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Research ArticleRegular Article

Diffusion Tensor Imaging in Mild Traumatic Brain Injury Litigation

Hal S. Wortzel, Marilyn F. Kraus, Christopher M. Filley, C. Alan Anderson and David B. Arciniegas
Journal of the American Academy of Psychiatry and the Law Online December 2011, 39 (4) 511-523;
Hal S. Wortzel
MD
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Marilyn F. Kraus
MD
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Christopher M. Filley
MD
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C. Alan Anderson
MD
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David B. Arciniegas
MD
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    Table 1

    DTI and mTBI

    StudyParticipantsmTBI Criteria and/or CharacteristicsDTI Timing Average (Range)Brain RegionsAnalytic Approach
    2010
        Little et al.2612 mTBI, 12 controlsACRM mTBI criteria>12 monthsVA thalamic nucleusROI analysis: FA
        Geary et al.2740 mTBI, 35 controlsACRM mTBI criteria5.29 yearsSLF, SS, UFROI analysis: FA
        Levin et al.2832 mTBI, 15 controls (8 healthy, 7 extracranial injury)OEF/OIF veterans with blast injury, 32 mild plus 5 moderate TBIs, essentially ACRM criteria871.5 daysNo group differences in FA or ADCTractography, ROI, and voxel-based analysis: FA, ADC
        Mayer et al.2922 mTBI, 21 controlsACRM mTBI criteria12.5 days (2–20)CC, CR, UFROI analysis: FA, AD, RD
    2009
        Chu et al.3010 mTBI, 10 controlsInitial GCS 15, negative CT, otherwise not reported2.7 days (1–6)Left thalamus, scattered white matterWhole-brain voxel-wise analysis: ADC,FA, AD
        Wu et al.3112 mTBI, 11 controlsGCS of 15 in ED and +LOC (<10 min)2.92 days (1–6)CBROI analysis: FA, ADC
        Lipton et al.420 mTBI, 20 controlsGCS ≤ 13, LOC < 20 min, PTA < 24 hr(2–14 days)Frontal white matter (DLPFC)Whole-brain voxel-wise analysis: FA, MD
        Kumar et al.3226 mTBI, 33 controlsGCS 13–15, all + LOC (<20 min), all + CT8.9 days (5–14)CCROI analysis: FA, MD, AD, RD
        Huang et al.3310 mTBI, 14 controlsLOC < 15 min, GCS 13–15, PTA < 24 hr, persistent PCS(1–46 months)ILF, SLF, temporal, parietal, occipital, frontalWhole-brain voxel-wise analysis: FA
        Lo et al.3410 mTBI, 10 controlsGCS ≥ 13, persistent cognitive impairment(>2 yrs)CC, ICROI analysis: FA, ADC
    2008
        Lipton et al.3517 mTBI, 10 controlsGCS ≥ 13, LOC < 20 min, PTA < 24 hr, persistent cognitive impairment(8 months to 3 years)CC, subcortical white matter, ICWhole-brain voxel-wise analysis: FA, MD
        Niogi et al.3643 mTBI, 23 controlsGCS ≥ 13, +PTA16.9 months (1–53 months)Corona radiata, UFROI analysis: FA
        Rutgers et al.3724 mild TBI, 10 controlsGCS ≥132.8 months (0.4–26.2)CCROI analysis: FA, ADC
        Wilde et al.3810 mTBI, 10 controlsGCS of 15 in ED and +LOC (<10 min)2.7 days (1–6)CCWhole CC analysis: FA, ADC, RD
        Niogi et al.3934 mTBI, 26 controlsGCS 13–15, +LOC,+PTA, ≥1 post concussive symptom(1–65 months)Anterior corona radiate, UF, CC, ILF, CBROI analysis: FA
        Miles et al.4017 mTBI, 29 controlsGCS 13–15, LOC < 20 min, PTS < 24 hr4 days (1–10)CS, CC, posterior limb ICROI analysis: MD, FA
        Rutgers et al.4121 mTBI, 11 controlsGCS ≥135.5 months (0.1–109.3 months)Cerebral lobar white matter, cingulum, CCWhole-brain voxel-wise analysis: FA, ADC
    2007
        Bazarian et al.426 mTBI, 6 orthopedic controlsGCS 13–15, +LOC or amnesia≤72 hoursLeft anterior IC, posterior CCROI and whole-brain analysis: trace, FA
        Kraus720 mTBI, 18 controlsACRM mTBI criteria107 monthsCST, SSWhite matter load and ROI analysis: FA, AD, RD
        Hashimoto et al.431 mTBI (case report)GCS 13 at 30 min3 yearsCC, cingulate, prefrontal areaMR tractography
        Wozniak et al.446 mTBI, 14 controlsLOC, PTA, altered MS, recurrent emesis or persistent headache, or transient focal neurological deficits + GCS 13–158.2 monthsSupracallosalROI analysis: FA
        Benson et al.456 mTBI, 14 controlsLOC or PTA + GCS 13–15, 4/6 with +CT findings35.3 months (3 days–15 years)Global white matterGlobal white matter histogram analysis: FA
    2002–2005
        Inglese et al.4646 mTBI, 29 controlsACRM mTBI criteria4.05 days for 20 subjects, 5.7 years for 26CC, IC, CS,Whole brain histogram and ROI analysis: FA, MD
        Arfanakis et al.475 mTBI, 10 controlsAmnesia, disorientation, or confusion + GCS 13–15<24 hoursCC, IC, ECROI analysis: FA, LI
    • VA, ventral anterior; CB, cingulum bundle; DLPFC, dorsolateral prefrontal cortex; CC, corpus callosum; ILF, inferior longitudinal fasciculus; SLF, superior longitudinal fasciculus; IC, internal capsule; UF, uncinate fasciculus; CS, centra semiovale; CST, corticospinal tract; SS, sagittal stratum; EC, external capsule.

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Journal of the American Academy of Psychiatry and the Law Online: 39 (4)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 39, Issue 4
1 Dec 2011
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Diffusion Tensor Imaging in Mild Traumatic Brain Injury Litigation
Hal S. Wortzel, Marilyn F. Kraus, Christopher M. Filley, C. Alan Anderson, David B. Arciniegas
Journal of the American Academy of Psychiatry and the Law Online Dec 2011, 39 (4) 511-523;

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Diffusion Tensor Imaging in Mild Traumatic Brain Injury Litigation
Hal S. Wortzel, Marilyn F. Kraus, Christopher M. Filley, C. Alan Anderson, David B. Arciniegas
Journal of the American Academy of Psychiatry and the Law Online Dec 2011, 39 (4) 511-523;
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  • Article
    • Abstract
    • Overview of Diffusion Tensor Imaging
    • Traumatic Axonal Injury and Diffusion Tensor Imaging
    • DTI Findings in Neurologic and Neuropsychiatric Disorders
    • DTI in the Mild TBI Literature: Review and Commentary
    • Consideration of Daubert Criteria to DTI in Mild TBI
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