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Law Office of Cohen & Jaffe, LLP

Using Diffusion Tensor Imaging to Prove Brain Injuries

Diffuse Tensor Imaging Used in Detecting Traumatic Brain Injury

One of the most crucial elements of any personal injury case is proving the severity of the injury. In settlement negotiations, this just means convincing an insurance company that if they do not settle, a jury will likely award more money. In a trial, however, nothing is as effective as visual evidence that a jury can relate to and understand.

Magnetic Resonance Imaging (MRI) technology has been around since 1977, and it is well-recognized as the gold standard for identifying spinal injuries and traumatic brain injuries, many of which cannot be detected through x-rays. However, it can be difficult for a typical juror to fully comprehend what is being shown on an MRI. Much of the value of an MRI is in its interpretation by an experienced radiologist or other expert who understands what to look for. Today, however, we are fortunate to have yet another new technology that takes MRI evidence to a new level – Diffuse Tensor Imaging (or “DTI”).

What Exactly is Diffuse Tensor Imaging?

DTI has actually been around for about 20 years, yet it is only now gaining popularity around the country. DTI observes water molecules within the white matter of the human brain by following and tracking movement in the brain. When these water molecules are unobstructed or unrestrained, they travel in circular or spherical patterns, but when there is some sort of constraint, they follow a different path. DTI analyzes these patterns.

How Does DTI Actually Work?

Using vivo magnetic resonance images of tissue, DTI analyzes molecular diffusion of water molecules (although others can be analyzed, as well). DTI then gives a number value to the type of movement measured. So, if the molecule is unrestrained, it is measured as a zero (0), but if there is constriction and the molecule is following a “fiber axis,” then it is measured as a one (1).  By assigning zeros and ones as values, the DTI can analyze patterns of constraint or obstruction within gray matter.

With this information in hand, a trained specialist can interpret brain function or injury in a particular region. Likewise DTI software allows for color mapping of these areas of obstruction or constraint. This is called “wire-tract” or “tractography.”

As explained by a 2008 article in Neurotherapeutics, the lower the overall number that is measured, the more damage the white matter fiber tracts sustained.

What Exactly do the Abnormalities Tell Us About Traumatic Brain Injuries?

Just like an abnormality in an x-ray may tell a radiologist that there is a fracture or an MRI may show a torn ligament, a radiologist can use data from the DTI to diagnose many types of injuries. It can also be used as part of a complex differential diagnosis to rule out conditions. For instance, DTI can rule out things like cerebrovascular accidents (CVA or “stroke”), encephalopathy, multiple sclerosis (MS), or past surgeries.

DTI can also help you and your doctor better understand whether this is a hereditary or congenital defect, rather than trauma-related.

Is DTI Admissible in Court?

Yes. There are generally two different standards that courts use in America to determine whether a particular type of scientific evidence is admissible. These are called the Frye Test or Daubert Test. The names come from the Supreme Court cases that created them. In New York, we still use the older Frye Test as the standard by which to measure whether scientific evidence is credible enough to be presented to a jury.

Courts use these tests to make sure that litigants do not try to admit junk science to prove their cases. These tests have been used over the years to bar testimony from psychics to ghost interpreters to faith healers and more. In general, the courts will only allow testimony and admission of medical evidence if it is generally recognized in the scientific community. Of course, this also means that new technology and cutting edge experimental trials are often excluded, only to later be found to be completely valid.

However, MRI technology is well-recognized and is rarely challenged. While DTI is more costly and not always available in all regions, it operates under the same general technology as an MRI, and there are literally hundreds of peer-reviewed academic texts that support the use and efficacy of DTI.

While it is possible that a defense lawyer may try to challenge the validity of DTI, working with an experienced Long Island personal injury lawyer will help. Your accident attorney should prepare in advance by having an experienced board certified physician who has the appropriate specializations testify regarding the validity and accuracy of DTI technology. This should usually be enough to get this type of evidence before a jury.

What is the True Value of DTI for a Brain Injury Case?

For one, DTI is more sensitive. It is more likely to detect evidence of traumatic brain injury (TBI) than an MRI or CT scan. In particular, DTI is far more likely to identify a specific type of brain injury known as “diffuse axonal injury.” According to a 2016 research article published in Frontiers in Neurology, diffuse axonal injury is when a person suffers microscopic damage to the axons within their “neural tracts, corpus callosum, and brain stem.” These injuries are among the most severe types of TBI, yet they are difficult to otherwise diagnose through traditional technologies. Plus, diffuse axonal injuries can occur even without a significant blow to the head. Just a violent shaking motion (as is common in car accidents) can cause these injuries.

Using DTI to Prove TBI or Other Head Injuries

By using color mapping technology, a lawyer can demonstrate to a jury the scientific and objective damage to a plaintiff’s brain. What may not otherwise be evident from x-rays or CT scans becomes much clearer with color and with patterns. An expert can walk the jury through the trauma, showing where the constrained molecules are unable to move freely and must travel along axons instead. This visual demonstration can be very powerful in proving that the injury is not exaggerated or fabricated, but rather, it is based on clear and distinct science.

If a victim has significant cognitive impairments following a head injury, the DTI might be useful for proving the cause of the diminished cognition.

DTI as Powerful Evidence to Rebut a Defense Expert

Many times in litigation, a defendant will retain an expert to testify that a victim’s personal injuries were not caused by the specific incident in question or that they are far less serious than claimed. These controlled experts are paid a lot of money to make it look like the injury is made-up or fabricated or exaggerated. Most of the time, these so-called experts have never evaluated the victim. In some cases, it comes out that the experts never even thoroughly reviewed the victim’s medical records or spoke with treating physicians before rendering their opinions.

Having solid evidence from a scientifically sound and objective source can be imperative to proving your case and maximizing recovery.

How is a DTI Performed?

For more information on brain mapping (“DTI”), check out this clinic’s page. There, you can view color images and examples of various diagnoses, along with the images from brain mapping.

The procedure is relatively non-invasive. You will likely get an injection that contains a dye. This dye shows up on the imaging results to allow the radiologist to better visualize problem areas. A few suggestions to prepare for your exam are as follows:

  • Do not drink caffeine
  • Avoid tobacco or other stimulants
  • Make sure your doctor knows about any medications you are taking in advance
  • Dress comfortably for the exam
  • Remove anything with metal

People with pacemakers cannot receive DTI brain mapping, as it is still a form of magnetic resonance.

Get Help from a Knowledgeable Long Island Traumatic Brain Injury Lawyer

If you have been hurt in a car accident, a serious fall, or some other incident, and you are now suffering symptoms of a traumatic brain injury, you need to talk to an experienced traumatic brain injury lawyer. You may have a right to be compensated for your injury if it was on the job or caused by someone else’s negligence. Symptoms of traumatic brain injury include:

  • Memory loss
  • Fatigue
  • Mood disturbances
  • Vision or hearing problems
  • Language or communication problems
  • Dizziness
  • Headaches
  • Problems with manual dexterity
  • Concussion or loss of consciousness
  • Fainting spells
  • Trouble sleeping

If you are suffering from any of these symptoms following an injury to your head, do not take chances. The trusted head injury lawyers of the Law Office of Cohen & Jaffe, LLP can put you in touch with highly specialized medical experts who can test you for TBI, including diffuse axonal injury. If your injury was due to someone else’s negligence, you may have a right to get your medical bills paid, and you may be entitled to compensation for your injury, including lost wages and cash for your pain and suffering. More importantly, finding out the nature of your injury is the first step to getting the treatment you need. Time is limited. You only have a short amount of time to bring a claim for injuries in New York. If you fail to do so in time, your rights are forever barred. Contact the Law Firm of  Cohen & Jaffe, LLP today to schedule a free consultation and get on the road to recovery. (866) 895-0420.

 

 

 

 

 

(c) Can Stock Photo / HighwayStarz

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