New “Enhanced” MRI Shows TBI Related Damage To Blood-Brain Barrier For First Time

An new, enhanced MRI scan may have some heavy implications for our understanding of brain injuries and decisions about athlete’s health following brain injuries. The new diagnostic approach was able to identify significant damage to the blood-brain barrier (BBB) in professional football players after “unreported” head trauma or mild concussions for the first time, according to a new report published in the current issue of JAMA Neurology.

Photo Credit: Rick Blumsack

Photo Credit: Rick Blumsack

According to Dr. Alon Friedman, from the Ben-Gurion University Brain Imaging Research Center and discoverer of the new diagnostic, “until now, there wasn’t a diagnostic capability to identify mild brain injury early after the trauma. In the NFL, other professional sports and especially school sports, concern has grown about the long-term neuropsychiatric consequences of repeated mild Traumatic Brain Injury (mTBI) and specifically sports-related concussive and sub-concussive head impacts.”

In their report, the researchers from Ben-Gurion University of the Negev (BGU) and Soroka University Medical Center describe their new diagnostic approach using an “enhanced” form of Magnetic Resonance Imaging (MRI) for detection and localization of vascular pathology and viewing the blood-brain barrier damage in football players.

“The goal of our study was to use our new method to visualize the extent and location of BBB dysfunction in football players using Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) on a Phillips 3-T Ingenia. Specifically, it generates more detailed brain maps showing brain regions with abnormal vasculature, or a ‘leaky BBB.’ ”

The study evaluated 16 football players from Israel’s professional football team, Black Swarm, along with 13 track and field athletes from Ben-Gurion University who participated as control subjects. All underwent the new MRI-based diagnostic.

The DCE-MRIs were given between games during the regular season and showed extensive damage to the BBB. Forty percent of the football players with unreported brain injuries showed evidence of “leaky BBB” compared to 8.3 percent of control athletes.

“The group of 29 volunteers was clearly differentiated into an intact-BBB group and a pathological-BBB group,” Friedman explains. “This showed a clear association between football and increased risk for BBB pathology that we couldn’t see before. In addition, high-BBB permeability was found in six players and in only one athlete from the control group.”

Friedman cited the fact that not all players showed pathology as evidence for the theory that repeated “sub-concussive” impacts may affect individuals differently. He also suggested the level of damage to the BBB may serve to show when individual players may be safe to return to competitive play.

“Generally, players return to the game long before the brain’s physical healing is complete, which could exacerbate the possibility of brain damage later in life,” says Friedman.

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