MRI Study Reveals Potential Biomarkers for Early CTE Risk in Living Athletes

In a promising development for diagnosing chronic traumatic encephalopathy (CTE) before death, researchers have identified structural brain changes visible on MRI that may serve as early indicators of the disease in living individuals. The findings, published in Brain Communications, suggest that specific changes in brain sulcal morphology—particularly in athletes with a history of repetitive head trauma—could help flag those at increased risk for developing CTE.

CTE, a progressive and often devastating neurodegenerative disorder, is currently only diagnosed postmortem through the analysis of brain tissue. This limitation has long obstructed efforts to track its development in real time or explore treatment strategies for those most at risk. But the new study, led by researchers at NYU Grossman School of Medicine, offers a possible path forward.

“Chronic traumatic encephalopathy is defined by the abnormal accumulation of phosphorylated tau protein, particularly at the depths of the superior frontal sulci, suggesting that sulcal morphology may serve as a relevant structural biomarker,” explained senior author Hector Arciniega, PhD, assistant professor in NYU’s Department of Rehabilitation Medicine.

The study analyzed MRI data from 169 former college and professional football players and compared them with 54 control subjects—men with no history of contact sports or military service. Researchers focused on examining sulcal structures—grooves in the brain’s surface—known to be involved in the development of CTE.

Their analysis revealed that the football players exhibited significantly shallower left superior frontal sulci, a brain region previously linked to tau protein buildup in confirmed cases of CTE. In addition, players with longer careers in the sport also showed widening of the left occipitotemporal sulcus, suggesting a relationship between extended exposure to head trauma and the extent of structural change.

Interestingly, these sulcal changes did not correlate with other clinical measures such as neuropsychological performance or tau-PET imaging, highlighting the potential of sulcal morphology as a unique and early-stage marker.

“Our study shows what we believe can be the first structural differences that tell apart brains more at risk of developing chronic traumatic encephalopathy from the brains of people who are less at risk,” said Arciniega. “The work also proves that we can apply what we know about the physical changes observed postmortem in the brains of those with confirmed chronic traumatic encephalopathy to brain scans of living people at increased risk for it.”

Despite the encouraging results, the study also raises new questions. The researchers were unable to explain why only the left hemisphere of the brain appeared to show these structural differences or why the anatomical findings were not mirrored by cognitive testing. The team intends to expand their research to other brain regions in an effort to deepen their understanding.

As concerns grow over long-term brain health in contact sport athletes, this study represents a key step toward identifying at-risk individuals during their lifetimes—potentially opening the door for earlier intervention, monitoring, or even preventative strategies in the future.