Multimodal brain imaging of mild traumatic brain injuries in athletes: a systematic review with narrative synthesis
- 1epartment of Psychology & Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
Abstract
Mild traumatic brain injury (mTBI) is a neurological event caused by external mechanical force to the head. Athletes in contact sports are at particular risk for repeated mTBI, which may result in cognitive symptoms and long-term adverse health outcomes. So far, neither diagnostic, prognostic, nor predictive biomarkers have been validated, and conventionally used radiological methods such as computed tomography and magnetic resonance imaging (MRI) have limited sensitivity to the subtle functional, metabolic, and microstructural abnormalities following mTBI. Moreover, research is challenged by the heterogeneous nature of mTBI and comorbid psychiatric conditions. To address these limitations, multimodal brain imaging studies appear promising. This study systematically reviewed multimodal imaging studies of athletes and narratively synthesized key neuroimaging findings. The databases Web of Science and PubMed (MEDLINE) were searched between January and August 2026 (all years). Studies were eligible if they included athletes with mTBI and acquired two or more complementary imaging modalities within the same participants using cross-sectional or longitudinal designs. Fourteen studies were included in the systematic review with a narrative synthesis. Risk of bias was assessed using the Newcastle-Ottawa Scale. The main modalities used were functional MRI, arterial spin labeling, diffusion tensor imaging, and magnetic resonance spectroscopy, assessing changes in functional connectivity, cerebral blood flow (CBF), diffusion metrics, and brain metabolites, respectively. No study, however, combined MRI-based and electrophysiological methods. Significant alterations in functional connectivity, diffusion metrics, CBF, and brain metabolites were reported at assessment time points beyond the acute phase. Nonetheless, no consistent neuroimaging pattern emerged due to clinical and methodological heterogeneity. To strengthen biomarker research, future studies should aim to implement standardized, longitudinal study designs that include baseline assessments followed by multimodal data fusion analyses.Systematic review registrationThe details of the OSF project are: doi: 10.17605/OSF.IO/R5B6S, https://osf.io/r5b6s/overview?view_only=9c2267f359474efc93a9ca67cf99ed57.
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BibTeX
@article{bergauer2026multimodal,
title = {{Multimodal brain imaging of mild traumatic brain injuries in athletes: a systematic review with narrative synthesis}},
author = {Anna E. Bergauer and Fabio Richlan},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1929474},
url = {https://doi.org/10.3389/fneur.2026.1929474},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Multimodal brain imaging of mild traumatic brain injuries in athletes: a systematic review with narrative synthesis
AU - Anna E. Bergauer
AU - Fabio Richlan
PY - 2026
DA - 2026/10/23
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1929474
UR - https://doi.org/10.3389/fneur.2026.1929474
AB - Mild traumatic brain injury (mTBI) is a neurological event caused by external mechanical force to the head. Athletes in contact sports are at particular risk for repeated mTBI, which may result in cognitive symptoms and long-term adverse health outcomes. So far, neither diagnostic, prognostic, nor predictive biomarkers have been validated, and conventionally used radiological methods such as computed tomography and magnetic resonance imaging (MRI) have limited sensitivity to the subtle functional, metabolic, and microstructural abnormalities following mTBI. Moreover, research is challenged by the heterogeneous nature of mTBI and comorbid psychiatric conditions. To address these limitations, multimodal brain imaging studies appear promising. This study systematically reviewed multimodal imaging studies of athletes and narratively synthesized key neuroimaging findings. The databases Web of Science and PubMed (MEDLINE) were searched between January and August 2026 (all years). Studies were eligible if they included athletes with mTBI and acquired two or more complementary imaging modalities within the same participants using cross-sectional or longitudinal designs. Fourteen studies were included in the systematic review with a narrative synthesis. Risk of bias was assessed using the Newcastle-Ottawa Scale. The main modalities used were functional MRI, arterial spin labeling, diffusion tensor imaging, and magnetic resonance spectroscopy, assessing changes in functional connectivity, cerebral blood flow (CBF), diffusion metrics, and brain metabolites, respectively. No study, however, combined MRI-based and electrophysiological methods. Significant alterations in functional connectivity, diffusion metrics, CBF, and brain metabolites were reported at assessment time points beyond the acute phase. Nonetheless, no consistent neuroimaging pattern emerged due to clinical and methodological heterogeneity. To strengthen biomarker research, future studies should aim to implement standardized, longitudinal study designs that include baseline assessments followed by multimodal data fusion analyses.Systematic review registrationThe details of the OSF project are: doi: 10.17605/OSF.IO/R5B6S, https://osf.io/r5b6s/overview?view_only=9c2267f359474efc93a9ca67cf99ed57.
SN - 1664-2295
ER -