Diffusion Imaging Reveals Sex Differences in the White Matter Following Sports-Related Concussion

Sports-related concussion (SRC) is a serious health concern. However, the temporal profile of neuropathophysiological changes after SRC and how these relate to biological sex are still poorly understood. This preliminary study investigated whether diffusion-weighted magnetic resonance imaging (dMRI) was sensitive to neuropathophysiological changes following SRC; whether these changes were sex-specific; and whether they persisted beyond the resolution of self-reported symptoms. Recently concussed athletes (n=14), and age- and education-matched nonconcussed control athletes (n=16), underwent MRI 24-48-h postinjury and again at 2-week postinjury (i.e., when cleared to return-to-play). Male athletes reported more symptoms and greater symptom severity compared with females. dMRI revealed white matter differences between athletes with SRC and their nonconcussed counterparts at 48-h postinjury. These differences were still present at 2-week postinjury, despite SRC athletes being cleared to return to play and may indicate increased cerebral vulnerability beyond the resolution of subjective symptoms. Furthermore, we identified sex-specific differences, with male SRC athletes having significantly greater white matter disruption compared with female SRC athletes. These results have important implications for the management of concussion, including guiding return-to-play decisions, and further improve our understanding regarding the role of sex in SRC outcomes.

Automated summary

The preliminary study showed that male athletes with SRC reported more severe symptoms compared to female athletes. dMRI revealed white matter differences between SRC athletes and non-concussed athletes at 48 hours post-injury, which persisted at 2 weeks post-injury. Furthermore, male SRC athletes exhibited significantly greater white matter disruption than female SRC athletes. These findings have implications for concussion management, including return-to-play decisions, and enhance our understanding of the role of sex in SRC outcomes.