[MicroMan]

Hi everyone,

I was going to contact Mark directly about this but figured it might be of interest to our community. As most people are aware, standard MRIs, while useful in detecting macroscopic brain damage (e.g. bleed outs, etc.), are of limited value in detecting the microscopic damage that commonly occurs in mild traumatic brain injuries (mTBIs) (i.e. axonal [neuron] damage). Recently, however, a new MRI-based imaging technique, termed Diffuse Tensor Imaging (DTI), is capable of detecting neural damage along axonal tracts and can do this in both acute and chronic PCS cases. Unfortunately, however, DTI's application to mTBI is relatively new and, correspondingly, finding imaging specialists with the know-how to do it has been a challenge for me.

I live on the west coast of Canada. To the best of my knowledge, the only places doing DTI in the country are research-based and not using it for TBI. While there is an imaging facility close to me possessing the technology, they aren't sure why anyone would use it for mTBI (fools!! ).

So, does anyone know of imaging facilities in either Canada or the US that uses DTI for mTBI?

[Mark in Idaho]

Diffusion Tensor Imaging (not Diffuse Tensor) has been been around and discussed here since 2009. There have just been some recent studies published.

From what I have read, it does not detect damage. Instead, it detects the changes in water flow that results from damage. High Tesla MRI's will image the microscopic damage.

But, the reason these technologies are not used is because they only show an injury exists. They do not direct or change the treatment. Their value in research is to see how the injured brain reacts to various treatments and drugs.

University of Washington Medical Center in Seattle is doing DTI imaging. Also, University of Minnesota Center for Magnetic Resonance Research and Mayo Clinic in Rochester, Minnesota. Don't know if they are doing it in clinical work.

What are you hoping to do with a DTI image ?

[MicroMan]

Hi Mark,

Thanks for your response and for catching the issue with the name... wicked sleep disturbance last night so today I'm very off.

Regarding the water diffusion, you're correct. Differences in the water diffusivity relate to axonal damage, which can be the axons themselves or the myelin sheath. With mTBI, the myelin sheath can be repaired whereas in moderate and severe TBI it evidently doesn't.

For me, I'm interested in having a DTI scan done for 2 reasons:

I. My employment is 100% intellectual, and therefore any brain damage has implications in my return to work;

ii. I've been attributing my PCS issues with an inability to process external stimuli. Recently, through this forum, I learned this is called "mental flooding". Despite what I've reported to several doctor's, the only thing they state is that ongoing depression, which I disagree that I have at this point, is the cause of my problems. Having info from the DTI will let me accept/refute and, ultimately, come to terms with what the new "me" is. Not sure this will be understandable, but it's something I feel I need to move forward regardless of what the results will be.

Thanks for the info on the facilities I'll check them out over the next couple days.

[Mark in Idaho]

Brain damage has no bearing if you can still do the job. I don't see how a DTI changes you capability. A NeuroPsych Assessment is the usual diagnostic for mental capabilities.

If you had a concussion, you suffered brain damage. That is the nature of a concussion.

A full battery NPA can determine whether you have just depression caused MCI or whether it is organic or a combination of the two. It will also give you a good idea at specifically defining your strengths and weaknesses.

If you can find someone who really knows qEEG and uses one of the many good TBI discrimination databases, it can show an organic injury. Google qEEG, TBI and database and you will find lots of interesting information. qEEG has a 97% reliability at diagnosing an mTBI. You just need to find someone who is knowledgeable and uses a good comparative database.

[MicroMan]

Thanks Mark. On the NPA, I had one of those done at 9 months... 2 days of testing and a veritable barrage of psych tests. These confirmed the mTBI and identified emotional issues... a real eye-opening experience, to say the least. Just declined having a second one done recently, but am planning it for the fall.

As for the DTI, it's more a personal thing... for moving forward, it's important to me. Might sound kind of silly, I know.

[Mark in Idaho]

So, if you know what your dysfunctions are, why are you still struggling to move forward, one way or the other ?

Did the NPA use the MMPI-II to determine emotional issues as the cause ? It can double indicate and if not full understood, point to depression as the main cause of dysfunctions. Is the doctor who wrote the NPA report contesting the cause of your dysfunctions as emotional rather than organic ? NeuroPsychs can be prone to do that. If your intelligence showed as high, but functions as low, there is more tendency to misreport the results.

If you want, PM or email specifics from your NPA report and I'll give you some ideas based on having such an experience. I've had 3 NPA's.

[Mark in Idaho]

I had an MRI done today on my shoulder. I asked the tech about DTI MRIs and she said they are quite common. The limit is finding a neuro to prescribe it. She said that some high end neuro surgeons and other high end neuros use them but generic neuros tend to not be interested in nor informed about them.

She said there are a number of doctors who spec them locally here in Idaho.
It may help to ask an MRI tech for the name of a neuro who uses them.

[Laupala]

So if there is any concussion damage, DTI can indirectly detect it? Or would there need to be fairly substantial damage for DTI to detect water flow changes due to damage?

I ask because it seems this might be a good way to distinguish between anxiety being the major force behind symptoms (not necessarily the exclusive force) or if there is actual detectable damage.

[Mark in Idaho]

There are some published studies that explain the issues. Google "diffusion tensor imaging of the brain". You'll find links to the published reports. Here is one: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2041910/