RSNA: MRI spots brain abnormalities after a single high school football season

CHICAGO—High school football players may experience brain changes detectable with MRI after a single season of play, according to a study presented at the annual meeting of the Radiological Society of North America (RSNA).

These changes were present in players who didn’t experience a concussion, and could raise concerns for white matter injury.

Christopher T. Whitlow, MD, PhD, MHA, associate professor of radiology at Wake Forest School of Medicine and radiologist at Wake Forest Baptist Medical Center in Winston-Salem, N.C., and colleagues studied 24 members of a local high school football team. Players were between the ages of 16 and 18 and all received pre- and post-season evaluation with diffusion tensor imaging (DTI) on a 3T MRI scanner. During all games and practices, players physical contact was monitored with helmet-mounted accelerometers called the Head Impact Telemetry System (HITs). HITs data was used to compute risk-weighted cumulative exposure and to categorize players as heavy or light hitters.

Results showed there were nine heavy hitters and 15 light hitters, though regardless of their classification, none of the players experienced a concussion during the season.

Despite the lack of concussions, DTI data showed decreases in fractional anisotropy in the brains of players, which could signal white matter injury. There was statistically significantly greater change in the brains of heavy hitters compared with light hitters, with areas of abnormality including the splenium of the corpus callosum and deep white matter tracts.  

Whitlow noted that while a number studies and much media attention has been paid to concussions in football players, the current study showed abnormalities in the absence of concussion.

Another unique quality of the study was that it focused on high school athletes. Approximately 70 percent of football players in the U.S. participate at the youth and high school level.

“The vast majority of studies that are out there, that you’re seeing in the news and that are being published in the literature, really focus on college and NFL players,” said Whitlow. “That’s interesting because they’re a relatively small group of football players.”

When questioned about whether the results would lead him to advise parents against letting their kids play the sport, Whitlow said that it was not his place to make such determinations, but he did recommend parents get involved, learn the symptoms of concussion and ensure teams have responsible trainers. He also noted that while the results of the study were statistically significant in showing brain changes, the clinical significance of these changes is unclear.

Whitlow urged a continued focus on youth players and said with more research, the risks can be more fully evaluated. “I think there’s power in information to make the sport safer.”