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Acute concussion precipitates a transient reduction in cerebral blood flow (CBF) that typically returns to pre\u2010injury levels. Recent work suggests that long\u2010term CBF alterations may be sex\u2010specific. We assessed whether concussion history was associated with chronic CBF alterations and whether sex moderated this relationship in otherwise healthy, active collegiate\u2010aged athletes. Collegiate\u2010aged athletes from the community (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u2009204, 37.8% female,\n                    <jats:italic>M<\/jats:italic>\n                    <jats:sub>age<\/jats:sub>\n                    \u2009=\u200921.0\u2009\u00b1\u20091.7) underwent magnetic resonance imaging with pseudo\u2010continuous arterial spin labeling to quantify global and regional CBF and spatial coefficient of variation. Participants also completed measures of depression, anxiety, and cognition. Multiple linear regressions incorporating prior concussion\u2010by\u2010sex interaction terms adjusted for relevant covariates were fit to estimate the extent to which sex moderated the concussion history\u2014CBF relationship. Exploratory analyses further assessed whether oral contraceptive use or pill formulation moderated this association in females. The number of prior concussions was negatively associated with global and regional gray\u2010matter CBF in female but not male athletes, with the strongest associations localizing to frontotemporal regions. CBF metrics were not related to cognitive performance or affective symptom burden. Contraceptive use did not appear to substantially moderate the concussion history\u2014CBF association in female athletes. Female\u2010specific associations between concussion history and cerebral hypoperfusion in early adulthood suggest potential sex differences in pathways and trajectories of adverse long\u2010term outcomes. Early chronic CBF alterations may represent one vulnerability to future risk in a sex\u2010specific manner.\n                  <\/jats:p>","DOI":"10.1002\/hbm.70584","type":"journal-article","created":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T06:18:52Z","timestamp":1781936332000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reduced Cerebral Blood Flow in the Early Chronic Phase of Recurrent Concussion Among Female Collegiate\u2010Aged Athletes"],"prefix":"10.1002","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4753-016X","authenticated-orcid":false,"given":"Mitchell J.","family":"Andersson","sequence":"first","affiliation":[{"name":"Department of Neurosurgery Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1541-9002","authenticated-orcid":false,"given":"Bryna D.","family":"Goeckner","sequence":"additional","affiliation":[{"name":"Department of Biophysics Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6466-4653","authenticated-orcid":false,"given":"Lezlie Y.","family":"Espa\u00f1a","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2396-5609","authenticated-orcid":false,"given":"Andrew R.","family":"Mayer","sequence":"additional","affiliation":[{"name":"The Mind Research Network\/Lovelace Biomedical Research Institute  Albuquerque New Mexico USA"},{"name":"Neurology Department University of New Mexico School of Medicine  Albuquerque New Mexico USA"},{"name":"Psychiatry Department University of New Mexico School of Medicine  Albuquerque New Mexico USA"},{"name":"Psychology Department University of New Mexico School of Medicine  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2849-4658","authenticated-orcid":false,"given":"Benjamin L.","family":"Brett","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Medical College of Wisconsin  Milwaukee Wisconsin USA"},{"name":"Department of Neurology Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4495-2754","authenticated-orcid":false,"given":"Timothy B.","family":"Meier","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Medical College of Wisconsin  Milwaukee Wisconsin USA"},{"name":"Department of Biomedical Engineering Medical College of Wisconsin  Milwaukee Wisconsin USA"},{"name":"Department of Cell Biology Neurobiology and Anatomy, Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001199-199309000-00010"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13102\u2010024\u201000989\u20100"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2011.10.025"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/10738584211012264"},{"key":"e_1_2_11_6_1","volume-title":"Beck Anxiety Inventory","author":"Beck A. 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