Dataset Information

Case Report: ¹⁸F-MK6240 Tau Positron Emission Tomography Pattern Resembling Chronic Traumatic Encephalopathy in a Retired Australian Rules Football Player.

ABSTRACT: Introduction: It remains unclear if tau imaging may assist diagnosis of chronic traumatic encephalopathy (CTE). Flortaucipir PET has shown superior frontal with medial temporal tau binding consistent with the provisional neuropathological criteria for mid-stage CTE in group-level analyses of retired symptomatic NFL players and in one individual with pathologically confirmed CTE. ¹⁸F-MK6240 is a new PET ligand that has high affinity for tau. We present the case of a 63-year-old cognitively impaired, former Australian rules football player with distinct superior frontal and medial temporal ¹⁸F-MK6240 binding and show it to be significantly different to the pattern seen in prodromal Alzheimer's disease (AD). Findings: The participant was recruited for a study of amyloid-? and tau several decades after traumatic brain injury. He had multiple concussions during his football career but no cognitive complaints at retirement. A thalamic stroke in his mid 50s left stable mild cognitive deficits but family members reported further short-term memory, behavioral, and personality decline preceding the study. Imaging showed extensive small vessel disease on MRI, a moderate burden of amyloid-? plaques, and ¹⁸F-MK6240 binding in bilateral superior frontal and medial temporal cortices. Voxel-wise analysis demonstrated that the frontally predominant pattern of the participant was significantly different to the posterior temporo-parietal predominant pattern of prodromal AD. Conclusion: Although lacking neuropathological examination to distinguish CTE from a variant of AD, the clear demonstration of a CTE-like tau pattern in a single at-risk individual suggests further research on the potential of ¹⁸F-MK6240 PET for identifying CTE is warranted.

SUBMITTER: Krishnadas N

PROVIDER: S-EPMC7783156 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Case Report: 18F-MK6240 Tau Positron Emission Tomography Pattern Resembling Chronic Traumatic Encephalopathy in a Retired Australian Rules Football Player.

Krishnadas Natasha N Doré Vincent V Lamb Fiona F Groot Colin C McCrory Paul P Guzman Rodney R Mulligan Rachel R Huang Kun K O'Donnell Meaghan M Ponsford Jennie J Hopwood Malcolm M Villemagne Victor L VL Rowe Christopher C CC

Frontiers in neurology 20201222

Introduction: It remains unclear if tau imaging may assist diagnosis of chronic traumatic encephalopathy (CTE). Flortaucipir PET has shown superior frontal with medial temporal tau binding consistent with the provisional neuropathological criteria for mid-stage CTE in group-level analyses of retired symptomatic NFL players and in one individual with pathologically confirmed CTE. 18F-MK6240 is a new PET ligand that has high affinity for tau. We present the case of a 63-year-old ...[more]

PMID: 33414760

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Project description:Player evaluation plays a fundamental role in the decision-making processes of professional sporting organisations. In the Australian Football League, both subjective and objective evaluations of player match performance are commonplace. This study aimed to identify the extent to which performance indicators can explain subjective ratings of player performance. A secondary aim was to compare subjective and objective ratings of player performance. Inside Football Player Ratings (IFPR) and Australian Football League Player Ratings were collected as subjective and objective evaluations of player performance, respectively, for each player during all 1026 matches throughout the 2013-2017 Australian Football League seasons. Nine common player performance indicators, player role classification, player age and match outcomes were also collected. Standardised linear mixed model and recursive partitioning and regression tree models were undertaken across the whole dataset, as well as separately for each of the seven player roles. The mixed model analysis produced a model associating the performance indicators with IFPR at a root mean square error of 0.98. Random effects accounting for differences between seasons and players ranged by 0.09 and 1.73 IFPR each across the five seasons and 1052 players, respectively. The recursive partitioning and regression tree model explained IFPR exactly in 35.8% of instances, and to within 1.0 IFPR point in 81.0% of instances. When analysed separately by player role, exact explanation varied from 25.2% to 41.7%, and within 1.0 IFPR point from 70.3% to 88.6%. Overall, kicks and handballs were most associated with the IFPR. This study highlights that a select few features account for a majority of the variance when explaining subjective ratings of player performance, and that these vary by player role. Australian Football League organisations should utilise both subjective and objective assessments of performance to gain a better understanding of the differences associated with subjective performance assessment.

Project description:ImportanceBiomarkers for chronic traumatic encephalopathy (CTE) are currently lacking. The radiotracer fluorine F 18-labeled (18F)-flortaucipir (FTP) detects tau pathology in Alzheimer disease, and positron emission tomography (PET) with FTP shows elevated binding in individuals at risk for CTE. No study, however, has assessed the correlation between in vivo FTP PET and postmortem tau in CTE.ObjectiveTo assess the regional association between in vivo FTP binding and postmortem tau pathology in a patient with pathologically confirmed CTE.Design, setting, and participantsA white male former National Football League player with 17 years of US football exposure was clinically diagnosed with traumatic encephalopathy syndrome at a neurology tertiary referral center. 18F-Fludeoxyglucose, carbon 11-labeled Pittsburgh compound B, and FTP PET were performed 52 months prior to death, and magnetic resonance imaging, 50 months prior to death. Brain images were assessed qualitatively for abnormalities blinded to autopsy data. Autopsy was performed using a neurodegenerative research protocol. The FTP standardized uptake value ratios (inferior cerebellar gray reference region) and W-score (age-adjusted z-score) maps were compared with phosphorylated tau immunohistochemical analysis with monoclonal antibody CP13.Main outcomes and measuresQualitative and quantitative comparisons between antemortem FTP PET and tau pathology at autopsy.ResultsFlortaucipir uptake was distributed in a patchy, frontotemporal-predominant pattern that overlapped with regions showing neurodegeneration on magnetic resonance imaging and hypometabolism on 18F-fludeoxyglucose PET. Pathological assessment revealed stage 4 CTE; limbic argyrophilic grain disease; stage 2 limbic-predominant, age-related transactive response DNA-binding protein 43 encephalopathy; and Braak neurofibrillary tangle stage 3. 18F-Flortaucipir W-maps matched areas of high postmortem tau burden in left fusiform and inferior temporal gyri and juxtacortical frontal white matter. High FTP W-scores with low tau burden were found in the basal ganglia, thalamus, motor cortex, and calcarine cortex. No regions with low FTP W-scores corresponded to areas with high pathological tau burden. A modest correlation, which did not reach statistical significance (ρ = 0.35, P = .17), was found between FTP standardized uptake value ratio and tau area fraction at the regional level.Conclusions and relevanceIn this patient, FTP PET findings during life showed a modest correspondence with postmortem pathology in CTE. These findings suggest that FTP may have limited utility as a tau biomarker in CTE.

Project description:ContextThe nature of Australian rules football (Australian football) predisposes both unique and common injuries compared with those sustained in other football codes. The game involves a combination of tackling, kicking, high-speed running (more than other football codes), and jumping. Two decades of injury surveillance has identified common injuries at the professional level (Australian Football League [AFL]).ObjectiveTo provide an overview of injuries in Australian rules football, including injury rates, patterns, and mechanisms across all levels of play.Study designA narrative review of AFL injuries, football injury epidemiology, and biomechanical and physiological attributes of relevant injuries.ResultsThe overall injury incidence in the 2015 season was 41.7 injuries per club per season, with a prevalence of 156.2 missed games per club per season. Lower limb injuries are most prevalent, with hamstring strains accounting for 19.1 missed games per club per season. Hamstring strains relate to the volume of high-speed running required in addition to at times having to collect the ball while running in a position of hip flexion and knee extension. Anterior cruciate ligament injuries are also prevalent and can result from contact and noncontact incidents. In the upper limb, shoulder sprains and dislocations account for 11.5 missed games per club per season and largely resulted from tackling and contact. Concussion is less common in AFL than other tackling sports but remains an important injury, which has notably become more prevalent in recent years, theorized to be due to a more conservative approach to management. Although there are less injury surveillance data for non-AFL players (women, community-level, children), many of these injuries appear to also be common across all levels of play.Clinical relevanceAn understanding of injury profiles and mechanisms in Australian football is crucial in identifying methods to reduce injury risk and prepare players for the demands of the game.

Dataset Information

Case Report: ¹⁸F-MK6240 Tau Positron Emission Tomography Pattern Resembling Chronic Traumatic Encephalopathy in a Retired Australian Rules Football Player.

Publications

Case Report: <sup>18</sup>F-MK6240 Tau Positron Emission Tomography Pattern Resembling Chronic Traumatic Encephalopathy in a Retired Australian Rules Football Player.

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