Amygdala Perfusion Is Associated with Persistent Affective Symptoms after Sports-Related Concussion
Sriramkumar Sridharan1, Christopher Sheridan2, Daniel Hudson3, Megan Lipford2, Kevin Bickart4, Corey Thibeault5, Christopher Giza6, Robert Hamilton5, Meeryo Choe4, Christopher Whitlow1
1Wake Forest School of Medicine, 2Department of Radiology, Wake Forest School of Medicine, 3Georgia Institute of Technology, 4UCLA, 5NovaSignal, 6UCLA, Depts of Pediatrics and Neurosurgery
Objective:
We evaluated PASL-based amygdala perfusion and symptom recovery after sports-related concussion (SRC).
Background:
Perfusion changes are well-documented in the pathophysiology of SRC. We have previously shown that rsfMRI-BOLD amygdala hyperconnectivity was associated with decreased acute symptoms, but increased chronic symptoms. We hypothesized that amygdala perfusion changes might correlate with symptoms after SRC and partly explain BOLD-connectivity findings.
Design/Methods:
We calculated PASL-based perfusion (mL/100g/min) at 3 timepoints after SRC (T1=1-4days, T2=10-14days, T3=2-3months) in collegiate athletes (N=31, female=14), as well as in-sport (ISC; N=29, female=15), and non-contact (NCC; N=35, female=14) controls. We assessed between- and within-group differences in four amygdala ROIs from the Brainnetome Atlas using ANOVA and Tukey’s HSD. Subject-level PASL values were correlated with SCAT-3 Graded Symptom Checklist (GSC) and Brief Symptom Inventory 18 (BSI-18) scores at each timepoint.
Results:
L medial and lateral amygdala (mAmy/lAmy) perfusion was elevated in SRC subjects compared to controls at T1, returning to control-level by T2 and T3. Among SRC subjects at T1, R lAmy perfusion positively correlated with BSI-18 depression subdomain; perfusion in all 4 amygdala ROIs positively correlated with BSI-18 anxiety subdomain and BSI-18 symptom total. Among ISC subjects at T1, R mAmy perfusion negatively correlated with GSC symptom total, GSC physical subdomain, and GSC cognitive subdomain; among NCC subjects, L mAmy perfusion negatively correlated with BSI-18 depression subdomain. Among SRC subjects at T2, L lAmy, L mAmy, and R lAmy perfusion positively correlated with BSI-18 depression subdomain, BSI-18 anxiety subdomain, and BSI-18 severity score. Among SRC subjects at T3, L lAmy perfusion positively correlated with all three BSI-18 subdomains and BSI-18 severity score.
Conclusions:
Increased amygdala perfusion after SRC positively correlated with affective symptoms; persistently elevated L lAmy perfusion was associated with increased chronic symptoms. Accounting for perfusion in analysis of BOLD-connectivity of the amygdala after SRC may improve prediction of affective symptom persistence.