Role Of Task-Based Functional MRI in the Assessment of Sports-Related Concussion: A Systematic Review

Abstract

Sport-related concussion (SRC) is a common and complex brain injury with variable recovery trajectories. The clinical assessment for SRC involves a comprehensive assessment of symptoms and cognitive, visual and motor function, with tools such as the Sport Concussion Assessment Tool (SCAT) integrating these components for diagnosis and monitoring. Task-based functional magnetic resonance imaging (tb-fMRI) has emerged as a potential tool to evaluate functional brain changes post-concussion. A systematic review was conducted according to PRISMA guidelines. Five databases were searched for original research studies up until July 2025 reporting tb-fMRI outcomes in SRC. Of 1,130 records identified, plus 9 through manual searching, 15 studies met the inclusion/exclusion criteria for full text review, encompassing 273 SRC patients with an age range of 9-37 years old. A meta-analysis was not possible since numerical data was largely absent in studies. Across the studies, tb-fMRI revealed different patterns of altered brain activation, including both hypoactivation and hyperactivation during cognitive and sensorimotor tasks. Importantly, several studies showed altered activation persisted beyond symptom resolution. Task-based fMRI demonstrates consistent alterations in brain activity following SRC, particularly within frontoparietal networks. However, tb-fMRI findings were heterogeneous, sample sizes were small and clinical applications such as return-to-play decisions based on functional imaging are not yet validated. To date, tb-fMRI provides no insights into post-concussive brain function but remains an investigational tool and hence, larger, standardized and longitudinal studies are needed to establish its clinical reproducibility and diagnostic utility.