The use of diffusion tensor imaging (“DTI”) to assess mild Traumatic Brain Injury (mTBI) has been discussed in several prior posts. Also as discussed in prior posts, DTI evidence has been challenged in dozens of cases (the results almost always favor the admission of this evidence, not as diagnostic of mTBI by itself, but as a useful component of the clinical assessment of mTBI. ) DTI imaging is useful because it has been shown to be a sensitive measure of the microstructural injury caused by head injury that cannot be visualized by conventional neuroimaging and can therefore aid in the diagnosis and prognosis of mTBI.
The latest issue of the peer-reviewed publication “Journal of Neurotrauma” includes a systematic review of the peer-reviewed literature concerning the role of DTI in the evaluation of the microstructural alterations in white matter associated with mTBI.
The review looked at 1507 articles published between 2007 and 2024. A total of 79 studies met the full eligibility criteria for inclusion in the review’s quantitative synthesis. The review concludes that the weight of the evidence supports the integration of objective DTI biomarkers along with subjective criteria and clinical measures “to produce the best possible clinical picture of mTBI.”
The use of this technology is particularly important with the minority of mTBI patient who do not experience rapid symptoms resolution. The review notes that “10-20% of patients report persistent symptoms lasting months to years post-injury.” “These long-term sequela,” the authors note, “may result from shearing forces applied to the brain during the traumatic event, leading to impaired microstructural integrity or diffuse axonal injury (DTI). The absence of definitive objective biomarkers and the variability in diagnostic criteria have led clinicians to adopt a probabilistic approach to mTBI diagnosis. This approach integrates available clinical assessments and neuroimaging data to inform diagnostic decision-making.”
The results of this review are consistent with the conclusions reached by most courts that have considered this evidence and will facilitate future decision making. Hopefully, it will expand the use of this tool in the clinical setting.
