This image of DCE-MRI reveals persistent blood brain barrier disorder in American football players. Using brain imaging techniques and analytical methods, researchers can determine whether football players have CTE by measuring leakage of the blood-brain barrier. Image courtesy of Ben-Gurion University

This image of DCE-MRI reveals persistent blood brain barrier disorder in American football players. Using brain imaging techniques and analytical methods, researchers can determine whether football players have CTE by measuring leakage of the blood-brain barrier. Image courtesy of Ben-Gurion University


June 22, 2020 — Chronic traumatic encephalopathy (CTE), a neurodegenerative disease caused by repeated head injuries often affecting athletes, can only be diagnosed currently through brain tissue analysis post-mortem. However, in a new study published in Brain, a Journal of Neurology, Ben-Gurion University of the Negev (BGU) researchers present a new test methodology. Using brain imaging techniques and analytical methods, they can determine whether football players have CTE by measuring leakage of the blood-brain barrier.

The blood-brain barrier (BBB) is a specialized interface between the blood and the brain environment that prevents the transfer of unwanted molecules or infectious organisms from the blood to the brain. Evidence shows that breaching the integrity of this barrier causes many brain diseases and neurodegeneration as a result of aging.

"Since a leaky BBB 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," said Prof. Alon Friedman, M.D., a neurosurgeon and researcher at BGU and Dalhousie University in Canada.

"Importantly, we believe that those with persistent leak encompassing months or years are more likely to develop CTE. Many players seem to repair their BBB quickly, and if they do not suffer from repeated TBIs [traumatic brain injuries] or are not sensitive to brain injury, they are not likely to develop CTE."

The study population included 42 Israelis who play amateur American football in the Israeli Football League (IFL), and a control group comprising 27 athletes practicing a non-contact sport and 26 non-athletes. Magnetic resonance scans were also performed on 51 patients with malignant brain tumors, ischemic stroke or traumatic brain injury (TBI). The NFL sideline concussion assessment tool was used to document history of previous head injuries, including concussions, as well as symptoms assessment and Standardized Assessment of Concussion (SAC) tests.

The researchers developed a modified dynamic contrast-enhanced-MRI (DCE-MRI) protocol and analytical methods to investigate vascular pathology and blood-brain barrier disorder (BBBD) associated with repeated mild TBI in American football players. For the first time, using human brain imaging, they distinguished between fast and slow leakage through the pathological BBB and showed that localized, specific post-traumatic vascular pathology may persist for months in a subset of players.

"We generated maps that visualized the permeability value for each 3D section (voxel), Friedman said. "Our permeability maps revealed an increase in slow blood-to-brain transport in a subset of amateur American football players, but not in the control group. The increase in permeability was region specific (white matter, midbrain peduncles, red nucleus, temporal cortex) and correlated with alterations in white matter tracts. Importantly, increased permeability persisted for months, as seen in players who were scanned both on- and off-season.

"Not less important is the observation that few players who did not complain of severe symptoms also showed a leaky BBB. This suggests that DCE-MRI should be used in conjunction with symptom questionnaires before return to play is approved."

Football players were three times more likely to display a leaky BBB than controls as BBBD was detected in a subgroup (27.4%) of players. This individual variability may explain the wide range of cognitive deficits and neuropsychiatric impairments observed in players, likely reflecting differences in affected brain networks.

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

The researchers note that while the present study was performed in otherwise-healthy amateur players, future studies are recommended to determine the prevalence and spatial-temporal characteristics of BBBD in professional players and/or retired players with and without CTE clinical signs and symptoms. Differences, if found, may improve the understanding of the effects of impact strength and frequency, age of onset, player's skill and extent of vascular injury.

For more information: www.aabgu.org


Related Content

Videos | Information Technology

A discussion on macro trends and the future of medical imaging with Jef Williams, managing partner, Paragon Consulting ...

Time February 07, 2023
arrow
News | Radiology Business

February 2, 2023 — Five additional imaging centers across Allegheny Health Network (AHN) have been recognized by the ...

Time February 02, 2023
arrow
News | Radiation Oncology

February 2, 2023 — The V Foundation, a top cancer research charity, has announced the establishment of a new grant ...

Time February 02, 2023
arrow
News | Magnetic Resonance Imaging (MRI)

February 1, 2023 — According to an accepted manuscript published in ARRS’ American Journal of Roentgenology (AJR), MRI ...

Time February 01, 2023
arrow
News | MRI Breast

February 1, 2023 — Compared to other common supplemental screening methods, breast MRI was superior at detecting breast ...

Time February 01, 2023
arrow
Feature | Radiology Business | By Melinda Taschetta-Millane

Here is a recap of what ITN viewers found most interesting during the month of January: 1. A Look at the Changes in 2023 ...

Time February 01, 2023
arrow
News | Ultrasound Imaging

January 31, 2023 — Esaote, a leading Italian company in the biomedical sector – in ultrasound, dedicated MRI and medical ...

Time January 31, 2023
arrow
News | Digital Pathology

January 27, 2023 — Fujifilm has completed its asset purchase of Inspirata, Inc.’s digital pathology business effective ...

Time January 27, 2023
arrow
News | Magnetic Resonance Imaging (MRI)

January 25, 2023 — On November 11th, 2022 at the Southern Hills Hospital in Las Vegas, USA, Robotic Spine Surgeon Dr ...

Time January 25, 2023
arrow
Feature | Enterprise Imaging

The Imaging Technology News (ITN) team was saddened to hear of the untimely passing of Frank Pecaitis, US North American ...

Time January 24, 2023
arrow
Subscribe Now