Neuroradiologic Evaluation of MRI in High-Contact Sports

Derek McAllister; Carolyn Akers; Brian Boldt; Lex A Mitchell; Eric Tranvinh; David Douglas; Maged Goubran; Jarrett Rosenberg; Marios Georgiadis; Mahta Karimpoor; Phillip DiGiacomo; Nicole Mouchawar; Gerald Grant; David Camarillo; Max Wintermark; Michael M Zeineh

doi:10.3389/fneur.2021.701948

Neuroradiologic Evaluation of MRI in High-Contact Sports

Front Neurol. 2021 Aug 11:12:701948. doi: 10.3389/fneur.2021.701948. eCollection 2021.

Authors

Derek McAllister¹, Carolyn Akers¹, Brian Boldt^{2

3}, Lex A Mitchell^{1

4

5}, Eric Tranvinh¹, David Douglas¹, Maged Goubran^{1

6

7}, Jarrett Rosenberg¹, Marios Georgiadis¹, Mahta Karimpoor¹, Phillip DiGiacomo¹, Nicole Mouchawar¹, Gerald Grant⁸, David Camarillo⁹, Max Wintermark¹, Michael M Zeineh¹

Affiliations

¹ Department of Radiology, Stanford School of Medicine, Stanford, CA, United States.
² Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
³ Department of Radiology, Madigan Army Medical Center, Tacoma, WA, United States.
⁴ Hawaii Permanente Medical Group, Honolulu, HI, United States.
⁵ John A. Burns School of Medicine, Honolulu, HI, United States.
⁶ Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.
⁷ Hurvitz Brain Sciences Program and Physical Sciences Platform, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
⁸ Department of Neurosurgery, Stanford School of Medicine, Stanford, CA, United States.
⁹ Department of Bioengineering, Stanford University, Stanford, CA, United States.

Abstract

Background and Purpose: Athletes participating in high-contact sports experience repeated head trauma. Anatomical findings, such as a cavum septum pellucidum, prominent CSF spaces, and hippocampal volume reductions, have been observed in cases of mild traumatic brain injury. The extent to which these neuroanatomical findings are associated with high-contact sports is unknown. The purpose of this study was to determine whether there are subtle neuroanatomic differences between athletes participating in high-contact sports compared to low-contact athletic controls. Materials and Methods: We performed longitudinal structural brain MRI scans in 63 football (high-contact) and 34 volleyball (low-contact control) male collegiate athletes with up to 4 years of follow-up, evaluating a total of 315 MRI scans. Board-certified neuroradiologists performed semi-quantitative visual analysis of neuroanatomic findings, including: cavum septum pellucidum type and size, extent of perivascular spaces, prominence of CSF spaces, white matter hyperintensities, arterial spin labeling perfusion asymmetries, fractional anisotropy holes, and hippocampal size. Results: At baseline, cavum septum pellucidum length was greater in football compared to volleyball controls (p = 0.02). All other comparisons were statistically equivalent after multiple comparison correction. Within football at baseline, the following trends that did not survive multiple comparison correction were observed: more years of prior football exposure exhibited a trend toward more perivascular spaces (p = 0.03 uncorrected), and lower baseline Standardized Concussion Assessment Tool scores toward more perivascular spaces (p = 0.02 uncorrected) and a smaller right hippocampal size (p = 0.02 uncorrected). Conclusion: Head impacts in high-contact sport (football) athletes may be associated with increased cavum septum pellucidum length compared to low-contact sport (volleyball) athletic controls. Other investigated neuroradiology metrics were generally equivalent between sports.

Keywords: MRI; concussion; football; mild TBI; neuroanatomy; sports.