MRI technique spots CTE markers in football players, with potential for real-time decision-making

Chronic traumatic encephalopathy or CTE is caused by repeated head injuries and is currently only found through brain tissue analysis after death. But a new imaging technique can spot markers of the condition in real-time by measuring leaks in the blood brain barrier.

That’s what researchers from Ben-Gurion University of the Negev in Beer-Sheva, Israel, claim in new research published in Brain. Their modified dynamic contrast-enhanced MRI protocol can distinguish between fast and slow leakages and determine the severity of a player’s injury.

"Since a leaky blood brain barrier is also found in CTE and causes brain dysfunction and degeneration, it now seems that this test could provide the first (and so far the only) evidence for brain injury in the players we studied on the Israel football team," Alon Friedman, MD, a neurosurgeon and researcher at BGU, said in a Friday statement.

The researchers tested their MRI approach in 42 amateur football players from the Israeli Football League, along with a control group of 27 non-contact athletes and 26 non-athletes. An additional 51 patients with malignant brain tumors, ischemic stroke or traumatic brain injury also received scans.

Permeability maps generated from these images, along with analytical models, revealed slow leakages in the blood brain barrier of football players. And In some cases, this lasted for months, the authors said, boosting their chances of developing CTE.

“The increase in permeability was region specific (white matter, midbrain peduncles, red nucleus, temporal cortex) and correlated with alterations in white matter tracts,” Friedman added. “Importantly, increased permeability persisted for months, as seen in players who were scanned both on- and off-season.”

In fact, football players were three times more likely to have a leaky BBB compared to controls.

Some athletes who did not complain of severe symptoms also showed a blood brain barrier leak, suggesting the MRI approach, along with symptom questionnaires, should be used before sending a player back out onto the field, Friedman suggested.

"Our findings show that DCE-MRI can be used to diagnose specific vascular pathology after traumatic brain injury and other brain pathologies,” he concluded.