Role of task-based functional MRI in the assessment of sport-related concussion: a systematic review

Introduction: Sport-related concussion (SRC) is a common and complex brain injury with variable recovery trajectories. The clinical assessment for SRC involves 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.

Methods: A systematic review was conducted according to PRISMA guidelines. Five databases (Medline, Embase, PsycINFO, Scopus, Web of Science) were searched for original research studies up to July 2025 reporting tb-fMRI outcomes in SRC. Eligible studies included human participants with SRC undergoing tb-fMRI.

Results: 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 suggesting functional recovery may lag behind clinical improvement.

Conclusions: 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 valuable 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.