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New Harvard Study Upholds Use of DTI in Mild Traumatic Brain Injury

I am so excited about a recent article entitled A Review of Magnetic Resonance Imaging and Diffusion Tensor Imaging Findings in Mild Traumatic Brain Injury which was authored by ten experts in the field from Harvard Medical School.The paper supports the use of DTI in diagnosing mild traumatic brain injury. The article was published in Brain Imaging and Behavior, March 22, 2012. 

The authors recognize that conventional tools such as MRI and CT do not adequately depict brain injury in mild traumatic brain injury, because they are not sensitive to detecting diffused axonal injuries (DAI). This has “led clinicians typically to diagnose mTBI on the basis of clinical and cognitive symptoms, which are generally based on self-report and are non-specific as they overlap with other diagnoses….”  Further, the authors state that while “most of the symptoms of mTBI are transient and resolve within days to weeks, approximately 15-30% of patients evince cognitive, physiological, and clinical symptoms that do not resolve three months post-injury” and that “these symptoms persist and in some cases lead to permanent disability and to what has been referred to as persistent post-concussive symptoms or post-concussive syndrome.”  The authors conducted a literature review, finding that there is evidence for brain abnormalities in mTBI based on studies using advanced MRI/DTI neuro imaging techniques.    The authors state, “importantly, these advances make it possible to use more sensitive tools to investigate the subtle brain alterations in mTBI…. Taken together, the findings presented below suggest that more sensitive neuro-imaging tools improve the detection of brain injuries in mTBI (i.e. diagnosis)….With the advent of DTI, however, DAI/TAI have the potential to be quantified and this information can be used for diagnosis, prognosis and for the evaluation of treatment efficacy.”

The authors conclude in summary, that while there was a great deal of variability in DTI, “nonetheless [they] were striking in that they all suggest that radiological evidence support small and subtle brain injuries in mTBI….  This evidence would not be possible if conventional MRI and CT scans alone were used to establish brain injury; it takes more advanced and sophisticated methods such as DIT that are sensitive to  diffuse axonal injury to delineate these abnormalities.”

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