While any type of brain injury has a great impact on the patient’s life, traumatic brain injuries (TBI) are particularly difficult to diagnose. Regular brain imaging techniques such as CT scans and MRIs might fail to detect mild and moderate injuries. This calls for an advanced diagnostic tool called diffusion tensor imaging or DTI for short.
Dr. Jose Pizarro of Longboat Key, Florida, completed a residency in radiology at Mount Sinai Medical Center and performed a fellowship in neuroradiology at the University of Miami- Jackson Memorial Hospital. Dr. Pizarro is board certified in diagnostic radiology and neuroradiology. He is the former chairman of radiology and section chief of neuroradiology at Mount Sinai Medical Center. Jose Pizarro MD has worked together with several leaders and researchers in the field of Alzheimer’s disease, memory disorders, and diffusion tensor imaging. He currently evaluates diffusion tensor imaging and the effects of trauma on thousands of patients every year, including many NFL players.
Traumatic Brain Injuries (TBI)
Despite being encased in a solid skull made of bone, our brain is subject to many injuries. Accidents do happen; however, traumatic brain injuries, no matter how mild, can have far-reaching consequences for the patient. According to Dr. Jose Pizarro, traumatic brain injuries can either be classified as a closed head injury or a penetrating head injury.
Closed head injuries are by far more common and happen more frequently. People who work in mines or construction sites, for example, are more prone to this type of head injury as a result of blasts or blunt traumas. Bikers also have a higher chance of sustaining closed head injuries if they get involved in an accident. Even children are not immune to these head injuries if they engage in a physical activity without proper supervision.
Penetrating head injury on the other hand is less common and is often the result of non-accidental actions. Gunshot injuries account for the majority of these cases and cause high velocity penetrating injuries. This is in contrast to head stabbings, which result in low-velocity penetrating injuries. This type of traumatic brain injury is easier to detect and diagnose compared to closed head injuries.
Jose Pizarro MD explains that the Glasgow Coma Scale (GCS) is used to assess the severity of the head injury. For example, a severe head injury scores between 3 to 8 on GCS while a moderate injury is one that scores between GCS 9 to 13. Mild head injuries have the highest GCS score between 14 and 15.
Different Types of Imaging
The two different types of imaging used to diagnose traumatic head injuries are CT scans and MRIs. Each has its own advantages and drawbacks. A CT scan uses X-rays to create detailed images, or slices, of the brain. CT scans are non-invasive, painless, and quick. However, radiation exposure to the brain poses a risk for many patients.
MRI scans, on the other hand, use radio waves and magnetic fields instead of ionizing radiation. This makes them safe to use, especially for patients with a higher cancer risk. The scans are also non-invasive and can be performed quickly.
However, when it comes to brain trauma injuries, especially those between GCS 9 to 15, both of those scans could return a false negative result. Radiologists and physicians need a more accurate diagnostic tool to assess the damage in the brain, if any.
Jose Pizarro MD on Diffusion Tensor Imaging (DTI)
Based on the same principles as MRI, diffusion tensor imaging (DTI) is an advancement in that technology. According to Dr. Jose Pizarro, DTI gives us a more detailed look into the microstructure of the brain. DTI examines white matter tracts and more subtle brain damage such as diffuse axonal injury.
The images that DTI produces are three dimensional and can depict subtle injuries to the white matter in the brain much better than MRIs or CT scans. Since DTI is better at detecting the diffusion of water molecules and their patterns, it makes it easy for radiologists to diagnose any abnormality in the integrity and structure of the white matter and the pathways of the axons.
When it comes to traumatic brain injuries, DTI offers a more accurate diagnostic tool that detects mild and moderate brain damage better than other imaging tests.