Rubin TG, Catenaccio E, Fleysher R, Hunter LE, Lubin N,
Stewart WF, Kim M, Lipton RB, Lipton ML. MRI-defined White Matter
Microstructural Alteration Associated with Soccer Heading Is More Extensive in Women
than Men. Radiology. Rubin TG, Catenaccio E, Fleysher R, Hunter LE, Lubin N,
Stewart WF, Kim M, Lipton RB, Lipton ML. MRI-defined White Matter
Microstructural Alteration Associated with Soccer Heading Is More Extensive in Women
than Men. Radiology.
2018 Jul 31:180217. doi: 10.1148/radiol.2018180217. [Epub
ahead of print]
Abstract
Purpose To examine the role of sex in abnormal white matter
microstructure after soccer heading as identified by using the diffusion-tensor
imaging (DTI) metric fractional anisotropy (FA). Materials and Methods In this
prospective cross-sectional study, 98 individuals who were enrolled in a larger
prospective study of amateur soccer players (from 2013 to 2016) were matched
1:1 for age and history of soccer heading in the prior 12 months. Among the
subjects, 49 men (mean age, 25.7 years; range, 18-50 years) and 49 women (mean
age, 25.8 years; range, 18-50 years) with median total soccer headings per year
of 487 and 469, respectively, underwent 3.0-T DTI. Images were registered to
the Johns Hopkins University template. A voxelwise linear regression was fitted
for FA with terms for the number of headings during the previous 12 months and
its interaction with sex after controlling for the following potential
confounders: age, years of education, number of lifetime concussions, and
handedness. In the resulting statistical maps, P < .01 indicated a
statistically significant difference, with a threshold cluster size larger than
100 mm3. Results Among men, three regions were identified in which greater
heading exposure was associated with lower FA; eight such regions were
identified among women (>100 contiguous voxels, P < .01). In seven of the
eight regions identified in women, the association between heading and FA was
stronger in women than in men. There was no significant difference of heading
with FA between the sexes for any region in which heading was associated with
FA among men (P > .01, <100 contiguous voxels). Conclusion With similar
exposure to heading, women exhibit more widespread evidence of microstructural
white matter alteration than do men, suggesting preliminary support for a
biologic divergence of brain response to repetitive trauma.
------------------------------------------------------------------------------------------------------------
Female soccer players may be more likely to experience brain
damage from heading the ball than male athletes, a U.S. study suggests.
Researchers examined brain scans of 49 male and 49 female
amateur soccer players who reported a similar number of headings during the
previous year. Half of the men had at least 487 headings, while half of the
women had at least 469.
The scans were done with diffusion tensor imaging, a form of
MRI that detects subtle brain damage by measuring the direction of the
diffusion of water in white matter.
Scans showed that the volume of damaged white matter in
women was five times greater than it was for men, researchers reported July 31
online in Radiology.
Women had eight brain regions where greater levels of
heading were associated with structural damage, compared with only three
regions in men, the study also found.
"It has long been known that women fare worse, in
general, following concussion," said senior study author Dr. Michael
Lipton of Albert Einstein College of Medicine and Montefiore Medical Center in
New York City.
"However, some have considered this an artifact due to
women being more likely to report symptoms than men," Lipton said by
email.
The current study suggests that different outcomes from
brain injuries in women and men can't be explained by reporting because all of
the participants in the current study experienced similar numbers of headings,
Lipton noted.
"It shows the greater sensitivity of women at the level
of brain tissue," Lipton said.
Men and women in the study were similar in many ways. For
example, they started playing soccer around the same age and played for roughly
the same number of years, and they also played with similar frequency.
Beyond its small size, another limitation of the study is
the lack of data on whether or how brain injuries from headings might translate
into impairments in athletes' physical or mental abilities. Headings were also
self-reported by athletes, and researchers only examined brain scans at one
point in time.
"(We don't know) whether these changes are sustained or
if they change once an individual stops participating in soccer and is no
longer exposed to heading," said Tamara Valovich McLeod, director of
athletic training programs and a sports medicine specialist A.T. Still
University in Mesa, Arizona.
Brain injuries in soccer most often occur from head to head
contact when two players are attempting to head the ball, or when players'
heads come in contact with the ground or another athlete, McLeod, who wasn't
involved in the study, said by email.
"There is limited evidence suggesting that heading the
ball results in a concussion," McLeod noted. "However,
epidemiological studies comparing males and females do seem to suggest females
have a higher rate of concussions in a sport where the rules are similar
between the male and female game."
The exact reason for this isn't clear, but one theory is
that different neck strength in women and injury biomechanics resulting from
this difference may predispose women to have more concussions than men. It's
unclear whether there are other physiological differences between the sexes, McLeod
added.
"Most studies suggest men have more such collisions
than women, and thus it is confusing why women might have a greater risk of
injury," said Dr. Sara Chrisman, an injury prevention researcher at the
University of Washington and Seattle Children's Hospital who wasn't involved in
the study.
"Heading itself is a high risk event for concussion,
but not due to hitting the ball," Chrisman said by email. "At a high
level of play almost all headers are contested, and thus athletes are more
likely to collide with another player during a heading attempt, and little is
known about why women and men might have different risk for brain injury."
https://www.medscape.com/viewarticle/900065?src=WNL_recnl_180806_MSCPEDIT_neuro&uac=60196BR&impID=1705183&faf=1
2018 Jul 31:180217. doi: 10.1148/radiol.2018180217. [Epub
ahead of print]
Abstract
Purpose To examine the role of sex in abnormal white matter
microstructure after soccer heading as identified by using the diffusion-tensor
imaging (DTI) metric fractional anisotropy (FA). Materials and Methods In this
prospective cross-sectional study, 98 individuals who were enrolled in a larger
prospective study of amateur soccer players (from 2013 to 2016) were matched
1:1 for age and history of soccer heading in the prior 12 months. Among the
subjects, 49 men (mean age, 25.7 years; range, 18-50 years) and 49 women (mean
age, 25.8 years; range, 18-50 years) with median total soccer headings per year
of 487 and 469, respectively, underwent 3.0-T DTI. Images were registered to
the Johns Hopkins University template. A voxelwise linear regression was fitted
for FA with terms for the number of headings during the previous 12 months and
its interaction with sex after controlling for the following potential
confounders: age, years of education, number of lifetime concussions, and
handedness. In the resulting statistical maps, P < .01 indicated a
statistically significant difference, with a threshold cluster size larger than
100 mm3. Results Among men, three regions were identified in which greater
heading exposure was associated with lower FA; eight such regions were
identified among women (>100 contiguous voxels, P < .01). In seven of the
eight regions identified in women, the association between heading and FA was
stronger in women than in men. There was no significant difference of heading
with FA between the sexes for any region in which heading was associated with
FA among men (P > .01, <100 contiguous voxels). Conclusion With similar
exposure to heading, women exhibit more widespread evidence of microstructural
white matter alteration than do men, suggesting preliminary support for a
biologic divergence of brain response to repetitive trauma.
Female soccer players may be more likely to experience brain
damage from heading the ball than male athletes, a U.S. study suggests.
Researchers examined brain scans of 49 male and 49 female
amateur soccer players who reported a similar number of headings during the
previous year. Half of the men had at least 487 headings, while half of the
women had at least 469.
The scans were done with diffusion tensor imaging, a form of
MRI that detects subtle brain damage by measuring the direction of the
diffusion of water in white matter.
Scans showed that the volume of damaged white matter in
women was five times greater than it was for men, researchers reported July 31
online in Radiology.
Women had eight brain regions where greater levels of
heading were associated with structural damage, compared with only three
regions in men, the study also found.
"It has long been known that women fare worse, in
general, following concussion," said senior study author Dr. Michael
Lipton of Albert Einstein College of Medicine and Montefiore Medical Center in
New York City.
"However, some have considered this an artifact due to
women being more likely to report symptoms than men," Lipton said by
email.
The current study suggests that different outcomes from
brain injuries in women and men can't be explained by reporting because all of
the participants in the current study experienced similar numbers of headings,
Lipton noted.
"It shows the greater sensitivity of women at the level
of brain tissue," Lipton said.
Men and women in the study were similar in many ways. For
example, they started playing soccer around the same age and played for roughly
the same number of years, and they also played with similar frequency.
Beyond its small size, another limitation of the study is
the lack of data on whether or how brain injuries from headings might translate
into impairments in athletes' physical or mental abilities. Headings were also
self-reported by athletes, and researchers only examined brain scans at one
point in time.
"(We don't know) whether these changes are sustained or
if they change once an individual stops participating in soccer and is no
longer exposed to heading," said Tamara Valovich McLeod, director of
athletic training programs and a sports medicine specialist A.T. Still
University in Mesa, Arizona.
Brain injuries in soccer most often occur from head to head
contact when two players are attempting to head the ball, or when players'
heads come in contact with the ground or another athlete, McLeod, who wasn't
involved in the study, said by email.
"There is limited evidence suggesting that heading the
ball results in a concussion," McLeod noted. "However,
epidemiological studies comparing males and females do seem to suggest females
have a higher rate of concussions in a sport where the rules are similar
between the male and female game."
The exact reason for this isn't clear, but one theory is
that different neck strength in women and injury biomechanics resulting from
this difference may predispose women to have more concussions than men. It's
unclear whether there are other physiological differences between the sexes, McLeod
added.
"Most studies suggest men have more such collisions
than women, and thus it is confusing why women might have a greater risk of
injury," said Dr. Sara Chrisman, an injury prevention researcher at the
University of Washington and Seattle Children's Hospital who wasn't involved in
the study.
"Heading itself is a high risk event for concussion,
but not due to hitting the ball," Chrisman said by email. "At a high
level of play almost all headers are contested, and thus athletes are more
likely to collide with another player during a heading attempt, and little is
known about why women and men might have different risk for brain injury."
https://www.medscape.com/viewarticle/900065?src=WNL_recnl_180806_MSCPEDIT_neuro&uac=60196BR&impID=1705183&faf=1
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