General Rugby Discussion II

Ardillaun

bob mcbob wrote: »

The diffusion tensor imaging (DTI) scans that confirmed the damage in the players’ brains are of a more sophisticated technology. They can detect what is going on inside, but they are expensive.

Regarding that interesting Guardian article, can’t DWI/DTI scans be done on regular MR machines with a bit of tweaking? I think one of the advantages of this method is that it can look at white matter damage better than most scans.

Diffusion-Weighted Imaging (DWI) is a variant of conventional Magnetic Resonance Imaging based on the tissue water diffusion rate. It is a non-invasive method, with unparalleled sensitivity to water movements within the architecture of the tissues that uses existing MRI technology and requires no new equipment, contrast agents, or chemical tracers. The introduction of the diffusion tensor model enabled the indirect measurement of the degree of anisotropy and structural orientation that characterizes diffusion tensor imaging (DTI) While DWI refers to the contrast of the acquired images, DTI is a specific type of modeling of the DWI datasets.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3594764/

A more recent reference:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5699448/

Pelezico

Ardillaun wrote: »

Can’t DWI/DTI scans be done on regular MR machines with a bit of tweaking? I think one of the advantages of this method is that it can look at white matter damage better than most scans.



A more recent reference:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5699448/

This could be the end of rugby as we know it. Steve Thompson actually got a large insurance payout related to neck injuries, and subsequently returned to rugby.

I heard an interview with an Irish doctor on 5 live yesterday. He suggests fewer players.

hahashake

Pelezico wrote: »

I remember seeing Graham Mourie in 1978 almost falling asleep during the haka in Lansdowne Road.

Not sure why you are offended. Lots of people do t want it....including WRU at one stage. The haka was not invented for rugby.

It was cultural expropriation by Europeans which got it to international attention.

The first Haka before a game was done by the touring NZ Native (Maori) team in 1888 which brought it to international attention (also the first team to wear black). The haka was not invented for rugby but neither were anthems.

If you don't like it or think that teams should be forced to choose between anthems and Haka/Sipi Tau/Siva Tau/Cibi, that is fine. But it isn't a modern addition or something with no foundational history in the sport.

Neil3030

Help me out here - DTI and DWI can infer the anisotropy of water flow in the brain, which allows you to chart white matter connectivity. How are they using this to diagnose CTE? You need evidence of tau proteins right? Or is there a way CTE can be inferred from disruption in water flow? In which case, at the single patient level, what's the baseline? Does anybody know more about the statement in the Guardian article that says these scans "confirmed damage"?

Hands Like Flippers

bilston wrote: »

Apologies if this has already been mentioned, but I was thinking about this a week or two ago, when I was growing up in the 80s and 90s I was always taught to tackle low, nowadays teams tackle higher to try and dislodge the ball or stop the offload.

Maybe a high tackle needs redefined, maybe a high tackle should be defined as above the waste. It would surely reduce the risk of head on head collisions (in the tackle anyway) and actually make for a better spectacle with more offloads. Obviously head on knee is still a risk, but that mostly comes down to good tackling technique.

.. .

Have said this now for a few years. Completely agree.

Hands Like Flippers

Pelezico wrote: »

I remember seeing Graham Mourie in 1978 almost falling asleep during the haka in Lansdowne Road.

Not sure why you are offended. Lots of people do t want it....including WRU at one stage. The haka was not invented for rugby.

It was cultural expropriation by Europeans which got it to international attention.

"cultural expropriation"

Sigh.

Ardillaun

Neil3030 wrote: »

Help me out here - DTI and DWI can infer the anisotropy of water flow in the brain, which allows you to chart white matter connectivity. How are they using this to diagnose CTE? You need evidence of tau proteins right? Or is there a way CTE can be inferred from disruption in water flow? In which case, at the single patient level, what's the baseline? Does anybody know more about the statement in the Guardian article that says these scans "confirmed damage"?

I had to google anisotropy, so bear that in mind when you read the following.

On the white matter damage issue, MR imaging can help one see diffuse axonal injury which is in the white, i.e. myelinated, axonal part of the brain. I don’t think it’s water flow per se but its distribution that enables one to see the injury to axonal pathways. Fat and water can be differentiated by their different ‘relaxation’ responses to the magnetic field and radio wave pulses in MR. I believe one feature of damaged axons is that they contain more water and have more water around them, so increased water can be seen in these damaged axon bundles passing from one part of the brain to the other due to a change in the appearance on the scan. Regarding damage in grey (neuronal) matter, they’re getting better at that all the time.

Unfortunately, the detailed cellular level of brain structure and pathology is still best seen at autopsy at the moment. This has been the gold standard for diagnosing CTE that the well-known group in Boston University has used on athletes and soldiers:

https://www.bu.edu/cte/

The challenge now is to move the diagnosis decades back. It seems to be a rapidly moving field. For example, here’s a recent report of abnormal blood brain barrier function in CTE:

https://www.eurekalert.org/pub_releases/2020-06/aabu-mtf061820.php

And elevated tau levels in the blood have been described as a marker of diffuse axonal injury:

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0214381

swiwi_

hahashake wrote: »

The first Haka before a game was done by the touring NZ Native (Maori) team in 1888 which brought it to international attention (also the first team to wear black). The haka was not invented for rugby but neither were anthems.

If you don't like it or think that teams should be forced to choose between anthems and Haka/Sipi Tau/Siva Tau/Cibi, that is fine. But it isn't a modern addition or something with no foundational history in the sport.

I personally think the Sipi Tau should be banned. It gives Tonga an unfair advantage and it's become wildly commercialised, not to mention all the Kiwis in their squad. It's a disgrace, really.

kuang1

Just realised that Argentina are in the 3rd band for the World Cup draw.
You could have New Zealand, Ireland/France & Argentina in one group!

aloooof

Pelezico wrote: »

Look at the haka of the seventies. The players were embarrassed by performing it.

Nowadays, it is a parody of itself.

Do you have anything positive to contribute, by any chance?

Pelezico wrote: »

Making gods out of lads with the latest retiree being trotted out as one of the greats is a peculiarity of rugby.

Doddie Weir is also one of the greats...as is that South African lad with the same condition.

Pelezico wrote: »

Yeah....<JJ Williams> wasnt great but all the lazy pundits are calling him a great.

Pelezico wrote: »

What sickens my hole is the silence when opposition players kicking for goal.

This is Munster..spiritual home of rugby nonsense...really hole sickening behaviour

kuang1

kuang1 wrote: »

Just realised that Argentina are in the 3rd band for the World Cup draw.
You could have New Zealand, Ireland/France & Argentina in one group!

Ireland most importantly want Wales (and preferably Italy from pot 3) in the group and a draw to face Japan in the 1/4

Come on Ireland, win one knockout game for the tenth time of asking....

It will only have been 36 years, don't push it out to 40.

The Lost Sheep

Nige to retire from reffing international games with immediate effect
Will still ref pro14 and at community level in Wales

flazio

Possibly the most famous character in World Rugby.
One of the greats. I've found myself on occasion when I don't even have much interest in the two teams playing, if he's reffing I'd watch the game regardless.

Pelezico

flazio wrote: »

Possibly the most famous character in World Rugby.
One of the greats. I've found myself on occasion when I don't even have much interest in the two teams playing, if he's reffing I'd watch the game regardless.

His problem is he just loves being the centre of attention...even as a linesman he wants to lecture the referee and get involved in the game.

I bet the other referees on the circuit cringe when he is officiating at their game.

razorblunt

flazio wrote: »

Possibly the most famous character in World Rugby.
One of the greats. I've found myself on occasion when I don't even have much interest in the two teams playing, if he's reffing I'd watch the game regardless.

That’s not a good thing if you’re watching for a ref as he will (and he has) gone looking to live up to that.

On a related note, Showtime Jr here in Northampton being influenced by the home crowd all a hundred of them or so.

razorblunt

Northampton are so poor, if Bordeaux had any interest in this they’d be well clear.
Or any sort of discipline too.

razorblunt

Try from gathering a penalty that hit the post! Love to see those.

Neil3030

Ardillaun wrote: »

I had to google anisotropy, so bear that in mind when you read the following.

On the white matter damage issue, MR imaging can help one see diffuse axonal injury which is in the white, i.e. myelinated, axonal part of the brain. I don’t think it’s water flow per se but its distribution that enables one to see the injury to axonal pathways. Fat and water can be differentiated by their different ‘relaxation’ responses to the magnetic field and radio wave pulses in MR. I believe one feature of damaged axons is that they contain more water and have more water around them, so increased water can be seen in these damaged axon bundles passing from one part of the brain to the other due to a change in the appearance on the scan. Regarding damage in grey (neuronal) matter, they’re getting better at that all the time.

Unfortunately, the detailed cellular level of brain structure and pathology is still best seen at autopsy at the moment. This has been the gold standard for diagnosing CTE that the well-known group in Boston University has used on athletes and soldiers:

https://www.bu.edu/cte/

The challenge now is to move the diagnosis decades back. It seems to be a rapidly moving field. For example, here’s a recent report of abnormal blood brain barrier function in CTE:

https://www.eurekalert.org/pub_releases/2020-06/aabu-mtf061820.php

And elevated tau levels in the blood have been described as a marker of diffuse axonal injury:

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0214381

Thanks for this.

Just on the imaging side of things, the key word for me is "change" in water levels. We know what normal ribs look like, we can tell in an XRay if a rib is therefore broken. We don't have near the same baseline intuition regarding the water:fat ratio in different voxels within brain regions. I can think of some ways this might change as we move forward, and the "brain MOT" is a great (if expensive) way to measure change relative to baseline.

But the very definitive statement in that Guardian piece was that the scans "confirmed damage" in a player who likely had no pre-injury image for comparison, which is the bit I'd like cleared up.

Ardillaun

Neil3030 wrote: »

But the very definitive statement in that Guardian piece was that the scans "confirmed damage" in a player who likely had no pre-injury image for comparison, which is the bit I'd like cleared up.

One thing that may be seen for diagnosis are distinct white spots in characteristic parts of the brain on the scan. These contain edema fluid, damaged axons and sometimes blood from small haemorrhages as well. Here are two examples of non-hemorrhagic DAI, A and B. The arrows indicate the damaged areas.

https://www.researchgate.net/figure/Detection-of-axonal-injury-with-conventional-magnetic-resonance-imaging-MRI-using_fig1_321166764

In A, there are two blobs in the white matter under the cortex. In B, the white matter connecting the two hemispheres, the corpus callosum, is damaged. These lesions really stand out from the normal anatomy of the brain. The lesions in C and D are a bit harder to see.

Neil3030

Ardillaun wrote: »

One thing that may be seen for diagnosis are distinct white spots in characteristic parts of the brain on the scan. These contain edema fluid, damaged axons and sometimes blood from small haemorrhages as well. Here are two examples of non-hemorrhagic DAI, A and B. The arrows indicate the damaged areas.

https://www.researchgate.net/figure/Detection-of-axonal-injury-with-conventional-magnetic-resonance-imaging-MRI-using_fig1_321166764

In A, there are two blobs in the white matter under the cortex. In B, the white matter connecting the two hemispheres, the corpus callosum, is damaged. These lesions really stand out from the normal anatomy of the brain. The lesions in C and D are a bit harder to see.

Yes they're quite clear indeed. What was the event related to B, that was a single trauma or the more cumulative damage you'd expect to see in rugby players?

For noticing concussions in DTI, seems an individual baseline will be more sensitive than normative data

Ardillaun

Neil3030 wrote: »

Yes they're quite clear indeed. What was the event related to B, that was a single trauma or the more cumulative damage you'd expect to see in rugby players?

For noticing concussions in DTI, seems an individual baseline will be more sensitive than normative data

I can't see any clinical history in the article:

https://www.researchgate.net/publication/321166764_Current_Opportunities_for_Clinical_Monitoring_of_Axonal_Pathology_in_Traumatic_Brain_Injury

But that lesion could occur in a sport like rugby.

Individual baselines makes sense because other lesions could be there already to confuse the picture. One could imagine a regular battery of specialized brain imaging and blood tests for cerebral trauma markers becoming mandatory in all physical contact sports at the elite amateur and professional levels.

Ardillaun

I think the haka and other similar ceremonial dances really add to the spectacle of rugby and mark out the rugby brand from other varieties of football for occasional viewers. Given the extraordinary contribution of Pacific Islanders to the game, respecting, and indeed celebrating, such traditions is the least we can do.

Paul Smeenus

I think this is possibly the stupidest, least coherent rugby article I have ever read.

Did they just find this Garry Doyle roaming the streets, ranting, because his local had shut during lockdown?

https://www.the42.ie/premiership-hype-5297814-Dec2020/

sydthebeat

Paul Smeenus wrote: »

I think this is possibly the stupidest, least coherent rugby article I have ever read.

Did they just find this Garry Doyle roaming the streets, ranting, because his local had shut during lockdown?

https://www.the42.ie/premiership-hype-5297814-Dec2020/

Meh

Not going to give it the oxygen its begging for

Paul Smeenus

sydthebeat wrote: »

Meh

Not going to give it the oxygen its begging for

Probably wise. I shouldn't have bothered posting it, but I was just incredulous.

sydthebeat

Paul Smeenus wrote: »

Probably wise. I shouldn't have bothered posting it, but I was just incredulous.

Theses things always have swings and roundabouts, but that article is pure controversy baiting

razorblunt

Duhan Van der Muerhe gets his Scotland caps and now he’s off down south for next season. Ouch.

AbusesToilets

Ardillaun wrote: »

I can't see any clinical history in the article:

https://www.researchgate.net/publication/321166764_Current_Opportunities_for_Clinical_Monitoring_of_Axonal_Pathology_in_Traumatic_Brain_Injury

But that lesion could occur in a sport like rugby.

Individual baselines makes sense because other lesions could be there already to confuse the picture. One could imagine a regular battery of specialized brain imaging and blood tests for cerebral trauma markers becoming mandatory in all physical contact sports at the elite amateur and professional levels.

Are they doing baseline scans for players, to facilitate future comparisons?

Bazzo

razorblunt wrote: »

Duhan Van der Muerhe gets his Scotland caps and now he’s off down south for next season. Ouch.

Where's he off to?

Really seems the SRU need to look at their selection policy from some direction but it'd take a smarter man than me to figure out the best path.

RugbyLover123

Bazzo wrote: »

Where's he off to?

Really seems the SRU need to look at their selection policy from some direction but it'd take a smarter man than me to figure out the best path.

Worcester by the looks of things.