What is Diffusion Tensor Imaging and How is it Used?
The technological and medical industries are experiencing an exciting period of growth. Regrettably, this keeps the majority of us continually occupied trying to stay up with the latest technology breakthroughs. Medical practitioners are likewise lagging when it comes to emerging technology.
Medical practitioners must verify the reliability of a new technology before it may be utilized on their patients.
Once medical practitioners have evaluated and acknowledged a technology, the courts must catch up to medicine’s adoption of the new technology. As a result, the courts are always two steps behind. This is particularly true when the court is confronted with expert evidence about traumatic brain injuries and diffusion tensor imaging (DTI).
As any novel diagnostic technique might be expected, DTI has come under fire from defense courtroom doctors and defense lawyers. The civil defense lawyers are fearful that the court’s adoption of DTI may compel them to compensate for brain impairments they were previously allowed to brush aside.
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WHAT EXACTLY IS DTI?
Researchers utilize DTI to examine the brains of various people, using the fact that diffusion tensor imaging exposes more information about the brain’s circuitry than other kinds of scans. This is DTI’s primary advantage: it reveals more information about the brain than other kinds of imaging.
By examining the network of connections in the brain’s center, researchers may uncover regions of variation across people, perhaps providing insight into mental disorders, degenerative illnesses, and other medically relevant issues. Because DTI enables us to better know the sorts of damages incurred by a brain injury victim, we will have a better chance of treating and compensating these victims.
DTI has been targeted by defense lawyers representing insurance companies. “Diffusion tensor imaging is a valuable diagnostic tool in research, and group analysis demonstrates that DTI can detect alterations in the brain associated with Traumatic Brain Damage throughout a spectrum of injury severity, from moderate to severe DTI.
However, the contention is that this result is based mostly on group studies and that there is now no solid proof that DTI may be used to diagnose…individual patients.
This argument overlooks a substantial body of peer-reviewed scientific research supporting the therapeutic application of DTI and the fact that Walter Reed Army Medical Center uses DTI to identify and treat injured military personnel returning from Afghanistan and Iraq.” DIFFUSION TENSOR IMAGING OBJECTIVE EVIDENCE OF TRAUMATIC BRAIN
COLORADO’S COURTS RECOMMEND DIFFUSION TENSOR IMAGING
A trial judge in El Paso County, Colorado rejected a defendant’s Frye argument to the admission of MRI with DTI.
The El Paso trial court noted that DTI is “neither unique nor novel science,” The plaintiff established that the fundamental ideas underpinning DTI have been properly examined and approved by the relevant scientific and medical institutions.
Plaintiff provided expert evidence from Stephen Anderson, M.D., a Board Certified radiologist, who stated that DTI investigations are universally acknowledged by practicing radiologists and are heavily relied upon by doctors ordering them to aid in identifying and treating traumatic brain injuries.
The court also cited the American College of Radiology’s position, which defined practice guidelines and technical standards for radiologic practice related to the performance and interpretation of magnetic resonance imaging of the brain, and which clearly states that MRI of the brain with diffusion imaging, if available, is beneficial in a variety of indications, including, but not limited to, acute and chronic neurologic deficits, headache, and mental status disorders. 1 6:12.40 Stern and Brown, Litigating Brain Injuries.
Acceptance of DTI is unquestionably beneficial for patients with brain damage. Occasionally, the previous testing does not adequately assess the entire amount of a person’s functional loss after a brain injury event. Due to the possibility that the prior testing method did not capture all possible brain injuries, many TBI sufferers were left uncompensated for a significant amount of their losses.
Hopefully, the continued adoption of DTI will assist more patients with traumatic brain injuries in obtaining compensation and therapy that they would not have received in the past.
Why Lawyers As with DTI, defense lawyers and claims experts examining traumatic brain injury claims are likely to encounter a kind of sophisticated neuroimaging called diffusion tensor imaging (DTI). Diffusion tensor imaging analyses and patterns of water diffusion in brain tissue using data from MRI sequences.
It utilizes this information to map the structure of white matter tracts in the brain and derive wider inferences about the integrity of—or subtle damage to—those white matter tracts. While the resulting colorful three-dimensional images are striking, they frequently conceal the complexity of this neuroimaging modality and its implications for the ultimate questions in a personal injury case—as well as the admissibility of DTI studies and expert opinions derived from them under Daubert v. Merrell Dow Pinjuryaceuticals.
Grigori Guitchounts addresses how technology improvements in neuroscience are overtaking our capacity to make sense of the massive amounts of data researchers are now able to unearth about the brain’s structure and function in a new essay in Nautilus, “An Existential Crisis in Neuroscience.” As he adds, “While technology has facilitated the collection of massive information, I’m not convinced that our knowledge of the brain has kept pace with the magnitude of the datasets.”
The piece discusses more discussions with experts working in the subject of connectomics,
which is concerned with mapping out brain structures at the neuronal level to produce a “wiring diagram.” These researchers highlight the lack of clarity on the link between brain shape and mental diseases such as schizophrenia and their efforts to employ machine intelligence to better comprehend the relationship between structure and function.
Despite decades of advancement and more access to comprehensive information on the brain’s composition than ever before, holistic knowledge and capacity to use that information remain elusive.
As Guitchounts observes, “the robots we have constructed—the ones modeled after cortical anatomy—fall short of accurately reflecting the essence of the human brain.” However, they have little difficulty detecting patterns in vast datasets.”
Diffusion tensor imaging proponents often highlight its sensitivity, or capacity to detect tiny changes in brain structures, to a degree previously unreachable with conventional structural imaging techniques such as computed tomography (CT) or “typical” MRI sequences such as T1, T2, SWI, and FLAIR. However, proponents overlook the fact that once a lesion—often referred to in neuroradiology as an area of diminished fractional anisotropy—is found on DTI; its clinical relevance is not always evident.
There is not necessarily a conclusive association between a white matter lesion and neurocognitive problems, whether or not they are diagnosed by neuropsychological testing. This is particularly important considering that white matter lesions may be caused by various factors unrelated to trauma, such as hypertension, pre-existing mental health disorders, or even the natural aging process.
Additionally, in the course of our firm’s national litigation of traumatic brain injury claims, we have occasionally seen DTI studies that describe a completely normal brain even though other imaging modalities such as MRI have documented obvious structural brain damage in a particular individual.
In such circumstances, DTI’s failure to find lesions where they plainly should exist casts doubt on the clinical and forensic importance of isolated lesions in concussion cases.
When assessing the strength and admissibility of expert opinions interpreting diffusion tensor imaging, it is necessary to be aware of a variety of potential issues associated with DTI and its interpretation in any given case, including partial volume effects the multiple comparisons problem, normative datasets, and mapping errors.
Additionally, when determining whether DTI evidence satisfies Daubert and Federal Rule of Civil Procedure 702 in a case, attorneys should consider whether a DTI study merely “identifies a pattern in a large dataset” without a clear understanding, based on actual science, of how that pattern correlates with an identified neuropsychological deficit or symptom at issue in the case.
DTI anomalies are not proof of a TBI in and of itself. An expert is opining that they are probably doing so with a degree of confidence that exceeds neuroscientists’ existing knowledge of the link between brain structure and function.
The Warrior Car Accident Lawyers, has extensive expertise obtaining compensation for sufferers of traumatic brain injuries. Please call the Warrior Car Accident Lawyers, at 719-300-1100 for further information on brain injuries and diffusion tensor imaging.
The attorneys of Warrior Car Accident Lawyers, are experienced traumatic brain injury attorneys frequently asked for co-law firm brain injury cases across Colorado by their colleagues