MRI & MRA brain scanning

Safe MMA are working together with fighters and promoters to try to make MMA as safe as it can be. As part of that process you may be asked to undergo an MRI of the brain, and in some cases an MRA of the intracranial blood vessels also. Before you agree to have a brain scan, you should be aware that it may show changes which could need further investigation.

The Good and Bad

Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) are types of scan that use strong magnetic fields and radio waves to produce very detailed images of the inside of the body. MRI is the best way to look at soft tissues, such as the brain and spinal cord, and MRA gives a clear picture of the blood vessels in the brain. Neither MRI nor MRA involves exposure to radiation.

On the downside, MR tests are expensive and take a long time to perform. The patient has to stay very still during the scan, as even slight movement could distort the pictures. MRI is a modern test which is very good at picking up abnormalities. It is also good at picking up unexpected, small or subtle changes – often called incidental findings. A lot of people have incidental findings on their MRI brain scans. These are more common as people get older. 

The scans however cannot always tell us what these incidental findings mean. In order to ascertain what an incidental finding means for each individual they must be further examined and most likely have further testing of their brain function. These results along with other individual factors like age, past medical history, family history as well as their participation in combat sports are then looked at as a whole to establish what the changes seen mean for that person both in the short and the long term.

Broadly there are 4 types of incidental findings:

• The vast majority of incidental findings are of no consequence to the patient, and will never cause any problems.
• Many findings may need further investigation or more scans to make sure that 
  everything is fine. 
• Some incidental findings can be associated with the development of symptoms in the future. It may be that Drs want to repeat the tests after a time interval to see if things are changing (most importantly worsening) and if so at what speed. 
• A very tiny proportion of incidental findings could stop you from participating in contact sports, or could be life-threatening and may need intervention.

If your MRI has shown an abnormality or incidental finding it can be worrying and confusing. We recommend that you see a neurologist who can carry out further testing and give you individual advice. This may be required before you are cleared to fight.

CTE in MMA

What is CTE?

If you are involved in MMA, you have likely heard of chronic traumatic encephalopathy (CTE). It is a degenerative brain disease found in people with a history of repeated impacts to the head over years. This may be from sport, military service, or domestic violence. CTE is caused by the clumping of tau protein in the brain. 

What happens to the brain in a head impact?

When the brain moves within the skull it causes trauma. The tissue accelerates and decelerates causing stretching, shearing, and tearing of the brain tissue. The brain also collides with the inside of the skull both at the site of impact and the opposite side. A protein called tau is released in the brain as a result. Clumps or tangles of tau can collect between brain cells and stop normal communication between the cells. 

Previously it was thought that only head trauma that was enough to cause symptoms (like headaches, dizziness, seeing stars or blacking out) would release tau protein. Now evidence shows that impacts to the head, which do not produce any symptoms can also cause tau protein releases. 

How do I know if I have CTE?

There is no easy method for diagnosing CTE. It can only be officially diagnosed after death by analysing the brain tissue. Symptoms in people thought to have CTE include mood and behaviour changes, frequent headaches, impaired judgement, and memory problems. Scientists are working to find biomarkers for CTE which could lead to blood tests being developed to help assess the risk of a person developing CTE as well as whether their brain is already exhibiting signs of tau entanglements.

Not everyone who has suffered repetitive hits to the head will develop CTE. There are several risk factors that make some people more prone to develop CTE than others, including greater number of years of head trauma, younger age at which head trauma started as well as other genetic and environmental factors. The disease gets worse over time. There is no cure for CTE so treatments involve helping patients to manage their symptoms.

What can I do to decrease my changes of CTE?

You can lessen your risk by reducing the number of times you take impacts to the head. You may want to modify your training to limit the length and number of training sessions with head impact and including some complete rest days. Taking concussion seriously however mild is also important. This means stopping training, taking time to recover, and following guidelines regarding when and how to return to training. With ongoing research there may be changes to the rules of the sport to better protect fighters. 

Summary

CTE is caused by repeated head impact and leads to a progressive loss in brain function such as thinking behaviour and mood. It is not possible to predict who will develop CTE. There is no cure. You can minimise your chance of developing CTE by minimising the number of impacts you experience, giving yourself adequate recovery time following head injuries and seeking medical advice if you notice changes in your brain functioning.