VANCOUVER -- An advanced form of ultrasound that maps blood flow in the brain could help clinicians diagnose concussions in athletes more easily, researchers suggested here.
Transcranial Doppler ultrasound studies were done on 66 high school athletes in contact sports who had been recently diagnosed with a concussion, and results were compared with a control group of 169 high school student athletes from both contact and non-contact sports.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
- An advanced form of ultrasound with transcranial Doppler that maps blood flow in the brain could help clinicians diagnose concussions in athletes more easily.
- Note that the imaging studies were able to differentiate between healthy and concussed athletes 83% of the time, although more research is needed.
The imaging studies were able to differentiate between healthy and concussed athletes 83% of the time, reported of Neural Analytics in Los Angeles, and colleagues.
In comparison, traditional transcranial ultrasound that measured cerebral blood flow was only about 60% accurate in diagnosing concussion, he reported in an emerging science presentation at the American Academy of Neurology annual meeting.
"There is growing evidence that concussions can change the blood flow in the brain," Hamilton said in a press statement. "While such changes may be detected with MRI, we believe there may be a less expensive and portable way to measure these changes with a transcranial Doppler device."
"A challenge with concussion assessment is the reliance upon subjective symptoms rather than objective measures based on physiological changes," he noted. "Quantifiable cerebral blood flow changes have been shown to occur following concussion and may enable objective diagnostics; however, these results are limited to advanced MRI techniques."
Transcranial Doppler uses ultrasound to map blood flow activity in the brain and, for this study, researchers used an advanced version of transcranial Doppler ultrasound to get a more complete picture of just how the blood moves through the middle cerebral artery, one of the three major arteries in the brain.
Examples of collision sports included in the study were football, soccer, basketball, hockey, water polo, and lacrosse. The non-contact sports were cheerleading, cross country, cycling, tennis, and track. Both the control and concussion groups were approximately 30% female.
Each of the concussed athletes had their brain blood flow measured with the advanced ultrasound headset within an average of 6 days after the injury. They were also given a general concussion evaluation and had their blood pressure checked.
"This research suggests that this advanced form of ultrasound may provide a more accurate diagnosis of concussion," Hamilton stated. "While more research is needed, the hope is such a tool could one day be used on the sidelines to help determine more quickly whether an athlete needs further testing."
More than 1 million athletes experience a concussion each year in the U.S., according to an AAN press release.
"This important work provides insight into a tool that may yet prove useful in the recognition and management of concussion," said of the Sports Neurology Clinic in Brighton, Mich., in a press statement "The potential of having an accessible technology that detects a physiological change following brain trauma is very exciting. However, what these detected blood flow changes mean to a patient's clinical care is still unclear."
And in a comment to 51˶, of the University of Florida College of Medicine in Gainesville, suggested that the modality was not ready for prime-time.
"This is a very sophisticated methodology," DeKosky concurred. "It shows some flow alterations that are highly likely related to the head trauma."
But he cautioned against labeling the presence of the abnormalities as a concussion.
"At this point, [the authors] have shown disturbed physiology that may eventually be reflective of the traumatic brain injury, but it is early days in this work and the significance of the changes, their correlation with clinical symptoms, duration, and other aspects, have yet to be demonstrated."
"These are very sophisticated procedures, so they may not be widely used for 'on the ground' determination of brain injury during games," he added. But "they do represent a unique way to assess effects of trauma in research and add another dimension in how to evaluate traumatic brain injury."
Disclosures
The study was supported by the NIH and the National Science Foundation.
Hamilton and co-authors disclosed relevant relationships with Neural Analytics.
Kutcher and DeKoskey disclosed no relevant relationships with industry.
Primary Source
American Academy of Neurology
Hamilton R, et al " Sports-related concussion diagnosis using advanced measures of cerebrovascular reactivity" AAN 2016; Abstract 006.