Soccer heading is associated with white matter microstructural and cognitive abnormalities

Radiology. 2013 Sep;268(3):850-7. doi: 10.1148/radiol.13130545. Epub 2013 Jun 11.


Purpose: To investigate the association of soccer heading with subclinical evidence of traumatic brain injury.

Materials and methods: With institutional review board approval and compliance with HIPAA guidelines, 37 amateur soccer players (mean age, 30.9 years; 78% [29] men, 22% [eight] women) gave written informed consent and completed a questionnaire to quantify heading in the prior 12 months and lifetime concussions. Diffusion-tensor magnetic resonance (MR) imaging at 3.0 T was performed (32 directions; b value, 800 sec/mm(2); 2 × 2 × 2-mm voxels). Cognitive function was measured by using a computerized battery of tests. Voxelwise linear regression (heading vs fractional anisotropy [FA]) was applied to identify significant regional associations. FA at each location and cognition were tested for a nonlinear relationship to heading by using an inverse logit model that incorporated demographic covariates and history of concussion.

Results: Participants had headed 32-5400 times (median, 432 times) over the previous year. Heading was associated with lower FA at three locations in temporo-occipital white matter with a threshold that varied according to location (885-1550 headings per year) (P < .00001). Lower levels of FA were also associated with poorer memory scores (P < .00001), with a threshold of 1800 headings per year. Lifetime concussion history and demographic features were not significantly associated with either FA or cognitive performance.

Conclusion: Heading is associated with abnormal white matter microstructure and with poorer neurocognitive performance. This relationship is not explained by a history of concussion.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Brain Injuries / pathology*
  • Cognition Disorders / diagnosis*
  • Female
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Nerve Fibers, Myelinated / pathology*
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Soccer / injuries*
  • Wounds, Nonpenetrating / pathology*