Association of Head Impact Exposure with White Matter Macrostructure and Microstructure Metrics

Prior studies have reported white matter abnormalities associated with a history of cumulative concussion and/or repetitive head impacts (RHI) in contact sport athletes. Growing evidence suggests these abnormalities may begin as more subtle changes earlier in life in active younger athletes. We investigated the relationship between prior concussion and contact sport exposure with multi-modal white matter microstructure and macrostructure using magnetic resonance imaging. High school and collegiate athletes ( n  = 121) completed up to four evaluations involving neuroimaging. Linear mixed-effects models examined associations of years of contact sport exposure (i.e., RHI proxy) and prior concussion across multiple metrics of white matter, including total white matter volume, diffusion tensor imaging (DTI) metrics, diffusion kurtosis imaging (DKI) metrics, and quantitative susceptibility mapping (QSM). A significant inverse association between cumulative years of contact sport exposure and QSM was observed, F (1, 237.77) = 4.67, p  = 0.032. Cumulative contact sport exposure was also associated with decreased radial diffusivity, F (1, 114.56) = 5.81, p  = 0.018, as well as elevated fractional anisotropy, F (1, 115.32) = 5.40, p  = 0.022, and radial kurtosis, F (1, 113.45) = 4.03, p  = 0.047. In contrast, macroscopic white matter volume was not significantly associated with cumulative contact sport exposure ( p  > 0.05). Concussion history was not significantly associated with QSM, DTI, DKI, or white matter volume (all, p  > 0.05). Cumulative contact sport exposure is associated with subtle differences in white matter microstructure, but not gross white matter macrostructure, in young active athletes. Longitudinal follow-up is required to assess the progression of these findings to determine their contribution to potential adverse effects later in life.