Abstract
Altered resting cerebral blood flow (CBF0) in the acute phase post-concussion may contribute to neurobehavioral deficiencies, often reported weeks after the injury. However, in addition to changes in CBF0, little is known about other physiological mechanisms that may be disturbed within the cerebrovasculature. The aim of this study was to assess whether changes in baseline perfusion following sport-related concussion (SRC) were co-localized with changes in cerebral metabolic demand. Forty-two subjects (15 SRC patients 8.0 ± 4.6 days post-injury and 27 age-matched healthy control athletes) were studied cross-sectionally. CBF0, cerebrovascular reactivity (CVR), resting oxygen extraction (OEF0) and cerebral metabolic rate of oxygen consumption (CMRO2|0) were measured using a combination of hypercapnic and hyperoxic breathing protocols, and the biophysical model developed in calibrated MRI. Blood oxygenation level dependent and perfusion data were acquired simultaneously using a dual-echo arterial spin labelling sequence. SRC patients showed significant decreases in CBF0 spread across the grey-matter (P < 0.05, corrected), and these differences were also confounded by the effects of baseline end-tidal CO2 (P < 0.0001). Lower perfusion was co-localized with reductions in regional CMRO2|0 (P = 0.006) post-SRC, despite finding no group-differences in OEF0 (P = 0.800). Higher CVR within voxels showing differences in CBF was also observed in the SRC group (P = 0.001), compared to controls. Reductions in metabolic demand despite no significant changes in OEF0 suggests that hypoperfusion post-SRC may reflect compromised metabolic function after the injury. These results provide novel insight about the possible pathophysiological mechanisms underlying concussion that may affect the clinical recovery of athletes after sport-related head injuries.
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Abbreviations
- [dHb]:
-
concentration of deoxy-hemoglobin
- ASL:
-
arterial spin labeling
- BOLD:
-
blood oxygen level dependent
- CBF:
-
cerebral blood flow
- CMRO2 :
-
cerebral metabolic rate of oxygen consumption
- CO2 :
-
carbon dioxide
- CVR:
-
cerebrovascular reactivity
- GM:
-
grey matter
- MNI:
-
montréal neurological institute
- MRI:
-
magnetic resonance imaging
- O2 :
-
oxygen
- OEF:
-
oxygen extraction fraction
- pCASL:
-
pseudo-continuous arterial spin labeling
- PETCO2 :
-
end-tidal pressure of carbon dioxide
- PETO2 :
-
end-tidal pressure of oxygen
- SRC:
-
sport-related concussion
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Acknowledgements
The authors of this paper would like to thank Mr. Don Brien and Mrs. Janet Mirtle-Stroman for their dedication and willingness to help with data collection. The authors would also like to thank Dr. J. J. Wang at UCLA for sharing the pCASL sequence used in this study, and Dr. Michael Germuska at Cardiff University for his insight and feedback regarding the methodology used in this manuscript.
Funding
This work was supported by the Canadian Institutes of Health Research (CIHR) and the Natural Sciences and Engineering Research Council (NSERC) through a Collaborative Health Research Project Grant (#315705).
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Champagne, A.A., Coverdale, N.S., Fernandez-Ruiz, J. et al. Compromised resting cerebral metabolism after sport-related concussion: A calibrated MRI study. Brain Imaging and Behavior 15, 133–146 (2021). https://doi.org/10.1007/s11682-019-00240-2
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DOI: https://doi.org/10.1007/s11682-019-00240-2