New York Court Upholds Validity of DTI

A New York trial court recently denied defendants’ motion to compel plaintiff’s radiologist to produce Diffusion Tensor Imaging (DTI) control group data.

In Siracusa v. City Ice Pavilion, LLC, the plaintiff was injured while participating in an ALS Ice Bucket Challenge, held at a hockey rink owned and operated by the defendant. Plaintiff sustained a traumatic brain injury (TBI), allegedly at the fault of the defendant. Plaintiff underwent an MRI-DTI which was analyzed by Dr. Michael Lipton. Dr. Lipton’s DTI analysis lead to the conclusion that the plaintiff has abnormally low FA levels, which is consistent with traumatic axonal injury, although also consistent with other non-traumatic causes.

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DTI Scans May Indicate Post-injury Compensatory Brain Processes and a Link to Better Outcomes

A study by doctors at Montefiore Medical Center and Albert Einstein College of Medicine provides additional support that use of Diffusion Tensor Imaging (DTI) may be clinically helpful to patients with mild Traumatic Brain Injuries (TBI) because it shows possible evidence of brain repair in post-injury patients. Scans conducted one year post-injury show that patients who exhibited abnormally high fractional anisotropy shortly after injury were “significantly associated” with better overall health outcomes.

The DTI scans were performed on a control group and on 39 injured subjects within 16 days of injury and one year later on 26 returning patients. According to the study, the patients were also tested for changes in cognition and symptomology. The results showed that DTI may be a “marker of compensatory neural mechanisms and an indicator of favorable outcome.” This is supportive data to an earlier study showing positive results from DTI use in pediatric patients, and an important study that used DTI to check the movement of water molecules in the brain of NFL players. In the NFL study the scans showed that those with marked deviations in fluid movement also demonstrated “abnormalities in attention and concentration, executive function, learning/memory and spatial/perceptual function.”

The ability to identify areas of damage and potential for repair are expected to inspire development of new effective treatments for patients with TBIs. Cognitive and physical effects of even mild TBIs may require extensive and long-term treatment from various healthcare providers including doctors, physical therapists, occupational therapists, and psychologists. If you or someone you know has suffered a TBI you should consult an experienced attorney to find out if you can seek reparation to get assistance with medical bills—consultations are usually free and services are often offered on a contingency basis.

Pediatric Traumatic Brain Injury (TBI) Study Finds Link Between Diffusion Tensor Imaging (DTI) & Cognition

A new study from the University of Adelaide in Australia found that in the medium- to long-term pediatric traumatic brain injury (TBI), the fractional anisotropy (FA) values for numerous large white matter tracks in comparison to the whole brain were related to cognition. This study, published online in Developmental Neuropsychology, specifically examined the relationship between diffusion tensor imaging (DTI) findings and cognition following pediatric traumatic brain injury.

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New York Court Again Rejects Defendant’s Motion to Bar DTI Evidence

A recent decision by the Supreme Court – State of New York, Nassau County, Part 40 rejected a motion by defendants to preclude the plaintiffs from presenting evidence regarding diffusion tensor imaging in support of their claim that the infant plaintiff suffered a traumatic brain injury as a result of a traumatic incident.  Sullivan v. Walters, Index number 6110-2005, Supreme Court-State of New York, Nassau County, Part 40.

There, defendants moved pursuant to Frye v. United States, 293 F. 1013 (1923) to bar the admissibility of plaintiffs’ expert Michael Lipton, M.D., Ph.D., asserting that the use of DTI violated the Frye standard.

In support of their motion, defendants submitted the affidavit of Dr. A. John Tsouris who is a board certified staff neuro radiologist and director of neurological MR imaging at New York Presbyterian Hospital-Weill Cornell Medical Center, and an associate professor of radiology.  Dr. Tsouri has co-authored two articles on DTI and is presently researching the possibility of utilizing DTI to establish mild traumatic brain injury in professional football players and patients suffering from MS, ALS, and brain neuoplasm as part of a collaborative study by the Hospital for Special Surgery and Weill-Cornell Medical Center’s Department of Neurology.  Dr. Tsouris affirmed that “research to date has shown that there is a significant overlap between FA values of individuals with traumatic brain injury and FA values in persons with no history of traumatic brain injury.”  Dr. Tsouris was also of the opinion that while DTI could be used if at all in a group study that individual results were meaningless unless compared to a control group.

Plaintiffs’ expert, Dr. Lipton, explained “MRIs are insensitive to white matter in the brain and so people who have sustained a closed head injury often have normal MRI results despite damage to white matter in their brains.  DTI is far more sensitive than MRI in that it measures the direction of extremely small-scale movement a/k/a diffusion of water molecules within tissue.  It was Dr. Lipton’s opinion that plaintiff’s quantitative analysis of FA images from the MRI/DTI study demonstrated multiple foci of significant low anisotropy consistent with traumatic axonal injury.  Dr. Lipton also explained that DTI does not and cannot, on its own, diagnose mild traumatic brain injury, but that it must be correlated with history and other clinical data to either substantiate or refute the diagnosis.

Plaintiff presented numerous medical literature and other publications which supported the use of DTI in establishing a traumatic brain injury as well as numerous Orders in which DTI has been admitted into evidence.

Defendants also asserted that Dr. Lipton’s failure to provide the computer programs and foundational data basis should also result in Dr. Lipton being barred.  The Court noted that these programs where the proprietary property of Montefiore Medical Center and Albert Einstein College of Medicine, which were not a party to the action nor had relief against them been sought.  More importantly, the Court noted that the information was confidential under HIPAA and the Court denied that portion of the motion as well.

New York Court Upholds Use of Diffusion Tensor Imaging in Litigation

I was recently sent two Orders from the State of New York in which defendant’s motion to bar the introduction of diffusion tensor imaging was denied.  Here is a discussion of the first case with the second to follow.

In the matter of Girgs v. Snapple Distribution Corp., Civil Court of the City of New York, County of Queens Part 30 the defendant moved to preclude the testimony of plaintiff’s medical expert, Michael Lipton, M.D., Ph.D. regarding his assessment of a traumatic brain injury based upon his analysis.  The basis of the motion was due to the plaintiff’s “alleged failure to comply with prior discovery orders wherein defendant sought to obtain various records, data, and information relied upon to reach the results in his report.  Defendant asserted that Dr. Lipton was unavailable and would always be unavailable to turnover his data as it is based on a comparison to individuals who did not waive their privilege under HIPAA.  Plaintiff asserted that discovery had been turned over.

According to the Order, Dr. Lipton performed an MRI of the plaintiff’s brain with results which were interpreted as being “unremarkable.”  Dr. Lipton also reviewed the plaintiff’s MRI with diffusion tensor imaging at which time he performed a quantitative analysis of the fractional anisotropy (“FA”) images from the DTI portion of the examination.  Dr. Lipton opined that this analysis revealed that plaintiff had multiple abnormalities consistent with axonal injury due to traumatic brain injury.

In response, defendant demanded discovery of all data, films, and information on which Dr. Lipton based his findings.  Defendant filed a motion to compel such discovery which was granted to the extent plaintiff was to provide all FA images using DTI, and any and all control values, including but not limited to films and images of the control group relied upon by Dr. Lipton and any other DTI imaging and films.  According to that Order, if plaintiff did not provide the requested information, plaintiff would be precluded from offering trial evidence and testimony from Dr. Lipton regarding the items not produced.

That early order was modified to the extent that defendant was given leave to subpoena the “computer programs and foundational data bases from Montefiore Medical Center and Albert Einstein College of Medicine.”  That early order was again modified to the extent that defendant was to serve a subpoena on Montefiore Medical Center requesting the data/information used for the comparative analysis by Dr. Lipton.

In response to that order, plaintiff turned over to defendant the DTI demographical data and quantitative analysis compiled by Dr. Lipton.  This information contained a number of participants in the control group, age, gender, and FA numbers.

In this most recent decision, the Court found that “since the images comprising the normal data base contained personal identifying information, as well as protected HIPAA information of parties not part of the lawsuit, who had not given consent, there is no legal basis to turnover this information.”  Furthermore, in that defendant’s “expert” Dr. Panasci, M.D. did not allege that he had any expertise in the quantitative analysis of DTI, the Court found that this information was not necessary for his analysis.  Accordingly, defendant’s motion to preclude the testimony of Dr. Lipton was denied.

Defendant then asserted that Dr. Lipton’s testimony should be precluded on the basis that the determinations in his report were not based on the “generally accepted standard” as set forth under Frye. The Court rejected this argument as well finding that the “data and methods relied upon by Dr. Lipton to quantitatively analyze plaintiff’s DTI images had been peer review endorsed by scientific publications including Radiology, Journal of Neuro Trauma, PLOS ONE, and Brain Imaging and Behavior. 

The Court stated: Moreover, to follow the defendant’s argument to its logical conclusion, would lead to an illogical result.  If the Court adopted defendant’s argument, there would not be any introduction of a great deal of generally accepted medical research since this privilege HIPAA information can never be turned over without consent.  Limitations of this type would be a waste of helpful resources and counterproductive to the administration of justice. Thus, defendant’s motion to preclude the testimony of Dr. Lipton based on Frye was denied.

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