• Andrew P Klein, Julie E Tetzlaff, Joshua M Bonis, Lindsay D Nelson, Andrew R Mayer, Daniel L Huber, Jaroslaw Harezlak, Vincent P Mathews, John L Ulmer, Grant P Sinson, Andrew S Nencka, Kevin M Koch, Yu-Chien Wu, Andrew J Saykin, John P DiFiori, Christopher C Giza, Joshua Goldman, Kevin M Guskiewicz, Jason P Mihalik, Stefan M Duma, Steven Rowson, Alison Brooks, Steven P Broglio, Thomas McAllister, Michael A McCrea, and Timothy B Meier.
• 1 Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
• J. Neurotrauma. 2019 Jun 1; 36 (11): 1776-1785.

AbstractPrevious studies have shown that mild traumatic brain injury (mTBI) can cause abnormalities in clinically relevant magnetic resonance imaging (MRI) sequences. No large-scale study, however, has prospectively assessed this in athletes with sport-related concussion (SRC). The aim of the current study was to characterize and compare the prevalence of acute, trauma-related MRI findings and clinically significant, non-specific MRI findings in athletes with and without SRC. College and high-school athletes were prospectively enrolled and participated in scanning sessions between January 2015 through August 2017. Concussed contact sport athletes (n = 138; 14 female [F]; 19.5 ± 1.6 years) completed up to four scanning sessions after SRC. Non-concussed contact (n = 135; 15 F; 19.7 ± 1.6) and non-contact athletes (n = 96; 15 F; 20.0 ± 1.7) completed similar scanning sessions and served as controls. Board-certified neuroradiologists, blinded to SRC status, reviewed T1-weighted and T2-weighted fluid-attenuated inversion recovery and T2*-weighted and T2-weighted images for acute (i.e., injury-related) or non-acute findings that prompted recommendation for clinical follow-up. Concussed athletes were more likely to have MRI findings relative to contact (30.4% vs. 15.6%; odds ratio [OR] = 2.32; p = 0.01) and non-contact control athletes (19.8%; OR = 2.11; p = 0.04). Female athletes were more likely to have MRI findings than males (43.2% vs. 19.4%; OR = 2.62; p = 0.01). One athlete with SRC had an acute, injury-related finding; group differences were largely driven by increased rate of non-specific white matter hyperintensities in concussed athletes. This prospective, large-scale study demonstrates that <1% of SRCs are associated with acute injury findings on qualitative structural MRI, providing empirical support for clinical guidelines that do not recommend use of MRI after SRC.

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