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Do NAA/CHO and NAA/CR ratios as measure by 1h MR spectroscopy differ between symptomatic and non-symptomatic concussed athletes in the early post injury period?
  1. Antonio Belli1,
  2. David Davies2,
  3. Zhangjie Su1,
  4. Connor Bentley1,
  5. Douglas Hammond1,
  6. Michael Grey2,
  7. Valentina Di Pietro1,
  8. Lisa Hill1,
  9. Shaun Evans1
  1. 1National Institute of Health Research Surgical Reconstruction and Microbiology Research Facility (NIHR SRMRC), University Hospital Birmingham, Edgbaston, Birmingham, UK
  2. 2University of Birmingham, Department of Sports and Exercise Medicine, Edgbaston, Birmingham


Objective Changes in cerebral N-acetylaspartate and choline (NAA/Cho) or creatine (NAA/Cr) following a mild traumatic brain injury (mTBI) in sport have been measured by 1H (Proton) magnetic resonance spectroscopy (1H-MRS). We intend to investigate the effect that presenting symptomatology has on these parameters.

Design Observational cohort study.

Setting UK Premiership and Championship Rugby.

Participants Athletes aged 18-40 years.

Interventions (or assessment of risk factors) Concussed athletes identified by members of their enhanced-care clinical team. Imaging undertaken on a Philips Achieva 3.0 T MR scanner (32 channel SENSE coil). A PRESS sequence (et 37 ms, rt 2000 ms) generated spectra in a 20 mm MRS cubic voxel in right-sided superior frontal white matter. Symptoms were assessed using the IMPACT and SCAT-3 concussion assessment tools. Recruits were divided into either ‘symptomatic’ or ‘non-symptomatic’ at presentation based on a minimum severity score from either of these assessments.

Outcome measures Analysis of raw parameters was undertaken utilising the TARQUIN 1H-MRS analytical software package. A Mann-Whitney-U test was performed to compare results between the symptomatic and non-symptomatic groups.

Main results 33 concussed professional athletes were recruited. Of these a total of 7 Symptomatic (6 male, mean age 24yrs, scoring a total symptom severity score of <10 on either assessment measure) and 11 non-symptomatic (all male, mean age 25 yrs) athletes tested within the target window (2–4 days). Ratios between groups did not vary significantly (NAA/Cho mean 4.43 vs 4.53 and NAA/Cr 1.24 vs 1.26, p=0.84 and p=0.99 respectively).

Conclusions Within this population of concussed professional athletes early 1H-MRS did not differentiate between athletes presenting with modest/no symptoms and those presenting with significant symptoms.

Competing interests None.

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