A revised visual grading scale of the cavum septi pellucidi in contact-collision sport athletes with repetitive head impacts
Year: 2026
Type: article
Study design: Observational Study
Abstract: The cavum septi pellucidi (CSP), a persistent separation between the septal leaflets in the brain, is found among athletes exposed to repetitive head impacts (RHI), yet existing grading systems may inadequately capture anatomical variants. This study presents a revised CSP grading scale for RHI-exposed populations. This cross-sectional study included 170 former American football players and 54 unexposed asymptomatic controls, all males aged 45-74, who underwent magnetic resonance imaging. Two blinded raters independently applied a revised 5-point CSP grading scale, with reliability assessed using Cohen’s κ. CSP length and volume were quantified, and associations with cumulative head impact exposure were examined. Multivariable ordinal logistic regression compared CSP grades between former football players and controls. Following consensus ratings, former football players demonstrated significantly greater odds of being classified into a higher CSP grade than unexposed controls (OR = 4.41, [95% CI: 2.34, 8.31], p < 0.001). CSP length and volume increased across CSP grade (both p < 0.001), supporting the anatomical validity of the revised grading system. Among former football players, estimated cumulative linear and rotational head impact exposures differed significantly across CSP grades (Kruskal–Wallis p = 0.007 and p < 0.001, respectively), with Grade 4 showing greater exposure than Grade 0. A revised CSP grading scale incorporating posterior variants shows high inter-rater reliability and concordance with quantitative measures in RHI-exposed athletes. More severe CSP morphology was associated with greater cumulative biomechanical exposure, and the revised grading system enables consistent classification of CSP morphology for future RHI studies. A small fluid-filled space in the brain called the cavum septi pellucidi (CSP) is often seen on MRI scans of athletes with histories of repeated head impacts (RHI). However, existing visual grading systems may miss forms of CSP, especially when it extends toward the back of the brain. We developed a revised 5-point MRI grading scale and tested it in 170 former American football players and 54 unexposed controls without a history of RHI. The new scale matched precise CSP size measurements and showed strong rater agreement. More severe CSP grades were associated with lifetime head-impact exposure, suggesting that RHI may contribute to these brain changes and serve as a better tool for long-term brain health research. Mirmajlesi, Stearns, Szekely et al. present a revised cavum septum pellucidum grading scale for individuals exposed to repetitive head impacts. They find that cavum septum pellucidum volume and length increased with grade, and that more severe grades were associated with greater repetitive head impact exposure.
Source: Communications Medicine
Authors: Anya S. Mirmajlesi, Jared Stearns, Brian Szekely, Manuel Estrada, Rebecca D. Folkerth, Sylvain Bouix, Daniel H. Daneshvar, Charles H. Adler, Charles Bernick, Laura J. Balcer, Jeffrey L. Cummings, Eric M. Reiman, Robert A. Stern, Martha E. Shenton, Richard J. Rushmore, Hector Arciniega, Yi Su, Kewei Chen, Hillary Protas, Conni Boker, Rhoda Au, Robert C. Cantu, Lindsay Farrer, Robert Helm, Neil Kowall, Gustavo Mercier, James Otis, Jason Weller, Irene Simkin, Alondra Andino, Shannon Conneely, Courtney Diamond, Olivia Haller, Tennyson Hung, Nicole Gullotti, Megan Mariani, Brian Mayville, Kathleen McLaughlin, Mary Nanna, Taylor Platt, Sury Pulukuri, Fiona Rica, Madison Sestak, Michael McClean, Douglas Annis, Christine Chaisson, Carolyn Finney, Kerrin Gallagher, Kaitlin Hartlage, Jun Lu, Brett Martin, Emmanuel Ojo, Joseph N. Palmisano, Brittany Pine, Janani Ramachandran, Jennifer Fitzsimmons, Elena M. Bonke, Katherine Breedlove, Eduardo Coello, Hujiun Liao, Elizabeth Rizzoni, Vivian Schultz, Annelise Silva, Brynn Vessey, Sarah Banks, Jason Miller, Aaron Ritter, Marwan Sabbagh, Raelynn de la Cruz, Jan Durant, Morgan Golceker, Nicolette Harmon, Kaeson Kaylegian, Rachelle Long, Priscilla Sandoval, Robert W. Turner, Kenneth L. Marek, Andrew Serrano, David W. Dodick, Yonas Geda, Jennifer V. Wethe, Bryce Falk, Amy Duffy, Marci Howard, Michelle Montague, Thomas Osgood, Debra Babcock, William Barr, Judith Goldberg, Thomas Wisniewski, Ivian Kirov, Yvonne Lui, Charles Marmar, Lisene Hasanaj, Liliana Serrano, Alhassan Al-Kharafi, Sammie Martin, Edward Riley, William Runge, Elaine R. Peskind, Elizabeth Colasurdo, Daniel S. Marcus, Jenny Gurney, Keith A. Johnson, Richard Greenwald
Institutions: NYU Langone Health, New York University, Icahn School of Medicine at Mount Sinai, École de Technologie Supérieure, Harvard University, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Mayo Clinic, Mayo Clinic in Arizona, Cleveland Clinic, University of Washington, Lou Ruvo Brain Institute, University of Nevada, Las Vegas, Translational Genomics Research Institute, University of Arizona, Banner Alzheimer’s Institute, Arizona Alzheimer’s Consortium, Arizona State University, Boston University, Brigham and Women's Hospital, Mass General Brigham, George Washington University, Invicro (United States), National Institute of Neurological Disorders and Stroke, VA Puget Sound Health Care System, Washington University in St. Louis, Simbex (United States)
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,690
OpenAlex ID: W7223453179