{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,14]],"date-time":"2026-11-14T02:29:15Z","timestamp":1794623355102,"version":"4.9.1"},"reference-count":39,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Youth football athletes are exposed to repetitive subconcussive head impacts during normal participation in the sport, and there is increasing concern about the long-term effects of these impacts. The objective of the current study was to determine if strain-based cumulative exposure measures are superior to kinematic-based exposure measures for predicting imaging changes in the brain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>\n                      This prospective, longitudinal cohort study was conducted from 2012 to 2017 and assessed youth, male football athletes. Kinematic data were collected at all practices and games from enrolled athletes participating in local youth football organizations in Winston-Salem, North Carolina, and were used to calculate multiple risk-weighted cumulative exposure (RWE) kinematic metrics and 36 strain-based exposure metrics. Pre- and postseason imaging was performed at Wake Forest School of Medicine, and diffusion tensor imaging (DTI) measures, including fractional anisotropy (FA), and its components (C\n                      <jats:sub>L<\/jats:sub>\n                      , C\n                      <jats:sub>P<\/jats:sub>\n                      , and C\n                      <jats:sub>S<\/jats:sub>\n                      ), and mean diffusivity (MD), were investigated. Included participants were youth football players ranging in age from 9 to 13 years. Exclusion criteria included any history of previous neurological illness, psychiatric illness, brain tumor, concussion within the past 6 months, and\/or contraindication to MRI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      A total of 95 male athletes (mean age 11.9 years [SD 1.0 years]) participated between 2012 and 2017, with some participating for multiple seasons, resulting in 116 unique athlete-seasons. Regression analysis revealed statistically significant linear relationships between the FA, linear coefficient (C\n                      <jats:sub>L<\/jats:sub>\n                      ), and spherical coefficient (C\n                      <jats:sub>S<\/jats:sub>\n                      ) and all strain exposure measures, and well as the planar coefficient (C\n                      <jats:sub>P<\/jats:sub>\n                      ) and 8 strain measures. For the kinematic exposure measures, there were statistically significant relationships between FA and RWE linear (RWE\n                      <jats:sub>L<\/jats:sub>\n                      ) and RWE combined probability (RWE\n                      <jats:sub>CP<\/jats:sub>\n                      ) as well as C\n                      <jats:sub>S<\/jats:sub>\n                      and RWE\n                      <jats:sub>L<\/jats:sub>\n                      . According to area under the receiver operating characteristic (ROC) curve (AUC) analysis, the best-performing metrics were all strain measures, and included metrics based on tensile, compressive, and shear strain.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Using ROC curves and AUC analysis, all exposure metrics were ranked in order of performance, and the results demonstrated that all the strain-based metrics performed better than any of the kinematic metrics, indicating that strain-based metrics are better discriminators of imaging changes than kinematic-based measures. Studies relating the biomechanics of head impacts with brain imaging and cognitive function may allow equipment designers, care providers, and organizations to prevent, identify, and treat injuries in order to make football a safer activity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2021.10.peds21355","type":"journal-article","created":{"date-parts":[[2022,1,21]],"date-time":"2022-01-21T03:39:17Z","timestamp":1642736357000},"page":"387-396","source":"Crossref","is-referenced-by-count":23,"title":["Cumulative strain-based metrics for predicting subconcussive head impact exposure\u2013related imaging changes in a cohort of American youth football players"],"prefix":"10.3171","volume":"29","author":[{"given":"Logan E.","family":"Miller","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem;"},{"name":"School of Biomedical Engineering and Sciences, Virginia Tech\u2013Wake Forest University, Winston-Salem;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jillian E.","family":"Urban","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem;"},{"name":"School of Biomedical Engineering and Sciences, Virginia Tech\u2013Wake Forest University, Winston-Salem;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Espeland","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P.","family":"Walkup","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"Holcomb","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Texas Southwestern Medical School, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth M.","family":"Davenport","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Texas Southwestern Medical School, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander K.","family":"Powers","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem;"},{"name":"Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher T.","family":"Whitlow","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem;"},{"name":"Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph A.","family":"Maldjian","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Texas Southwestern Medical School, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel D.","family":"Stitzel","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem;"},{"name":"School of Biomedical Engineering and Sciences, Virginia Tech\u2013Wake Forest University, Winston-Salem;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Orthop J Sports Med","doi-asserted-by":"publisher","first-page":"2325967116686784","DOI":"10.1177\/2325967116686784","article-title":"Youth football injuries: a prospective cohort","volume":"5","author":"Peterson AR","year":"2017","unstructured":"Peterson AR, Kruse AJ, Meester SM, Olson TS, Riedle BN, Slayman TG,  Youth football injuries: a prospective cohort. 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