Objectively proving brain injury is the best and quickest way to win or settle a brain injury case. However, objective evidence of brain injury is not always present on MRI or CT scan, and patient symptoms alone such as confusion and memory loss may not be sufficient evidence of injury. A new technology added to traditional MRI called “Diffusion Tensor Imaging,” or MRI/DTI, is more sensitive to injury than traditional MRI and has helped to prove traumatic brain injury.
Juries tend to be sympathetic to brain injuries that can be objectively proved. However, imaging tools such as MRI and CT scans don’t always show evidence of brain injury, causing doctors to diagnose concussions more often based on the signs and symptoms a patient demonstrates, which insurance companies can often easily disprove.
Insurance companies, attempting to disprove an injury, will assume a patient is faking injuries or has psychological problems that pre-existed the accident. Grade school records, medical records from childhood, psychological and psychiatric records, and anything else through the years that insurance companies can obtain can be brought out as defense against litigation.
DTI Provides Better Evidence of TBI
DTI (Diffusion Tensor Imaging) is giving doctors objective evidence missing with traditional MRI. Invented 20 years ago, DTI is an imaging method that grew out of and is part of MRI. It is performed on a normal MRI machine with special “Diffusion Tensor Imaging” software that records damage in the white matter tracts inside the brain. White matter, like telegraph wires, connects different lobes of the brain. When white matter is injured, communication between areas of the brain it connects is decreased.
MRI/DTI tracks movement of water molecules within white matter fibers, and can detect interference with that movement. DTI can show injury to the white matter of the brain which cannot be seen on MRI, CT scan, PET scan, or SPECT, and can provide objective evidence of continued cognitive decline associated with confusion and memory loss.
A radiologist reading an MRI/DTI will perform a differential diagnosis to rule out other possible causes of an abnormality seen on DTI, such as an old stroke, a prior TBI, a prior brain surgery, prior infectious process such as encephalopathy, or history of MS. Other possible causes of abnormality on DTI could be a congenital process or degeneration due to advanced age of the patient. In those cases, DTI evidence would be seen on both sides of the brain, and not on just one side where the injury occurred. Once other possible causes of cognitive decline can be ruled out, a definitive diagnosis of TBI can be achieved.
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