Is diffusion anisotropy an accurate monitor of myelination?: Correlation of multicomponent T2 relaxation and diffusion tensor anisotropy in human brain

We compare T2-relaxation and diffusion tensor data from normal human brain. The relationships between myelin-water fraction (MWF) and various diffusion tensor measures [e.g., fractional anisotropy (FA), perpendicular diffusivity (ADC perpendicular) and mean diffusivity ] in white matter (WM) and gray matter (GM) structures in the brain were examined in 16 normal volunteers at 1.5 T and 6 normal subjects at 3.0 T and mean diffusivity. We found some degree of linear correlation between these measurements, but by using region of interest (ROI)-based analysis, we also observed several structures which seemed to deviate significantly from a linear relationship. From all investigated relationships between various diffusion tensor measures and myelin-water content, FA and ADC perpendicular yielded the highest correlation coefficients with MWF. However, diffusion anisotropy was also significantly influenced by factors other than myelin-water content. The less operator-dependent voxel-based analysis (VBA) between myelin-water and diffusional anisotropy measures is proposed as an innovative alternative to ROI-based analysis. We confirmed that WM structures, in general, have higher diffusional anisotropy than GM structures and also have higher myelin-water content. However, our findings suggest that in the highly organized fibre arrangement of compact WM structures such as the genu of the corpus callosum, elevated degrees of diffusional anisotropies are measured, which do not necessarily correspond to an elevated myelin content but more likely reflect the highly organized directionality of fibre bundles in these areas (low microscopic and macroscopic tortuosity) as well as strongly restricted diffusion in the interstitial space between the myelinated axons. Conversely, in structures with disorganized fibre bundles and multiple fibre crossings, such as the minor and major forceps, low FA values were measured, which does not necessarily reflect a decrease myelin-water content.     

Diffusion abnormality in the posterior cingulum and hippocampal volume: correlation with disease progression in Alzheimer's disease

The purpose of this study was to determine correlations among disease progression, diffusion abnormalities in the posterior cingulum and hippocampal volume in patients with Alzheimer's disease (AD). We studied 25 AD patients by neuropsychological testing, including the Mini-Mental State Examination (MMSE), and by magnetic resonance imaging, including diffusion tensor imaging (DTI) and high-resolution three-dimensional T1-weighted imaging. The MMSE score was used as an indicator of disease progression. Diffusion tensor tractography of the posterior cingulum was generated from the DTI; mean diffusivity (MD) and fractional anisotropy (FA) were measured in co-registered voxels along the posterior cingulum. Hippocampal volume was measured using automated voxel-based morphometry. The relationships among MMSE score, hippocampal volume and MD and FA of the posterior cingulum were evaluated by bivariate correlation analysis. MD in the posterior cingulum correlated significantly with the MMSE score. No significant correlation was seen between FA and MMSE score and between hippocampal volume and MMSE score, FA or MD. Our results suggest that MD in the posterior cingulum is a more sensitive indicator of progression of AD than FA of the posterior cingulum and hippocampal volume.     

Water diffusion features as indicators of muscle structure ex vivo

The structures of two different bovine muscles, the Semitendinosus (ST) and the Triceps brachii (TB), were studied using quantitative maps obtained by diffusion tensor imaging at 4.7 T. The estimated features were: mean diffusivity, intra- and inter-voxel anisotropy and fiber tract orientation angles. Significant differences in anisotropy (fractional anisotropy and lattice index), spatial variations of anisotropy and fiber tract orientation were detected between ST and TB, and are discussed. Accumulation of free water, which diffuses more freely and isotropically than in the rest of the muscle, was detected and localized in ST. These results underline the usefulness of diffusion tensor measurements to characterize muscle structure and help understand the mechanisms of post mortem water exudation.     

Diffusion properties of cortical and pericortical tissue: regional variations, reliability and methodological issues

Characterizing the diffusion properties of cortical tissue is complicated by intersubject variability in the relative locations of gyri and sulci. Here we extend methods of measuring the average diffusion properties of gyral and sulcal structures after they have been aligned to a common template of cortical surface anatomy. Diffusion tensor image (DTI) data were gathered from 82 young subjects and co-registered with high-resolution T1 images that had been inflated and co-registered to a hemispherically unified spherical coordinate system based on FreeSurfer. We analyzed fractional anisotropy (FA), mean diffusivity (MD) and the novel quantity of cortical primary diffusion direction (cPDD) at five surfaces parallel to the white/gray junction, spanning approximately 5 mm from the pial surface into white matter. FA increased with increasing depth, whereas MD and cPDD were reduced. There were highly significant and reliable regional differences in FA, MD and cPDD as well as systematic differences between cortical lobes and between the two hemispheres. The influence of nearby cortical spinal fluid (CSF), local cortical curvature and thickness, and sulcal depth was also investigated. We found that FA correlated significantly with cortical curvature and sulcal depth, while MD was strongly influenced by nearby CSF. The measurement of FA, MD and cPDD near the cortical surface clarifies the organization of fiber projections to and from the cortex.     

Validation of the anisotropy index ellipsoidal area ratio in diffusion tensor imaging

A new diffusion anisotropy index, ellipsoidal area ratio (EAR), was described recently and proved to be less noise-sensitive than fractional anisotropy (FA) by theory and simulation. Here we show that EAR has higher signal-to-noise ratios than FA in average diffusion tensor imaging data from 40 normal subjects. EAR was also more sensitive than FA in detecting white matter abnormalities in a patient with widespread diffuse axonal injury. Monte Carlo simulation showed that EAR's mean values are more biased by noise than FA when anisotropy is small, both for single fiber tracts and when fiber tracts cross. However, the improved signal-to-noise ratio of EAR relative to FA suggests that EAR may be a superior measure of anisotropy both in quantifying both deep white matter with relatively uniform fiber tracts and pericortical white matter structure with relatively low anisotropy and fiber crossings.     

The effect of gradient sampling schemes on diffusion metrics derived from probabilistic analysis and tract-based spatial statistics

Purpose

The purpose was to systematically evaluate the effect of diffusion gradient encoding scheme on estimated fractional anisotropy (FA), mean diffusivity (MD) and the voxel-wise probability of identifying crossing fibers in the brain.

Materials and Methods

Eight healthy volunteers (mean age 26.5±1.3 years, 5 males, 3 females) were imaged using a Spin-Echo Echo-Planar-Imaging sequence acquired with two signal averages [number of signals averaged (NSA)], 127 diffusion directions, and b-values of 750 s/mm² and 1500 s/mm². The number of diffusion gradient directions (N_d) was reduced from the original value whilst maintaining a homogeneous gradient distribution enabling direct comparison of subsampled data sets with N_d=15, 28, 43, 84, 112 and 127. FA and MD maps were generated and analyzed using tract-based spatial statistics. Effect of N_d on estimated FA and MD was tested with voxel-wise statistics in 13 regions of interest. The number of voxels supporting two fiber populations (NV²) at different N_d values was estimated using Bayesian estimation of diffusion parameters.

Results

Low FA values decreased significantly with increasing N_d and with increasing NSA. MD was only marginally sensitive to N_d and NSA. NV₂ increased significantly with N_d but not with NSA. Thus, we conclude that accurate estimation of standard diffusion metrics FA and MD is mainly dependent on the signal-to-noise ratio (SNR), whereas the ability to differentiate multiple fiber populations requires a high diffusion sampling density.     

How does distortion correction correlate with anisotropic indices? A diffusion tensor imaging study

PURPOSE: The purpose of this study was to determine a suitable registration algorithm for diffusion tensor imaging (DTI) using conventional preprocessing tools [statistical parametric mapping (SPM) and automated image registration (AIR)] and to investigate how anisotropic indices for clinical assessments are affected by these distortion corrections. MATERIALS AND METHODS: Brain DTI data from 15 normal healthy volunteers were used to evaluate four spatial registration schemes within subjects to correct image distortions: noncorrection, SPM-based affine registration, AIR-based affine registration and AIR-based nonlinear polynomial warping. The performance of each distortion correction was assessed using: (a) quantitative parameters: tensor-fitting error (Ef), mean dispersion index (MDI), mean fractional anisotropy (MFA) and mean variance (MV) within 11 regions of interest (ROI) defined from homogeneous fiber bundles; and (b) fiber tractography through the uncinate fasciculus and the corpus callosum. Fractional anisotropy (FA) and mean diffusivity (MD) were calculated to demonstrate the effects of distortion correction. Repeated-measures analysis of variance was used to investigate differences among the four registration paradigms. RESULTS: AIR-based nonlinear registration showed the best performance for reducing image distortions with respect to smaller Ef (P<.02), MDI (P<.01) and MV (P<.01) with larger MFA (P<.01). FA was decreased to correct distortions (P<.0001) whether the applied registration was linear or nonlinear and was lowest after nonlinear correction (P<.001). No significant differences were found in MD. CONCLUSION: In conventional DTI processing, anisotropic indices of FA can be misestimated by noncorrection or inappropriate distortion correction, which leads to an erroneous increase in FA. AIR-based nonlinear distortion correction would be required for a more accurate measurement of this diffusion parameter.     

Influence of steady background gradients on the accuracy of molecular diffusion anisotropy measurements

Spatial susceptibility variations of body components lead to local gradients of the static magnetic field. Effects of such background gradients on fractional diffusion anisotropy (FA) measurements on whole-body magnetic resonance units operating at 1.5, 3.0 and 7.0 T were analyzed theoretically and experimentally. Analytical expressions were derived for the cases of diffusion occurring in isotropic media and in tissues with cylindrical symmetry (e.g., white matter tracts or skeletal musculature). Typical magnitudes of background gradient strengths were estimated from in vivo and in vitro measurements with B0 field mapping sequences. Additionally, numerical simulations of magnetic field distributions and resulting field gradients were performed considering tissue-air interfaces in simplified geometrical arrangements. For media with isotropic diffusion, both measurements and analytical calculations showed increasing FA inaccuracy with stronger coupling between diffusion-encoding and background gradients. For cylindrical symmetry, FA values were estimated for a standard diffusion tensor imaging protocol in a realistic scenario. At 1 mm distance from a water-air interface, susceptibility-related background gradients amount to approximately 9 mT/m at 7 T and lead to a relative error of the measured FA of up to 48%. The error in the anisotropy assessment rises considerably with increasing field strength and must be taken into account especially for experimental and clinical studies on modern high-field systems.     

Manifestation and post hoc correction of gradient cross-term artifacts in DTI

Cross-terms between imaging and diffusion gradients, unaccounted for during tensor calculations, can lead to erroneous estimation of diffusivity and fractional anisotropy (FA) in regions of isotropic and anisotropic diffusion. Cross-term of magnitude 136.8±1.6 s/mm(2), artificially introduced in the slice-encode direction, caused an increase in FA in isotropic phantom from 0.0546±0.0001 to 0.0996±0.0001, while the change in chimpanzee brain depended on the orientation of the white matter (WM). Mean diffusivity (MD) remained unchanged in isotropic phantom, but increased by ～20% in the WM due to cross-terms. A bias was observed in the principal eigenvectors in both phantom and chimpanzee brain, resulting in significant increase in midline crossing fibers along the bias than perpendicular to it in tractography in chimpanzee brain. Post hoc correction of these artifacts was achieved by estimating the cross-term factors using calibration scans on an isotropic phantom and modifying the b-matrix before tensor calculation. Upon correction, the FA and MD values closely resembled the values obtained from sequence without cross-terms, and the bias in principal eigenvectors was eliminated. Customized sequences involving large b-values, high-resolution imaging, or long diffusion or echo times should therefore be evaluated and any residual cross-terms corrected before implementation.     

Diffusion anisotropy in excised normal rat spinal cord measured by NMR microscopy

A conventional spin-echo NMR imaging pulse sequence was used to obtain high-resolution images of excised normal rat spinal cord at 7 and 14 T. It was observed that the large pulsed-field gradients necessary for high-resolution imaging caused a diffusion weighting that dominated the image contrast and that could be used to infer microscopic structural organization beyond that defined by the resolution of the image matrix (i.e., fiber orientation could be assigned based on diffusion anisotropy). Anisotropic diffusion coefficients were therefore measured using apparent diffusion tensor (ADT) imaging to assess more accurately fiber orientations in the spinal cord; structural anisotropy information is portrayed in the six unique images of the complete ADT. To reduce the dimensionality of the data, a trace image was generated using a separate color scale for each of the three diagonal element images of the ADT. This new image retains much of the invariance of the trace to the relative orientations of laboratory and sample axes (inherent to a greyscale trace image) but provides, by the use of color, contrast reflecting diffusion anisotropy. The colored trace image yields a pseudo-three-dimensional view of the rat spinal cord, from which it is possible to deduce fiber orientations.     

Rapid microscopic fractional anisotropy imaging via an optimized linear regression formulation

Water diffusion anisotropy in the human brain is affected by disease, trauma, and development. Microscopic fractional anisotropy (μFA) is a diffusion MRI (dMRI) metric that can quantify water diffusion anisotropy independent of neuron fiber orientation dispersion. However, there are several different techniques to estimate μFA and few have demonstrated full brain imaging capabilities within clinically viable scan times and resolutions. Here, we present an optimized spherical tensor encoding (STE) technique to acquire μFA directly from the 2nd order cumulant expansion of the powder averaged dMRI signal obtained from direct linear regression (i.e. diffusion kurtosis) which requires fewer powder-averaged signals than other STE fitting techniques and can be rapidly computed. We found that the optimal dMRI parameters for white matter μFA imaging were a maximum b-value of 2000 s/mm² and a ratio of STE to LTE tensor encoded acquisitions of 1.7 for our system specifications. We then compared two implementations of the direct regression approach to the well-established gamma model in 4 healthy volunteers on a 3 Tesla system. One implementation used mean diffusivity (D) obtained from a 2nd order fit of the cumulant expansion, while the other used a linear estimation of D from the low b-values. Both implementations of the direct regression approach showed strong linear correlations with the gamma model (ρ = 0.97 and ρ = 0.90) but mean biases of −0.11 and − 0.02 relative to the gamma model were also observed, respectively. All three μFA measurements showed good test-retest reliability (ρ ≥ 0.79 and bias = 0). To demonstrate the potential scan time advantage of the direct approach, 2 mm isotropic resolution μFA was demonstrated over a 10 cm slab using a subsampled data set with fewer powder-averaged signals that would correspond to a 3.3-min scan. Accordingly, our results introduce an optimization procedure that has enabled nearly full brain μFA in only several minutes.     

In vivo structural analysis of articular cartilage using diffusion tensor magnetic resonance imaging

Purpose

The articular cartilage is a small tissue with a matrix structure of three layers between which the orientation of collagen fiber differs. A diffusion-weighted twice-refocused spin-echo echo-planar imaging (SE-EPI) sequence was optimized for the articular cartilage, and the structure of the three layers of human articular cartilage was imaged in vivo from diffusion tensor images.

Materials and Methods

The subjects imaged were five specimens of swine femur head after removal of the flesh around the knee joint, five specimens of swine articular cartilage with flesh present and the knee cartilage of five adult male volunteers. Based on diffusion-weighted images in six directions, the mean diffusivity (MD) and the fractional anisotropy (FA) values were calculated.

Results

Diffusion tensor images of the articular cartilage were obtained by sequence optimization. The MD and FA value of the specimens (each of five examples) under different conditions were estimated. Although the articular cartilage is a small tissue, the matrix structure of each layer in the articular cartilage was obtained by SE-EPI sequence with GRAPPA. The MD and FA values of swine articular cartilage are different between the synovial fluid and saline. In human articular cartilage, the load of the body weight on the knee had an effect on the FA value of the surface layer of the articular cartilage.

Conclusion

This method can be used to create images of the articular cartilage structure, not only in vitro but also in vivo. Therefore, it is suggested that this method should support the elucidation of the in vivo structure and function of the knee joint and might be applied to clinical practice.     

Measurement of the principal values of the anisotropic diffusion tensor in an unoriented sample by exploiting the chemical shift anisotropy: (19)F PGSE NMR with homonuclear decoupling

NMR methods (S. V. Dvinskikh et al., J. Magn. Reson. 142, 102-110 (2000) and S. V. Dvinskikh and I. Furó, J. Magn. Reson. 144, 142-149 (2000)) that combine PGSE with dipolar decoupling are extended to polycrystalline solids and unoriented liquid crystals. Decoupling suppresses dipolar dephasing not only during the gradient pulses but also under signal acquisition so that the detected spectral shape is dominated by the chemical shift tensor of the selected nucleus. The decay of the spectral intensity at different positions in the powder spectrum provides the diffusion coefficient in sample regions with their crystal axes oriented differently with respect to the direction of the field gradient. Hence, one can obtain the principal values of the diffusion tensor. The method is demonstrated by (19)F PGSE NMR with homonuclear decoupling in a lyotropic lamellar liquid crystal.     

Role of diffusion tensor imaging metrics and in vivo proton magnetic resonance spectroscopy in the differential diagnosis of cystic intracranial mass lesions

The purpose of this study was to determine whether proton magnetic resonance spectroscopy (PMRS) and diffusion tensor imaging (DTI) indices, fractional anisotropy (FA) and mean diffusivity (MD) can be used to distinguish brain abscess from cystic brain tumors, which are difficult to distinguish by conventional magnetic resonance imaging (MRI). Fifty-three patients with intracranial cystic mass lesions and 10 normal controls were studied. Conventional MRI, PMRS and DTI of all the patients were performed on a 1.5-T GE scanner. Forty patients were with brain abscess and 13 with cystic tumors. Cytosolic amino acids (AAs) were present in 32 of 40 brain abscess patients. Out of 13 patients with cystic tumors, lactate and choline were seen in 3 and only lactate was present in 10 patients on PMRS. All 40 cases of abscess had high FA, while all 13 cases of tumor cysts had high MD values. We conclude that FA measurements are more sensitive in predicting the abscess, while PMRS and MD are more specific in differentiating abscess from cystic tumors. We suggest that PMRS should be combined with DTI rather than with diffusion-weighted imaging as FA can be used as an additional parameter for separation of abscess from other cystic intracranial mass lesions.     

Diffusional kurtosis imaging of cingulate fibers in Parkinson disease: Comparison with conventional diffusion tensor imaging

Objective

The pathological changes in Parkinson disease begin in the brainstem; reach the limbic system and ultimately spread to the cerebral cortex. In Parkinson disease (PD) patients, we evaluated the alteration of cingulate fibers, which comprise part of the limbic system, by using diffusional kurtosis imaging (DKI).

Methods

Seventeen patients with PD and 15 age-matched healthy controls underwent DKI with a 3-T MR imager. Diffusion tensor tractography images of the anterior and posterior cingulum were generated. The mean kurtosis (MK) and conventional diffusion tensor parameters measured along the images in the anterior and posterior cingulum were compared between the groups. Receiver operating characteristic (ROC) analysis was also performed to compare the diagnostic abilities of the MK and conventional diffusion tensor parameters.

Results

The MK and fractional anisotropy (FA) in the anterior cingulum were significantly lower in PD patients than in healthy controls. The area under the ROC curve was 0.912 for MK and 0.747 for FA in the anterior cingulum. MK in the anterior cingulum had the best diagnostic performance (mean cutoff, 0.967; sensitivity, 0.87; specificity, 0.94).

Conclusions

DKI can detect alterations of the anterior cingulum in PD patients more sensitively than can conventional diffusion tensor imaging. Use of DKI can be expected to improve the ability to diagnose PD.     

Inversion of self-diffusion anisotropy by chemical substitution in smectic A liquid crystals as evidenced by PGSE experiment combined with a quadrupole-coil rotation

A technique of pulsed-field-gradient spin-echo (PGSE) NMR combined with a quadrupole-coil rotation was applied to the study of anisotropic self-diffusion in smectic A liquid crystals. Diffusion anisotropy was found to be inverted by chemical substitution of the terminal groups in homologous compounds: Namely, the diffusion across the layer is faster for the cyano compound, whereas the diffusion within the layer is faster for the trifluoromethoxy compound.     

Age-related diffusion patterns in human lumbar intervertebral discs: a pilot study in asymptomatic subjects

Diffusion tensor imaging (DTI) may provide an accurate noninvasive method of detecting degenerative matrix alterations in human lumbar intervertebral discs (IVDs). This study aimed to investigate age-related degenerative changes in human lumbar IVDs using DTI. Thirty asymptomatic volunteers ranging in age from 25 to 67 years underwent single-shot diffusion weighted echo-planar imaging on a 3 T scanner. DTI-derived metrics including fractional anisotropy (FA) and mean diffusivity (MD) were analyzed by a histogram analysis method. A Mann-Whitney test was used to compare subject groups (young and elderly) with respect to the diffusion measures, and piecewise linear regression was used to characterize the change in each metric as a function of age. We found significant age-related changes in the elderly adult group, with decrease of MD (11%, P<.001) and increase of FA (20%, P<.001). Our results demonstrate that the degenerative-related changes taking place in the IVDs through aging can be quantitatively accessed by DTI-derived metrics, while the morphologic changes are difficult to be identified in conventional T(2)-weighted images. Our initial findings suggest that it would be worthwhile to validate the relationship between DTI metrics and the actual degenerative status of IVDs using extracted disc samples and to extend it to studies on patients with degenerative discs in order to further explore the clinical usefulness and relevance of DTI.     

Elevations of diffusion anisotropy are associated with hyper-acute stroke: a serial imaging study

Diffusion tensor imaging (DTI) studies of human ischemic stroke within 24 h of symptom onset have reported variable findings of changes in diffusion anisotropy. Serial DTI within 24 h may clarify these heterogeneous results. We characterized longitudinal changes of diffusion anisotropy by analyzing discrete ischemic white matter (WM) and gray matter (GM) regions during the hyperacute (2.5-7 h) and acute (21.5-29 h) scanning phases of ischemic stroke onset in 13 patients. Mean diffusivity (MD), fractional anisotropy (FA) and T2-weighted signal intensity were measured for deep and subcortical WM and deep and cortical GM areas in lesions outlined by a > or =30% decrease in MD. Average reductions of approximately 40% in relative (r) MD were observed in all four brain regions during both the hyperacute and acute phases post stroke. Overall, 9 of 13 patients within 7 h post symptom onset showed elevated FA in at least one of the four tissues, and within the same cohort, 11 of 13 patients showed reduced FA in at least one of the ischemic WM and GM regions at 21.5-29 h after stroke. The fractional anisotropy in the lesion relative to the contralateral side (rFA, mean+/-S.D.) was significantly elevated in some patients in the deep WM (1.10+/-0.11, n=4), subcortical WM (1.13+/-0.14, n=4), deep GM (1.07+/-0.06, n=1) and cortical GM (1.22+/-0.13, n=5) hyperacutely (< or =7 h); however, reductions of rFA at approximately 24 h post stroke were more consistent (rFA= 0.85+/-0.12).     

A framework for quality control and parameter optimization in diffusion tensor imaging: theoretical analysis and validation

In this communication, a theoretical framework for quality control and parameter optimization in diffusion tensor imaging (DTI) is presented and validated. The approach is based on the analytical error propagation of the mean diffusivity (D(av)) obtained directly from the diffusion-weighted data acquired using rotationally invariant and uniformly distributed icosahedral encoding schemes. The error propagation of a recently described and validated cylindrical tensor model is further extrapolated to the spherical tensor case (diffusion anisotropy approximately 0) to relate analytically the precision error in fractional tensor anisotropy (FA) with the mean diffusion-to-noise ratio (DNR). The approach provided simple analytical and empirical quality control measures for optimization of diffusion parameter space in an isotropic medium that can be tested using widely available water phantoms.     

Subject-specific changes in brain white matter on diffusion tensor imaging after sports-related concussion

Background and Purpose

Current approaches to diffusion tensor imaging (DTI) analysis do not permit identification of individual-level changes in DTI indices. We investigated the ability of wild bootstrapping analysis to detect subject-specific changes in brain white matter (WM) before and after sports-related concussion.

Materials and Methods

A prospective cohort study was performed in nine high school athletes engaged in hockey or football and six controls. Subjects underwent DTI pre- and postseason within a 3-month interval. One athlete was diagnosed with concussion (scanned within 72 h), and eight suffered between 26 and 399 subconcussive head blows. Fractional anisotropy (FA) and mean diffusivity (MD) were measured in each WM voxel. Bootstrap samples were generated, and a permuted t test was used to compare voxel-wise FA/MD changes in each subject pre- vs. postseason.

Results

The percentage of WM voxels with significant (p<.05) pre–post FA changes was highest for the concussion subject (3.2%), intermediary for those with subconcussive head blows (mean 1.05%±.15%) and lowest for controls (mean 0.28%±.01%). Similarly, the percentage of WM voxels with significant MD changes was highest for the concussion subject (3.44%), intermediary for those with subconcussive head blows (mean 1.48%±.17%) and lowest for controls (mean 0.48%±.05%). Significantly changed FA and MD voxels colocalized in the concussion subject to the right corona radiata and right inferior longitudinal fasciculus.

Conclusions

Wild bootstrap analysis detected significantly changed WM in a single concussed athlete. Athletes with multiple subconcussive head blows had significant changes in a percentage of their WM that was over three times higher than controls. Efforts to understand the significance of these WM changes and their relationship to head impact forces appear warranted.