RSNA Press Release

• Researchers used diffusion tensor imaging to determine if heading a soccer ball could cause brain injury.
• Players who most frequently headed the ball exhibited abnormalities in five brain regions.
• Players who headed the ball at least 1,000 to 1,500 times per year showed detectable white matter injury.

CHICAGO—Using diffusion tensor imaging (DTI) to study the effects of soccer 'heading,' researchers have found that players who head the ball with high frequency have brain abnormalities similar to those found in traumatic brain injury (TBI) patients. Results of their study were presented today at the annual meeting of the Radiological Society of North America (RSNA).

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Michael L. Lipton, M.D., Ph.D.

Heading, in which players field the soccer ball with their head, is an essential part of the game and the focus of many training drills.

"Heading a soccer ball is not an impact of a magnitude that will lacerate nerve fibers in the brain," said Michael L. Lipton, M.D., Ph.D., associate director of the Gruss Magnetic Resonance Research Center at the Albert Einstein College of Medicine and medical director of MRI services at Montefiore Medical Center in New York. "But repetitive heading could set off a cascade of responses that can lead to degeneration of brain cells."

DTI, an advanced magnetic resonance (MR) technique, allows researchers to assess microscopic changes in the brain's white matter, which is composed of millions of nerve fibers called axons that act like communication cables connecting various regions of the brain. DTI produces a measurement, called fractional anisotropy (FA), of the movement of water molecules along axons. In healthy white matter, the direction of water movement is fairly uniform and measures high in FA. When water movement is more random, FA values decrease.

"Abnormally low FA within white matter has been associated with cognitive impairment in patients with TBI," Dr. Lipton said.

Dr. Lipton and colleagues conducted DTI on 32 amateur soccer players (average age: 30.8 years), all of whom have played the sport since childhood. The researchers estimated how often each soccer player headed the ball on an annual basis and then ranked the players based on heading frequency. They then compared the brain images of the most frequent headers with those of the remaining players and identified areas of the brain where FA values differed significantly.

"Between the two groups, there were significant differences in FA in five brain regions in the frontal lobe and in the temporooccipital region," Dr. Lipton said. "Soccer players who headed most frequently had significantly lower FA in these brain regions."

The five regions identified by the researchers are responsible for attention, memory, executive functioning and higher-order visual functions.

To assess the relationship between the frequency of heading and white matter changes, the researchers also compared the magnitude of FA in each brain region with the frequency of heading in each soccer player.

"Our goal was to determine if there is a threshold level for heading frequency that, when surpassed, resulted in detectable white matter injury," Dr. Lipton said.

The analysis revealed a threshold level of approximately 1,000 to 1,500 heads per year. Once players in the study surpassed that level, researchers observed a significant decline in their FA in the five identified brain regions.

"What we've shown here is compelling evidence that there are brain changes that look like traumatic brain injury as a result of heading a soccer ball with high frequency," Dr. Lipton said. "Given that soccer is the most popular sport worldwide and is played extensively by children, these are findings that should be taken into consideration in order to protect soccer players."

Coauthors are Namhee Kim, Ph.D., Molly Zimmerman, Ph.D., Richard Lipton, M.D., Walter Stewart, Ph.D., Edwin Gulko, M.D., and Craig Branch, Ph.D.

Note: Copies of RSNA 2011 news releases and electronic images will be available online at RSNA.org/press11 beginning Monday, Nov. 28.

RSNA is an association of more than 48,000 radiologists, radiation oncologists, medical physicists and related scientists committed to excellence in patient care through education and research. The Society is based in Oak Brook, Ill. (RSNA.org)

Editor's note: The data in these releases may differ from those in the printed abstract and those actually presented at the meeting, as researchers continue to update their data right up until the meeting. To ensure you are using the most up-to-date information, please call the RSNA Newsroom at 1-312-949-3233.

For patient-friendly information on brain imaging, visit RadiologyInfo.org.

Press conference video

Video clips

• Video clip (1,110 KB)
  Study participant Peter Hiatrides shares his reaction after learning the effects of heading.
• Video clip (1,075 KB)
  Study participant Peter Hiatrides discusses symptoms that occur due to heading.
• Video clip (879 KB)
  Study participant Peter Hiatrides shares the importance of the study.
• Video clip (1,319 KB)
  Study participant Peter Hiatrides explains why safety gear is important when playing soccer.
• Video clip (537 KB)
  Study participant Peter Hiatrides shares what he believes athletes should be taught.
• Video clip (500 KB)
  Study participant Peter Hiatrides shares his advice to young athletes.
• Video clip (482 KB)
  Study participant Peter Hiatrides explains what he would do differently.
• Video clip (1,380 KB)
  Study participant Peter Hiatrides reveals how athletes can benefit from this study.
• Video clip (1,502 KB)
  Study participant Peter Hiatrides discusses his thoughts on how to include heading in soccer.
• Video clip (2,007 KB)
  Study participant Peter Hiatrides discusses the importance of knowing the long term effects of heading.
• Video clip (392 KB)
  Patient and radiologic technologist walking into MRI scanning room.
• Video clip (1,061 KB)
  MRI image of the head.
• Video clip (187 KB)
  Dr. Michael Lipton and radiologic technologist reviewing images.
• Video clip (714 KB)
  Dr. Michael Lipton reveals the findings of the study.
• Video clip (507 KB)
  Dr. Michael Lipton explains what the study involved.
• Video clip (888 KB)
  Dr. Michael Lipton shares his advice as it relates to heading.
• Video clip (949 KB)
  Dr. Michael Lipton discusses the possible key to prevention against brain injury.
• Video clip (874 KB)
  Dr. Michael Lipton discusses how to protect the brain against injury.
• Video clip (557 KB)
  Dr. Michael Lipton reveals the brain findings of the study.
• Video clip (577 KB)
  Dr. Michael Lipton describes traumatic brain injury.
• Video clip (498 KB)
  Dr. Michael Lipton discusses what the study examined.
• Video clip (531 KB)
  Dr. Michael Lipton discusses brain repair.
• Video clip (795 KB)
  Dr. Michael Lipton reveals treatment options for brain injury
• Video clip (650 KB)
  Dr. Michael Lipton describes diffusion tensor imaging (DTI).
• Video clip (1,771 KB)
  Dr. Michael Lipton discusses what diffusion tensor imaging (DTI) helps detect.
• Video clip (902 KB)
  Dr. Michael Lipton discusses why soccer players were studied.
• Video clip (1,110 KB)
  Dr. Michael Lipton discusses why soccer was selected to study.
• Video clip (646 KB)
  Dr. Michael Lipton describes the demographics of the patients studied.
• Video clip (1,070 KB)
  Dr. Michael Lipton describe the methodology of the study.
• Video clip (760 KB)
  Dr. Michael Lipton reveals the results of the study.
• Video clip (933 KB)
  Dr. Michael Lipton shares the findings of the study.
• Video clip (964 KB)
  Dr. Michael Lipton discusses the differences between the study participants and the findings related to heading.
• Video clip (1,000 KB)
  Dr. Michael Lipton reveals the next steps for the study.
• Video clip (933 KB)
  Dr. Michael Lipton reveals the next steps for the study as it relates to pediatric patients.
• Video clip (2,032 KB)
  Dr. Michael Lipton discusses brain injury prevention methods.
• Video clip (2,020 KB)
  Dr. Michael Lipton shares his recommendations to prevent brain injury.

Images (.JPG format)

Figure 1: Colored areas represent brain locations where more heading was associated with DTI abnormalities similar to those seen in traumatic brain injury affecting the white matter. High-res (TIF) version (Right-click and Save As)	Figure 2: As the number of heads per year (horizontal axis) increases, fractional anisotropy (FA; vertical axis), an indicator of microscopic integrity of the brain's white matter fibers, declines. The reverse “S” shape of this relationship (red line) indicates that only after exceeding just over 1,000 heads per year, does FA significantly decline. This pattern suggests that heading below this threshold may not lead to brain injury-like changes in the way that more excessive heading does. High-res (TIF) version (Right-click and Save As)	Figure 3: Philips Achieva 7.0 T MRI research system. High-res (TIF) version (Right-click and Save As)	Figure 4: Philips Achieva 7.0 T MRI research system. High-res (TIF) version (Right-click and Save As)
Figure 5: Philips Achieva 7.0 T MRI research system. High-res (TIF) version (Right-click and Save As)	Figure 6: Philips Achieva 7.0 T MRI research system. High-res (TIF) version (Right-click and Save As)	Figure 7: Philips 32 Channel Head Coil. High-res (TIF) version (Right-click and Save As)	Figure 8: Philips Sense Head Coil 32 Elements. High-res (TIF) version (Right-click and Save As)