Traumatic Brain Injury Lawyer Dr. Aaron DeShaw:
Diffuse Tensor Imaging or "DTI" is an advanced brain imaging technology that our Oregon brain injury law firm started using in our brain injury cases shortly after the technology became available to the public. Today, DTI is a widely accepted, scientifically valid method of brain imaging that has been approved for admissibility in courtrooms throughout the United States.
This video discusses our history using DTI in legal cases on behalf of clients with brain injuries in Oregon and Washington.
Problems with Brain Injury Imaging
In cases of traumatic brain injury, 80% of people have negative brain imaging. This is the case even with the types of brain injuries commonly discussed in society such as brain injuries sustained in the military from IEDs, as well as the severe CTE experienced by football players, hockey players and other athletes. Even when an athlete has severe advanced CTE with small holes in their brain, their imaging will be negative.
The present quality of brain imaging is still so poor that most brain injury cases do not warrant brain imaging, because it is negative so often. It is very important to note that just because you have a negative CT or MRI, does not mean you do not have a traumatic brain injury. This is particularly critical when young student athletes and combat soldiers consider a return to a setting in which the person can have a second brain injury while still healing from the first. These secondary injuries can be lethal, or result in severe permanent brain damage that is far more damaging than the injury might suggest.
What is a Complex Mild Traumatic Brain Injury?
As discussed on this web site, a mild Traumatic Brain Injury or "mTBI" can deeply imact a person with an mTBI. The designation of "mild" only means they did not have a loss of consciousness of greater than 30 minutes, or a Glasgow Coma Scale score of less than 13. People with a mild traumatic brain injury can have life changing permanent symptoms.
People with a mild traumatic brain injury almost never have positive imaging on MRI or CT. A Complex Mild Traumatic Brain Injury is a mTBI with positive findings on medical imaging. It does not mean that the symptoms will necessarily be worse than a person with a mTBI with negative imaging, however, the recovery rates are considered to be lower; similar to those seen with a moderate traumatic brain injury.
What is a DTI or Diffuse Tensor Imaging study?
In the cases that warrant brain imaging, we want to look at what is being shown not only on a CT or an MRI but also on a DTI study.
A Diffuse Tensor Imaging study or "DTI" is performed in a high resolution MRI unit, and allows a neuroradiologist to look at the physical tracts of neurons that go from the spinal cord or the brain stem into the brain and then back out again. It allows doctors to look at parts of the brain like the corpus callosum, which is the superhighway between the left and right parts of your brain.
What is the benefit of a DTI of the brain?
DTI can allow us to see if there's damage in the nerve fiber tracts in a way that is not available with a CT or MRI. While CT and MRI look at the brain with very little detail, DTI allows us a bit more detail in terms of "wiring" of the brain itself.
We have seen cases where there are DTI that you will not see in MRI, because you'll see actual damage to the nerve fibers that go between the lobes or from the middle of the brain out into the left or right hemisphere. And so it's important to see this, because we can now tell in a large number of cases that there is physical and objectively provable damage to our clients.
One case we had an MRI that looked largely normal and we ended up with a DTI that showed a large hole in the persons corpus callosum which is essentially the communication center between the left and right lobe. This is a client who worked at a very high level for a large corporation, communicating and doing things in multiple different countries and she had a great difficulty doing that type of complexity afterwards, and eventually had to resign from her job as a result of the traumatic brain injury. That would have been missed had we not done the DTI.
The downside of DTI: DTI still misses most brain injuries
Unfortunately, DTI has mostly failed to deliver on its initial promise to demonstrate a higher percentage of the injuries missed by CT and MRI. While DTI may detect some of the TBIs missed by other imaging methods, or demonstrate them in different ways, DTI does not materially change the fact that 80% of all brain injuries do not have positive imaging of any kind, including DTI. Other methods, such as computerized eye tracking and neuropsychology are more sensitive than DTI at confirming a traumatic brain injury.
DTI Admissibility in Court
One of the primary challenges of using DTI is that the defense lawyers will often contest the use of DTI on the premise that it is experimental. Our Portland brain injury lawyers had DTI admitted both in trial and arbitration by 2014, well before most of the other brain injury lawyers in the country - doing so without any motion from the defense. Since that time many courts in states throughout the United States have approved of the admissibility of DTI. But, unless you hire a brain injury with the list of DTI admissions and the orders, you could be at a significant disadvantage in getting your DTI admitted into evidence during trial.
Our Portland personal injury lawyers provide unique benefits to our clients because we keep updated on the most recent medical literature, medical advances, and legal case rulings throughout the United States that can impact our clients traumatic brain injury cases.
If you are seeking an Oregon lawyer to handle your brain injury settlement or lawsuit, please contact us or call our office at (503) 227-1233 for a free consultation.