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CARE Consortium: Prevalence of clinically significant MRI findings in athletes

Andrew Klein, an assistant professor of radiology at the Medical College of Wisconsin, led a team of researchers that sought to characterize and compare the prevalence of acute, head-trauma-related MRI findings and nonspecific MRI findings in contact and noncontact athletes with and without sport-related concussion by using data from the NCAA-Department of Defense Concussion Assessment, Research and Education Consortium study. Their findings were published in the Journal of Neurotrauma. They prospectively enrolled concussed student-athletes who participated in contact sports at the college or high school level (n = 138; 14 female [F]; 19.5 ± 1.6 years). These participants completed up to four MRI scanning sessions over a period of 2.5 years after being diagnosed with sport-related concussion. They also enrolled nonconcussed contact sport athletes (n = 135; 15 F; 19.7 ± 1.6) and noncontact athletes (n = 96; 15 F; 20.0 ± 1.7), who completed similar scanning sessions and served as controls. Board-certified neuroradiologists, blinded to sport-related concussion status, reviewed images for acute (i.e., injury-related) or nonacute findings.

What did the study find?

Only one of the 138 concussed athletes who were enrolled was determined to have an acute, injury-related finding via MRI during the period following a concussion. 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 noncontact 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).

What are the implications?

Previous studies have shown that mild traumatic brain injury can cause abnormalities in magnetic resonance imaging sequences, but this is the first large-scale study to prospectively assess this in athletes with sport-related concussion. Findings demonstrated that less than 1% of sport-related concussions were associated with acute injury findings on qualitative structural MRI, highlighting the uncertainty of the clinical value of using MRI to identify abnormalities in the acute period immediately after sport-related concussion.  

What’s next?

The study’s authors felt that the findings provided “empirical support for clinical guidelines that do not recommend use of MRI after a sport-related concussion.” Results should lead to further scientific and industry discussion regarding the use of MRI as a diagnostic tool for concussion among athletes.