Abnormal white matter integrity related to head impact exposure in a season of high school varsity football

Elizabeth M. Davenport, Christopher T. Whitlow, Jillian E. Urban, Mark A. Espeland, Youngkyoo Jung, Daryl A. Rosenbaum, Gerard A. Gioia, Alexander K. Powers, Joel D. Stitzel, Joseph A. Maldjian

Research output: Contribution to journalArticlepeer-review

148 Scopus citations


The aim of this study was to determine whether the cumulative effects of head impacts from a season of high school football produce magnetic resonance imaging (MRI) measureable changes in the brain in the absence of clinically diagnosed concussion. Players from a local high school football team were instrumented with the Head Impact Telemetry System (HITS™) during all practices and games. All players received pre- and postseason MRI, including diffusion tensor imaging (DTI). Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) was also conducted. Total impacts and risk-weighted cumulative exposure (RWE), including linear (RWELinear), rotational (RWERotational), and combined components (RWECP), were computed from the sensor data. Fractional, linear, planar, and spherical anisotropies (FA, CL, CP, and CS, respectively), as well as mean diffusivity (MD), were used to determine total number of abnormal white matter voxels defined as 2 standard deviations above or below the group mean. Delta (post-preseason) ImPACT scores for each individual were computed and compared to the DTI measures using Spearman's rank correlation coefficient. None of the players analyzed experienced clinical concussion (N=24). Regression analysis revealed a statistically significant linear relationship between RWECPand FA. Secondary analyses demonstrated additional statistically significant linear associations between RWE (RWECPand RWELinear) and all DTI measures. There was also a strong correlation between DTI measures and change in Verbal Memory subscore of the ImPACT. We demonstrate that a single season of football can produce brain MRI changes in the absence of clinical concussion. Similar brain MRI changes have been previously associated with mild traumatic brain injury.

Original languageEnglish (US)
Pages (from-to)1617-1624
Number of pages8
JournalJournal of Neurotrauma
Issue number19
StatePublished - Oct 1 2014
Externally publishedYes


  • diffusion tensor imaging
  • football
  • Head Impact Telemetry System
  • mild traumatic brain injury
  • risk-weighted cumulative exposure

ASJC Scopus subject areas

  • Clinical Neurology


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