Advanced neuroimaging provides critical evidence in TBI cases, particularly when standard CT scans and MRI appear normal despite significant symptoms. Understanding what different imaging modalities show—and their limitations—helps attorneys build stronger cases.

Standard Imaging

CT Scans

CT (computed tomography) is typically the first imaging performed after head trauma:

  • What it shows: Skull fractures, brain bleeding, large contusions, swelling
  • Advantages: Fast, widely available, good for emergencies
  • Limitations: Poor sensitivity to mild TBI; may miss diffuse injury

Standard MRI

MRI (magnetic resonance imaging) offers better soft tissue visualization:

  • What it shows: Smaller lesions, contusions, microbleeds
  • Advantages: More sensitive than CT to subtle damage
  • Limitations: May still appear normal in mild TBI; takes longer

Advanced Imaging Techniques

Diffusion Tensor Imaging (DTI)

DTI maps white matter tracts—the nerve fiber bundles connecting brain regions:

  • What it shows: Axonal injury, white matter damage
  • Significance: Can detect diffuse axonal injury that standard MRI misses
  • Legal value: Objective evidence of structural damage

Functional MRI (fMRI)

fMRI measures brain activity during tasks:

  • What it shows: Abnormal brain activation patterns during cognitive tasks
  • Significance: Documents functional impairment
  • Limitations: Results can be variable; interpretation debated

PET Scans

PET (positron emission tomography) shows metabolic activity:

  • What it shows: Decreased metabolic activity in damaged areas
  • Significance: May show abnormalities when other imaging is normal
  • Limitations: Expensive, less widely available

SWI (Susceptibility Weighted Imaging)

An MRI sequence sensitive to blood products:

  • What it shows: Microbleeds, small hemorrhages
  • Significance: Detects bleeding standard MRI may miss

Using Imaging in Litigation

When Normal Imaging Helps Defense

Defense attorneys cite normal CT and MRI as evidence no injury occurred. Advanced imaging may refute these arguments.

Expert Interpretation Required

All imaging requires expert radiologist or neurologist interpretation. Raw images alone don't prove cases.

Timing Matters

Some imaging findings (like microbleeds) may resolve over time. Early imaging is important.

Conclusion

Neuroimaging is powerful TBI evidence, but selecting appropriate modalities and timing is critical. Attorneys should work with medical experts to determine which imaging best documents the specific brain injury at issue.