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Literature Review Finds Diffusion Tensor Imaging Effectively Differentiates Patients with Traumatic Brain Injury from Controls

This month’s issue of the American Journal of Neuro Radiology includes one of the most important research neurolaw articles.  Researchers from the Gruss Magnetic Resonance Research Center and the Saul R. Korey Department of Neurology at Albert Einstein College of Medicine reviewed over 100 published articles involving diffusion tensor imaging and traumatic brain injury published over the past ten years.  Dr. Michael Lipton and his colleagues systematically reviewed, summarized, and detail “the landscape of DTI applied to the study of traumatic brain injury and to highlight both the salient conclusions to be drawn from this large literature and its limitations, which can serve as important considerations for future research.” 

Using PubMed, the researchers conducted a structured search of all relevant articles through 2011 using the following keyword combinations:  “diffuser tensor imaging and traumatic brain injury,” “DTI and TBI,” and “DTI and concussion.”  This search resulted in 391 articles, 293 of them unique.  The researchers further examined the references cited by these articles to identify additional relevant articles.  After eliminating articles based on exclusion criteria, 100 articles remained and were systematically analyzed and included in the review.  Most of the studies reviewed were “defined on the basis of comparison with the control group because universal thresholds for abnormality have not yet been established.”  With regard to severity and chronicity, the review included studies across the wide spectrum of traumatic brain injury, ranging from mild to severe forms of TBI.

The researchers stated:

“DTI has been studied extensively as a tool for identification of brain abnormalities related to TBI and understand the relationship of these brain abnormalities to other clinical features of the disorder.  During the past decade, the number of such studies has risen exponentially and continues to increase with no sign of abatement.  A unifying theme can be deduced from this large body of research: 

DTI is an extremely useful and robust tool for the detection of TBI-related brain abnormalities.  Overwhelming consensus of these studies is that low white matter FA is characteristic of TBI. 

We also found an overwhelming consensus that imaging abnormalities detected with DTI are associated with important clinical outcomes.  This further validates DTI as a meaningful measure of clinically important brain injury.

In summary, DTI provides a robust measure of clinically important TAI at cross-section, despite the variability inherent in characteristics of patients with TBI and injury mechanisms as well as study differences in data acquisition and analysis methods. “

This research goes a long way to support the use of diffusion tensor imaging in litigation involving brain injury and trauma.

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