Prevalence of Potentially Clinically Significant Magnetic Resonance Imaging Findings in Athletes with and without Sport-Related Concussion

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. DumaSteven Rowson, Alison Brooks, Steven P. Broglio, Thomas McAllister, Michael A. McCrea, Timothy B. Meier

Research output: Contribution to journalArticle

2 Scopus citations


Previous 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.

Original languageEnglish (US)
Pages (from-to)1776-1785
Number of pages10
JournalJournal of neurotrauma
Issue number11
StatePublished - Jun 2019



  • MRI
  • concussion
  • mTBI
  • sport
  • white matter hyperintensity

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Klein, A. P., Tetzlaff, J. E., Bonis, J. M., Nelson, L. D., Mayer, A. R., Huber, D. L., Harezlak, J., Mathews, V. P., Ulmer, J. L., Sinson, G. P., Nencka, A. S., Koch, K. M., Wu, Y. C., Saykin, A. J., DiFiori, J. P., Giza, C. C., Goldman, J., Guskiewicz, K. M., Mihalik, J. P., ... Meier, T. B. (2019). Prevalence of Potentially Clinically Significant Magnetic Resonance Imaging Findings in Athletes with and without Sport-Related Concussion. Journal of neurotrauma, 36(11), 1776-1785.