Academy of Chiropractic
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From the Desk of Dr. Mark Studin
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006
“mTBI Diagnosis and Diffusion Weighted Images”
“Truth” Mark Studin 2021
mTBI is often elusive to diagnosis, and one technology that emerged was Diffusion Tensor Imaging (DTI) that is synonymous with Diffusion-Weighted Images (DWI). When this technology emerged 10 years ago, Dr. Peyster used it extensively to determine the accuracy and he personally stated that is was too inconsistent to consider reliable, and refrained from diagnosing mTBI with this technology.
Many others heavily relied on this technology both in the chiropractic arena with consultants stressing the utilization of the technology, with many radiologists nationally acquiescing to do the test and give definitive diagnosis. For too many in our industry, it is only about the money and not the science (wow… this sounds like politics☹).
I choose to follow the evidence, and Dr. Peyster as he NEVER is inflammatory on his opinion or findings, no matter the pressure in the industry. I was also at odds with many other “self-proclaimed guru’s” (consultants) in our industry that was running excitedly to lawyers and having doctors strongly rely on this emerging technology. Like Dr. Peyster, I too held my ground.
5 days ago, the following article came out:
Lindsey, Hannah M., et al. "Diffusion-Weighted Imaging in Mild Traumatic Brain Injury: A Systematic Review of the Literature." Neuropsychology Review (2021): 1-80.
The authors reported: “There is evidence that diffusion-weighted imaging (DWI) is able to detect tissue alterations following mild traumatic brain injury (mTBI) that may not be observed on conventional neuroimaging; however, findings are often inconsistent between studies.”
They concluded: “We conclude that DWI is able to detect structural mTBI-related abnormalities that may persist over time, although future DWI research will benefit from larger samples, improved data analysis methods, standardized reporting, and increasing transparency.”
This is not a technology I want to “hang my reputation” on. To date, EEG-ERP is the best evidenced-based, reproducible technology to diagnose mTBI. If you want to learn more, call Dr. Donna Meeks 661-209-2782, and she will take the time to bring you up to speed. If I was practicing today, that is what I would use.
If you have taken the concussion course, I centered the diagnostic discussion on this proven technology. It has been successfully utilized for many years and is all conclusively evidenced-based.