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. 2016 Feb 15;33(4):346-53.
doi: 10.1089/neu.2015.3880. Epub 2015 Dec 15.

Cavum Septi Pellucidi in Symptomatic Former Professional Football Players

Inga K Koerte  1   2 , Jakob Hufschmidt  1   3 , Marc Muehlmann  1   2 , Yorghos Tripodis  4   5   6 , Julie M Stamm  1   5   7 , Ofer Pasternak  1 , Michelle Y Giwerc  1 , Michael J Coleman  1 , Christine M Baugh  5   8 , Nathan G Fritts  5 , Florian Heinen  3 , Alexander Lin  1   9   10 , Robert A Stern  5   6   7   11 , Martha E Shenton  1   9   12
Affiliations

Cavum Septi Pellucidi in Symptomatic Former Professional Football Players

Inga K Koerte et al. J Neurotrauma. .

Abstract

Post-mortem studies reveal a high rate of cavum septi pellucidi (CSP) in chronic traumatic encephalopathy (CTE). It remains, however, to be determined whether or not the presence of CSP may be a potential in vivo imaging marker in populations at high risk to develop CTE. The aim of this study was to evaluate CSP in former professional American football players presenting with cognitive and behavioral symptoms compared with noncontact sports athletes. Seventy-two symptomatic former professional football players (mean age 54.53 years, standard deviation [SD] 7.97) as well as 14 former professional noncontact sports athletes (mean age 57.14 years, SD 7.35) underwent high-resolution structural 3T magnetic resonance imaging. Two raters independently evaluated the CSP, and interrater reliability was calculated. Within National Football League players, an association of CSP measures with cognitive and behavioral functioning was evaluated using a multivariate mixed effects model. The measurements of the two raters were highly correlated (CSP length: rho = 0.98; Intraclass Correlation Coefficient [ICC] 0.99; p < 0.0001; septum length: rho = 0.93; ICC 0.96; p < 0.0001). For presence versus absence of CSP, there was high agreement (Cohen kappa = 0.83, p < 0.0001). A higher rate of CSP, a greater length of CSP, as well as a greater ratio of CSP length to septum length was found in symptomatic former professional football players compared with athlete controls. In addition, a greater length of CSP was associated with decreased performance on a list learning task (Neuropsychological Assessment Battery List A Immediate Recall, p = 0.04) and decreased test scores on a measure of estimate verbal intelligence (Wide Range Achievement Test Fourth Edition Reading Test, p = 0.02). Given the high prevalence of CSP in neuropathologically confirmed CTE in addition to the results of this study, CSP may serve as a potential early in vivo imaging marker to identify those at high risk for CTE. Future research is needed to investigate the pathomechanism underlying the development of CSP after repetitive head impacts, and its potential association with neuropathologically confirmed CTE.

Keywords: MRI; biomarkers; head trauma; neurodegenerative disorders; traumatic brain injury.

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Figures

<b>FIG. 1.</b>
FIG. 1.
Left: Illustration of measurement of septum length on a T1-weighted magnetic resonance image in the midsagittal plane; Right: Example of cavum septi pellucidi visible on a coronal slice.
<b>FIG. 2.</b>
FIG. 2.
Results of group comparison of the length of the septum pellucidum: Wilcoxon two-sample test of National Football League (NFL) players (mean = 53.2 mm; standard deviation [SD] = 4.6) and controls (mean = 55.3 mm; SD = 5.1); No significant difference was found (W = 1.40; p = 0.17);
<b>FIG. 3.</b>
FIG. 3.
Results of group comparison of the length of the cavum septi pellucidi (CSP): Wilcoxon two-sample test of National Football League (NFL) players (mean = 7.7 mm; SD = 7.8) and controls (mean = 4.4 mm; SD = 6.8); length of the CSP was significantly (W = −2.2; p = 0.03) greater in NFL players.
<b>FIG. 4.</b>
FIG. 4.
Results of group comparison of the ratio of cavum septi pellucidi (CSP) length to septum length: Wilcoxon two-sample test of National Football League (NFL) players (mean = 0.15; SD = 0.14) and controls (mean = 0.08; SD = 0.12); ratio of CSP/septum length was significantly (W = −2.17; p = 0.03) higher in NFL players.
See this image and copyright information in PMC

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