{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T22:24:53Z","timestamp":1791066293060,"version":"4.1.0"},"reference-count":120,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2021,7,22]],"date-time":"2021-07-22T00:00:00Z","timestamp":1626912000000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"James Drake and The Drake Foundation"},{"name":"European Research Area Network","award":["MR\/R004528\/1"],"award-info":[{"award-number":["MR\/R004528\/1"]}]},{"name":"National Institute of Health Research Professorship","award":["NIHR-RP-011-048"],"award-info":[{"award-number":["NIHR-RP-011-048"]}]},{"name":"Medical Research Council through a Clinician Scientist Fellowship"},{"name":"National Institute of Health Research Clinical Research Facility and Biomedical Research Centre at Imperial College Healthcare NHS Trust"},{"name":"Care Research and Technology Centre, UK Dementia Research Institute and the Royal British Legion Centre for Blast Injury Studies"},{"name":"Dementia Research Institute Ltd"},{"name":"UK Medical Research Council, Alzheimer\u2019s Society and Alzheimer\u2019s Research UK"},{"name":"Alzheimer\u2019s Research UK Clinical Research Fellowship","award":["ARUK-CRF2017A-1"],"award-info":[{"award-number":["ARUK-CRF2017A-1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The recognition, diagnosis and management of mild traumatic brain injuries are difficult and confusing. It is unclear how the severity and number of injuries sustained relate to brain injuries, such as diffuse axonal injury, diffuse vascular injury and progressive neurodegeneration. Advances in neuroimaging techniques enable the investigation of neuropathologies associated with acute and long-term effects of injury. Head injuries are the most commonly reported injury seen during professional rugby. There is increased vigilance for the immediate effects of these injuries in matches, but there has been surprisingly little research investigating the longer-term effects of rugby participation. Here, we present a longitudinal observational study investigating the relationship of exposure to rugby participation and sub-acute head injuries in professional adult male and female rugby union and league players using advanced MRI. Diffusion tensor imaging and susceptibility weighted imaging was used to assess white matter structure and evidence of axonal and diffuse vascular injury. We also studied changes in brain structure over time using Jacobian Determinant statistics extracted from serial volumetric imaging. We tested 41 male and 3 female adult elite rugby players, of whom 21 attended study visits after a head injury, alongside 32 non-sporting controls, 15 non-collision-sport athletic controls and 16 longitudinally assessed controls. Eighteen rugby players participated in the longitudinal arm of the study, with a second visit at least 6\u2009months after their first scan. Neuroimaging evidence of either axonal injury or diffuse vascular injury was present in 23% (10\/44) of players. In the non-acutely injured group of rugby players, abnormalities of fractional anisotropy and other diffusion measures were seen. In contrast, non-collision-sport athletic controls were not classified as showing abnormalities. A group level contrast also showed evidence of sub-acute injury using diffusion tensor imaging in rugby players. Examination of longitudinal imaging revealed unexpected reductions in white matter volume in the elite rugby players studied. These changes were not related to self-reported head injury history or neuropsychological test scores and might indicate excess neurodegeneration in white matter tracts affected by injury. Taken together, our findings suggest an association of participation in elite adult rugby with changes in brain structure. Further well-designed large-scale studies are needed to understand the impact of both repeated sports-related head impacts and head injuries on brain structure, and to clarify whether the abnormalities we have observed are related to an increased risk of neurodegenerative disease and impaired neurocognitive function following elite rugby participation.<\/jats:p>","DOI":"10.1093\/braincomms\/fcab133","type":"journal-article","created":{"date-parts":[[2021,6,11]],"date-time":"2021-06-11T19:22:18Z","timestamp":1623439338000},"source":"Crossref","is-referenced-by-count":43,"title":["White matter abnormalities in active elite adult rugby players"],"prefix":"10.1093","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1239-3414","authenticated-orcid":false,"given":"Karl A","family":"Zimmerman","sequence":"first","affiliation":[{"name":"Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK"},{"name":"Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4302-9252","authenticated-orcid":false,"given":"Etienne","family":"Laverse","sequence":"additional","affiliation":[{"name":"Department of Clinical and Movement Neuroscience, University College London, London NW3 2PF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravjeet","family":"Samra","sequence":"additional","affiliation":[{"name":"Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5187-2501","authenticated-orcid":false,"given":"Maria","family":"Yanez Lopez","sequence":"additional","affiliation":[{"name":"Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King\u2019s College London, London SE1 7EH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7413-9772","authenticated-orcid":false,"given":"Amy E","family":"Jolly","sequence":"additional","affiliation":[{"name":"Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK"},{"name":"Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6478-1430","authenticated-orcid":false,"given":"Niall J","family":"Bourke","sequence":"additional","affiliation":[{"name":"Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK"},{"name":"Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0183-3368","authenticated-orcid":false,"given":"Neil S N","family":"Graham","sequence":"additional","affiliation":[{"name":"Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK"},{"name":"Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maneesh C","family":"Patel","sequence":"additional","affiliation":[{"name":"Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Hardy","sequence":"additional","affiliation":[{"name":"Department of Neurodegenerative Disease, Reta Lila Weston Laboratories, Queen Square Genomics, UCL Dementia Research Institute, London WC1N 3BG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3250-2713","authenticated-orcid":false,"given":"Simon","family":"Kemp","sequence":"additional","affiliation":[{"name":"Rugby Football Union, Twickenham, London TW2 7BA, UK"},{"name":"Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5473-3774","authenticated-orcid":false,"given":"Huw R","family":"Morris","sequence":"additional","affiliation":[{"name":"Department of Clinical and Movement Neuroscience, University College London, London NW3 2PF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4995-2240","authenticated-orcid":false,"given":"David J","family":"Sharp","sequence":"additional","affiliation":[{"name":"Computational, Cognitive and Clinical 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