madigan Army Medical Center, Tacoma, WA, 98431, USA
David Douglas
Department of Radiology, Stanford University, Stanford, CA, 94035, USA
Sohrab Sami
Stanford Center for Clinical Research, Stanford, CA, 94304, USA
Nicole Mouchawar
Department of Radiology, Stanford University, Stanford, CA, 94035, USA
Eugene W. Wilson
Department of Radiology, Stanford University, Stanford, CA, 94035, USA
Phil DiGiacomo
Department of Radiology, Stanford University, Stanford, CA, 94035, USA
Mansi Parekh
Department of Radiology, Stanford University, Stanford, CA, 94035, USA
Huy Do
Department of Radiology, Stanford University, Stanford, CA, 94035, USA
Jaime Lopez
Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, 94035, USA
Jarrett Rosenberg
Department of Radiology, Stanford University, Stanford, CA, 94035, USA
David Camarillo
Department of Bioengineering, Stanford University, Stanford, CA, 94035, USA
Gerald Grant
Department of Neurosurgery, Stanford University, Stanford, CA, 94035, USA
Max Wintermark
Department of Radiology, Stanford University, Stanford, CA, 94035, USA
Michael Zeineh
Department of Radiology, Stanford University, Stanford, CA, 94035, USA; Corresponding author. Lucas Center for Imaging, Rm. P271, 1201 Welch Road, Stanford, CA, USA.
Collegiate football athletes are subject to repeated head impacts. The purpose of this study was to determine whether this exposure can lead to changes in brain structure. This prospective cohort study was conducted with up to 4 years of follow-up on 63 football (high-impact) and 34 volleyball (control) male collegiate athletes with a total of 315 MRI scans (after exclusions: football n = 50, volleyball n = 24, total scans = 273) using high-resolution structural imaging. Volumetric and cortical thickness estimates were derived using FreeSurfer 5.3’s longitudinal pipeline. A linear mixed-effects model assessed the effect of group (football vs. volleyball), time from baseline MRI, and the interaction between group and time. We confirmed an expected developmental decrement in cortical thickness and volume in our cohort (p < .001). Superimposed on this, total cortical gray matter volume (p = .03) and cortical thickness within the left hemisphere (p = .04) showed a group by time interaction, indicating less age-related volume reduction and thinning in football compared to volleyball athletes. At the regional level, sport by time interactions on thickness and volume were identified in the left orbitofrontal (p = .001), superior temporal (p = .001), and postcentral regions (p < .001). Additional cortical thickness interactions were found in the left temporal pole (p = .003) and cuneus (p = .005). At the regional level, we also found main effects of sport in football athletes characterized by reduced volume in the right hippocampus (p = .003), right superior parietal cortical gray (p < .001) and white matter (p < .001), and increased volume of the left pallidum (p = .002). Within football, cortical thickness was higher with greater years of prior play (left hemisphere p = .013, right hemisphere p = .005), and any history of concussion was associated with less cortical thinning (left hemisphere p = .010, right hemisphere p = .011). Additionally, both position-associated concussion risk (p = .002) and SCAT scores (p = .023) were associated with less of the expected volume decrement of deep gray structures. This prospective longitudinal study comparing football and volleyball athletes shows divergent age-related trajectories of cortical thinning, possibly reflecting an impact-related alteration of normal cortical development. This warrants future research into the underlying mechanisms of impacts to the head on cortical maturation.
