Association between proteomic blood biomarkers and DTI/NODDI metrics in adolescent football players

The objective of the study was to examine the association between diffusion MRI techniques [diffusion tensor imaging (DTI) and neurite orientation/dispersion density imaging (NODDI)] and brain-injury blood biomarker levels [Tau, neurofilament-light (NfL), glial-fibrillary-acidic-protein (GFAP)] in high-school football and cross-country runners at their baseline, aiming to detect cumulative neuronal damage from prior seasons. Twenty-five football players and 8 cross-country runners underwent MRI and blood biomarker measures during preseason data collection. The whole-brain, tract-based spatial statistics was conducted for six diffusion metrics: fractional anisotropy (FA), mean diffusivity (MD), axial/radial diffusivity (AD, RD), neurite density index (NDI), and orientation dispersion index (ODI). Diffusion metrics and blood biomarker levels were compared between groups and associated within each group. The football group showed lower AD and MD than the cross-country group in various axonal tracts of the right hemisphere. Elevated ODI was observed in the football group in the right hemisphere of the corticospinal tract. Blood biomarker levels were consistent between groups except for elevated Tau levels in the cross-country group. Tau level was positively associated with MD and negatively associated with NDI in the corpus callosum of football players, but not in cross-country runners. Our data suggest that football players may develop axonal microstructural abnormality. Levels of MD and NDI in the corpus callosum were associated with serum Tau levels, highlighting the vulnerability of the corpus callosum against cumulative head impacts. Despite observing multimodal associations in some brain areas, neuroimaging and blood biomarkers may not strongly correlate to reflect the severity of brain damage.