This video on brain imaging in TBI legal cases features Portland Brain Injury Trial Lawyer Aaron DeShaw:
Many people are unaware of the differences in CT (often called a CAT scan), and MRI. But the difference in function of these two major types of advanced diagnostic imaging can result in very different results.
Brain CT
Computed Tomography or "CT" studies are often the preferred method of imaging the brain while a patient is in the ER. CT is much faster than an MRI, but its use is mostly limited to bone and blood vessels. As a result, CTs use in brain injury cases is mostly limited to frank brain bleeds (such as a subdural hematoma), or skull fractures. For this reason, it is the first option, but definitely not the best option for brain imaging. Only a small fraction of all brain injuries have positive CT results. For this reason if you have a brain CT that is negative, it does not mean that you do not have a brain injury.
A brain MRI is usually the preferred method of imaging the brain after an injury. That is because MRI focuses more on "soft" tissues of the body and can detect brain structures in much more detail. But even with the best MRI machine and technique, most people with a brain injury will still have a negative MRI. For this reason, it is important to understand that just because you have a negative MRI does not mean that you do not have a traumatic brain injury. A diagnosis of concussion, traumatic brain injury, post-concussion syndrome, and related diagnoses are almost exclusively related to the facts of an injury and the symptoms that follow. All brain imaging is only confirmatory of the diagnosis of a doctor who is well educated about traumatic brain injuries.
What few people know is that 80% of all traumatic brain injuries have no positive findings on either a CT or an MRI. So, it is only the most serious brain injury cases that a brain MRI or CT is positive. These almost always fall into the category of "moderate" or "severe" traumatic brain injury. Over 80% of all brain injuries, including those suffered by members of the military and NFL football players are almost all designated as "mild traumatic brain injuries" regardless of the severity of symptoms that follow.
One of the most exciting things that's happening in the traumatic brain injury field right now is the improvements of brain imaging. Doctors and researchers in this field are called neuroradiologists.
Brain MRI
The most common of these involve MRIs of the brain. It's important for people to understand that there are three different varieties of MRI studies. Low resolution open MRIs, standard definition closed MRIs, and high definition MRI machines. The difference in quality comes down to two main issues; 1. the magnet strength and improved resolution, and 2. the distance between the "slices" of images captured by the MRI machine.
MRI Magnet Strength and Brain MRI resolution
Open MRI, which is often used for people with claustrophobia, have lower strength magnets, usually referred to as somewhere between 0.2T and 0.7T. In our opinion, open MRIs do not have sufficient resolution for brain imaging.
Standard resolution closed MRI have been the standard in the industry for all types of MRIs since the 1980s. Their magnet strength is stronger than an open MRI. Standard resolution closed MRI is usually referred to as being a 1.5T MRI.
High resolution MRI has been used in Oregon since the 2000s. In fact, Siker Medical Imaging in Portland had one of the country's first Siemens 3T MRIs. The magnet strength of these machines is 3T - double that of the standard MRI machine. This substantially increases the resolution of the MRI images. At this point other radiology facilities in Oregon and Washington have 3T MRIs for brain imaging, including OHSU, University of Washington, and others.
The difference in quality of these three types of MRI machines is critically important in brain injury cases, because both doctors and brain injury lawyers want to look at the highest definition MRIs possible so that we can better understand a person's brain injury.
Brain MRI Slice Thickness
MRI takes "slices" of the body at set intervals. The MRI's computer then takes this data and reconstructs the body from the data at this slice sites. The thinner the slices, the more accurate the findings of the MRI. In the brain this is particularly important because the brain has an estimated 100 billion neurons and 100 trillion connections. There are billions of connections within a 1 mm area. As discussed above, 80% of all brain injuries have negative MRI and CT findings. This is because the physical brain damage that occurs is very small - often the size of a grain of rice or smaller. But with billions of neuronal connections in that area, it can permanently change a person's life even with a single microscopic injury that is too small to be seen even on the best MRI machines.
Most busy commercial MRI facilities maximize the number of MRIs they can run in a day by taking brain MRIs at 5mm slices. So, there are 5mm between each slice. Given the tiny size of brain lesions, a brain MRI run at 5mm slice thickness can easily miss significant brain damage from a traumatic brain injury.
There are high resolution 3T MRI facilities that take brain MRIs at 1mm or 2mm slice thickness. They take longer for the MRI because the machine is taking 5x as many images. And, those MRIs may cost more because it reduces the number of studies a facility can do in a day with that MRI machine. But, it is important to get the best answer for your brain injury case. That involves taking brain MRIs at maximum resolution and minimum slice thickness.
We've seen the real world differences in some of our trials where brain injuries missed at facilities using a low resolution MRI machine set to a slice thickness of 5mm, but later demonstrated at a neuroradiology clinic with a high resolution 3T machine where the slice thickness was 1mm. Optimally, you want the right answer the first time, otherwise the insurer will claim that there was no injury after their incident, and that the lesion seen on the later 3T MRI study was due to something else, even if nothing else has happened to cause a brain injury.
Few doctors, let alone lawyers, know about the importance of the difference in MRI machines used for brain imaging. This is one of many areas where having the best brain injury lawyer becomes so critical.
Using MRI and CT Imaging Data in Our Legal Cases
Most of the time when an MRI report is sent to our office (or a doctors office) there are words on a page that convey the findings and diagnosis. But, usually there are no images that show the injury. But, a picture often demonstrates the client's injuries better than words. Our past jury verdicts also demonstrate the power of medical imaging.
One of the most exciting things that we're doing at our Portland Brain Injury Law Firm is we're getting the imaging files from the radiologist, or the neuroradiologist, and opening the MRI and CT files in a medical radiologist program. We are able to look at the images ourselves in order to see what the traumatic brain injury looks like in our own clients. The imaging software is also capable of compiling the data from the MRI or CT machine in 3D, and look at what's occurring in our client's brains. This allows us to capture screenshots of the injuries as discussed in the neuroradiology report. From here we provide the images to the insurance company during settlement negotiations. If the injury isn't clear to someone without a background in radiology, we will often work with a legal graphics company to illustrate the injury or the impact of a surgery. These have proven very effective in settlement negotiations, mediation, arbitration and in trial.
Other Brain Imaging Methods
There are other imaging methods available for doctors who are treating people with traumatic brain injuries. In some cases these studies can be done in Oregon, but for the more advanced brain imaging, injured people often have to fly out of state to one of the nation's leading medical universities or diagnostic imaging clinics.
The advanced brain imaging studies include diffusion tensor imaging (DTI), PET, SPECT, qEEG, and magnetoencephalography (MEG) - particularly useful in post-TBI seizure cases.
Oregon Brain Injury Lawyer
If you are looking for the best Oregon brain injury lawyer to handle your personal injury case, please contact us on this web site, or call our office at (503) 227-1233 for a free consultation.