Imaging the later-life white matter pathologies of repetitive head impacts: A novel pattern revealed through T2 FLAIR MRI

Jenna R. Groh; Annalise E. Miner; Mohamad J. Alshikho; Chad Farris; Anna Cui; Erika Pettway; Jacob Labonte; Sydney Mosaheb; Yorghos Tripodis; Charles H. Adler; Laura J. Balcer; Charles Bernick; Robert C. Cantu; Michael J. Coleman; David W. Dodick; Nicholas J. Ashton; Henrik Zetterberg; Kaj Blennow; Elaine R. Peskind; Christopher Nowinski; Monica Ly; Caroline Altaras; Steven Lenio; Gil D. Rabinovici; Breton Asken; Howard Rosen; Yann Cobigo; Jan Krzysztof Blusztajn; Andrew E. Budson; Katherine Turk; Wei Qiao Qiu; Lee Goldstein; Brett Martin; Joseph N. Palmisano; Diane Dixon; Greta Schneider; Eric G. Steinberg; Yi Su; Hillary Protas; Ofer Pasternak; Inga Koerte; Sylvain Bouix; Jeffrey L. Cummings; Eric M. Reiman; Martha E. Shenton; Robert A. Stern; Ann C. McKee; Thor D. Stein; Adam M. Brickman; Jesse Mez; Michael L. Alosco

doi:10.1002/alz.71351

Imaging the later-life white matter pathologies of repetitive head impacts: A novel pattern revealed through T2 FLAIR MRI

Jenna R. Groh
, Annalise E. Miner
, Mohamad J. Alshikho
, Chad Farris
, Anna Cui
, Erika Pettway
, Jacob Labonte
, Sydney Mosaheb
, Yorghos Tripodis
, Charles H. Adler
, Laura J. Balcer
, Charles Bernick
, Robert C. Cantu
, Michael J. Coleman
, David W. Dodick
, Nicholas J. Ashton
, Henrik Zetterberg
, Kaj Blennow
, Elaine R. Peskind
, Christopher Nowinski

Monica Ly, Caroline Altaras, Steven Lenio, Gil D. Rabinovici, Breton Asken, Howard Rosen, Yann Cobigo, Jan Krzysztof Blusztajn, Andrew E. Budson, Katherine Turk, Wei Qiao Qiu, Lee Goldstein, Brett Martin, Joseph N. Palmisano, Diane Dixon, Greta Schneider, Eric G. Steinberg, Yi Su, Hillary Protas, Ofer Pasternak, Inga Koerte, Sylvain Bouix, Jeffrey L. Cummings, Eric M. Reiman, Martha E. Shenton, Robert A. Stern, Ann C. McKee, Thor D. Stein, Adam M. Brickman, Jesse Mez, Michael L. Alosco

Boston University
Columbia University
Mayo Clinic Scottsdale, AZ
New York University
Cleveland Clinic Lou Ruvo Center for Brain Health
Massachusetts General Hospital
University of Gothenburg
Banner Health
University College London
Kong Center for Neurodegenerative Diseases
University of Wisconsin-Madison
Sahlgrenska University Hospital
University of Washington
Concussion Legacy Foundation
University of California at San Francisco
University of Florida
Department of Veterans Affairs
University of Nevada, Las Vegas
Translational Genomics Research Institute
University of Arizona
Harvard University
VA Bedford Healthcare System
Framingham Heart Study

Research output: Contribution to journal › Journal Article › peer-review

Abstract

INTRODUCTION: Repetitive head impacts (RHI) from contact sports may cause a unique pattern of white matter hyperintensities (WMH) on T2-weighted fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI), termed RHI-associated WMH (RHI-WMH). These lesions are punctate, circular, and located at the gray–white matter boundary, an area vulnerable to trauma-related damage. METHODS: We investigated the association of RHI with these lesions in two aging cohorts: (1) former American football players versus asymptomatic unexposed men and (2) individuals with RHI from various contact sports versus non-RHI participants. RHI-WMH were assessed using visual ratings and a novel automated quantification pipeline. RESULTS: Individuals with RHI had greater RHI-WMH by both detection methods in both cohorts. RHI-WMH were associated with plasma neurofilament light and p-tau231, and flortaucipir positron emission tomography (PET) uptake. DISCUSSION: RHI-WMH may represent a new supportive biomarker for the detection of RHI-related neuropathologies later in life.

Original language	English
Article number	e71351
Journal	Alzheimer's and Dementia
Volume	22
Issue number	4
DOIs	https://doi.org/10.1002/alz.71351
Publication status	Published - Apr 2026

!!!Keywords

CTE
head injury
repetitive head impacts
sports
white matter injury

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10.1002/alz.71351

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Groh, J. R., Miner, A. E., Alshikho, M. J., Farris, C., Cui, A., Pettway, E., Labonte, J., Mosaheb, S., Tripodis, Y., Adler, C. H., Balcer, L. J., Bernick, C., Cantu, R. C., Coleman, M. J., Dodick, D. W., Ashton, N. J., Zetterberg, H., Blennow, K., Peskind, E. R., ... Alosco, M. L. (2026). Imaging the later-life white matter pathologies of repetitive head impacts: A novel pattern revealed through T2 FLAIR MRI. Alzheimer's and Dementia, 22(4), Article e71351. https://doi.org/10.1002/alz.71351

@article{ee147634a2da4fc7b353521039e4b780,

title = "Imaging the later-life white matter pathologies of repetitive head impacts: A novel pattern revealed through T2 FLAIR MRI",

abstract = "INTRODUCTION: Repetitive head impacts (RHI) from contact sports may cause a unique pattern of white matter hyperintensities (WMH) on T2-weighted fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI), termed RHI-associated WMH (RHI-WMH). These lesions are punctate, circular, and located at the gray–white matter boundary, an area vulnerable to trauma-related damage. METHODS: We investigated the association of RHI with these lesions in two aging cohorts: (1) former American football players versus asymptomatic unexposed men and (2) individuals with RHI from various contact sports versus non-RHI participants. RHI-WMH were assessed using visual ratings and a novel automated quantification pipeline. RESULTS: Individuals with RHI had greater RHI-WMH by both detection methods in both cohorts. RHI-WMH were associated with plasma neurofilament light and p-tau231, and flortaucipir positron emission tomography (PET) uptake. DISCUSSION: RHI-WMH may represent a new supportive biomarker for the detection of RHI-related neuropathologies later in life.",

keywords = "CTE, head injury, repetitive head impacts, sports, white matter injury",

author = "Groh, \{Jenna R.\} and Miner, \{Annalise E.\} and Alshikho, \{Mohamad J.\} and Chad Farris and Anna Cui and Erika Pettway and Jacob Labonte and Sydney Mosaheb and Yorghos Tripodis and Adler, \{Charles H.\} and Balcer, \{Laura J.\} and Charles Bernick and Cantu, \{Robert C.\} and Coleman, \{Michael J.\} and Dodick, \{David W.\} and Ashton, \{Nicholas J.\} and Henrik Zetterberg and Kaj Blennow and Peskind, \{Elaine R.\} and Christopher Nowinski and Monica Ly and Caroline Altaras and Steven Lenio and Rabinovici, \{Gil D.\} and Breton Asken and Howard Rosen and Yann Cobigo and Blusztajn, \{Jan Krzysztof\} and Budson, \{Andrew E.\} and Katherine Turk and Qiu, \{Wei Qiao\} and Lee Goldstein and Brett Martin and Palmisano, \{Joseph N.\} and Diane Dixon and Greta Schneider and Steinberg, \{Eric G.\} and Yi Su and Hillary Protas and Ofer Pasternak and Inga Koerte and Sylvain Bouix and Cummings, \{Jeffrey L.\} and Reiman, \{Eric M.\} and Shenton, \{Martha E.\} and Stern, \{Robert A.\} and McKee, \{Ann C.\} and Stein, \{Thor D.\} and Brickman, \{Adam M.\} and Jesse Mez and Alosco, \{Michael L.\}",

note = "Publisher Copyright: {\textcopyright} 2026 The Author(s). Alzheimer's \& Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.",

year = "2026",

month = apr,

doi = "10.1002/alz.71351",

language = "English",

volume = "22",

journal = "Alzheimer's and Dementia",

issn = "1552-5260",

publisher = "John Wiley and Sons Inc",

number = "4",

}

Groh, JR, Miner, AE, Alshikho, MJ, Farris, C, Cui, A, Pettway, E, Labonte, J, Mosaheb, S, Tripodis, Y, Adler, CH, Balcer, LJ, Bernick, C, Cantu, RC, Coleman, MJ, Dodick, DW, Ashton, NJ, Zetterberg, H, Blennow, K, Peskind, ER, Nowinski, C, Ly, M, Altaras, C, Lenio, S, Rabinovici, GD, Asken, B, Rosen, H, Cobigo, Y, Blusztajn, JK, Budson, AE, Turk, K, Qiu, WQ, Goldstein, L, Martin, B, Palmisano, JN, Dixon, D, Schneider, G, Steinberg, EG, Su, Y, Protas, H, Pasternak, O, Koerte, I, Bouix, S, Cummings, JL, Reiman, EM, Shenton, ME, Stern, RA, McKee, AC, Stein, TD, Brickman, AM, Mez, J & Alosco, ML 2026, 'Imaging the later-life white matter pathologies of repetitive head impacts: A novel pattern revealed through T2 FLAIR MRI', Alzheimer's and Dementia, vol. 22, no. 4, e71351. https://doi.org/10.1002/alz.71351

TY - JOUR

T1 - Imaging the later-life white matter pathologies of repetitive head impacts

T2 - A novel pattern revealed through T2 FLAIR MRI

AU - Groh, Jenna R.

AU - Miner, Annalise E.

AU - Alshikho, Mohamad J.

AU - Farris, Chad

AU - Cui, Anna

AU - Pettway, Erika

AU - Labonte, Jacob

AU - Mosaheb, Sydney

AU - Tripodis, Yorghos

AU - Adler, Charles H.

AU - Balcer, Laura J.

AU - Bernick, Charles

AU - Cantu, Robert C.

AU - Coleman, Michael J.

AU - Dodick, David W.

AU - Ashton, Nicholas J.

AU - Zetterberg, Henrik

AU - Blennow, Kaj

AU - Peskind, Elaine R.

AU - Nowinski, Christopher

AU - Ly, Monica

AU - Altaras, Caroline

AU - Lenio, Steven

AU - Rabinovici, Gil D.

AU - Asken, Breton

AU - Rosen, Howard

AU - Cobigo, Yann

AU - Blusztajn, Jan Krzysztof

AU - Budson, Andrew E.

AU - Turk, Katherine

AU - Qiu, Wei Qiao

AU - Goldstein, Lee

AU - Martin, Brett

AU - Palmisano, Joseph N.

AU - Dixon, Diane

AU - Schneider, Greta

AU - Steinberg, Eric G.

AU - Su, Yi

AU - Protas, Hillary

AU - Pasternak, Ofer

AU - Koerte, Inga

AU - Bouix, Sylvain

AU - Cummings, Jeffrey L.

AU - Reiman, Eric M.

AU - Shenton, Martha E.

AU - Stern, Robert A.

AU - McKee, Ann C.

AU - Stein, Thor D.

AU - Brickman, Adam M.

AU - Mez, Jesse

AU - Alosco, Michael L.

PY - 2026/4

Y1 - 2026/4

N2 - INTRODUCTION: Repetitive head impacts (RHI) from contact sports may cause a unique pattern of white matter hyperintensities (WMH) on T2-weighted fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI), termed RHI-associated WMH (RHI-WMH). These lesions are punctate, circular, and located at the gray–white matter boundary, an area vulnerable to trauma-related damage. METHODS: We investigated the association of RHI with these lesions in two aging cohorts: (1) former American football players versus asymptomatic unexposed men and (2) individuals with RHI from various contact sports versus non-RHI participants. RHI-WMH were assessed using visual ratings and a novel automated quantification pipeline. RESULTS: Individuals with RHI had greater RHI-WMH by both detection methods in both cohorts. RHI-WMH were associated with plasma neurofilament light and p-tau231, and flortaucipir positron emission tomography (PET) uptake. DISCUSSION: RHI-WMH may represent a new supportive biomarker for the detection of RHI-related neuropathologies later in life.

AB - INTRODUCTION: Repetitive head impacts (RHI) from contact sports may cause a unique pattern of white matter hyperintensities (WMH) on T2-weighted fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI), termed RHI-associated WMH (RHI-WMH). These lesions are punctate, circular, and located at the gray–white matter boundary, an area vulnerable to trauma-related damage. METHODS: We investigated the association of RHI with these lesions in two aging cohorts: (1) former American football players versus asymptomatic unexposed men and (2) individuals with RHI from various contact sports versus non-RHI participants. RHI-WMH were assessed using visual ratings and a novel automated quantification pipeline. RESULTS: Individuals with RHI had greater RHI-WMH by both detection methods in both cohorts. RHI-WMH were associated with plasma neurofilament light and p-tau231, and flortaucipir positron emission tomography (PET) uptake. DISCUSSION: RHI-WMH may represent a new supportive biomarker for the detection of RHI-related neuropathologies later in life.

KW - CTE

KW - head injury

KW - repetitive head impacts

KW - sports

KW - white matter injury

UR - https://www.scopus.com/pages/publications/105036138697

U2 - 10.1002/alz.71351

DO - 10.1002/alz.71351

M3 - Journal Article

C2 - 42002804

AN - SCOPUS:105036138697

SN - 1552-5260

VL - 22

JO - Alzheimer's and Dementia

JF - Alzheimer's and Dementia

IS - 4

M1 - e71351

ER -

Imaging the later-life white matter pathologies of repetitive head impacts: A novel pattern revealed through T2 FLAIR MRI

Abstract

!!!Keywords

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