Localizing Sports-related Concussion and Characterizing Recovery Trajectories with Multimodal Brain Imaging

This case report uses magnetoencephalography (MEG), electroencephalography (EEG), diffusion kurtosis imaging (DKI), pseudo-continuous arterial spin labelling (pCASL), and resting-state functional MRI (rs-fMRI) to compare female, high-school soccer dizygotic twins who differed in recent concussion history. One twin, "Twin A", sustained her first clinically diagnosed concussion 72 hours before baseline imaging. "Twin B" was not concussed and served as a control for Twin A. Participants completed clinical, neuropsychological, and neurophysiological assessments at baseline (T1), 1 month (T2), and 3 months (T3) timepoints. Imaging and electrophysiology were acquired using a harmonized protocol across modalities. MEG was collected with a MEGIN Triux Neo whole-head system, and 64-channel EEG was acquired simultaneously. MRI was conducted on a 3T Siemens Prisma scanner following the Adolescent Brain Cognitive Development (ABCD) protocol. DKI was processed using FSL to generate fractional anisotropy and mean diffusivity maps. pCASL was analyzed using BASIL to estimate cerebral blood flow. rs-fMRI preprocessing and denoising were performed in CONN, and voxel-wise power spectral density (0.01-0.1 Hz) was computed to quantify low-frequency oscillatory activity. Twin A demonstrated acute symptoms, left frontal hypoperfusion, reduced rs-fMRI power, and increased low-frequency electrophysiological activity at T1, with gradual recovery across modalities. Twin B exhibited stable findings across all assessments. Our findings highlight the potential of multimodal brain imaging to localize sports-related concussion and to help inform return-to-play decisions.