Quick answer
MRI is more sensitive than CT and can detect subtler brain changes.[1] NINDS lists diffusion tensor imaging (DTI), fluid-attenuated inversion recovery (FLAIR) and susceptibility-weighted imaging (SWI) among the techniques researchers use to detect milder damage.[1] DTI is contested in court: some experts argue it is seldom appropriate as evidence in mild TBI cases,[2] while others argue chronic-stage DTI should be admitted when supported by a clinician,[3] and at least one federal court has admitted it under Daubert.[4]
Conventional MRI
NINDS states that MRI “is more sensitive and can pick up more subtle brain changes that a CT scan may miss.”[1] In the Annals of Neurology study of 135 mild TBI patients, 27% of those with a normal CT had an abnormal early MRI.[5]
Research imaging methods
NINDS lists these methods researchers may use:[1]
DTI
Diffusion tensor imaging, which “could identify damage in white matter tracts in the brain.”
FLAIR
Fluid-attenuated inversion recovery, which “could detect small areas of damage.”
SWI
Susceptibility-weighted imaging, which “could identify even small and hard to detect brain bleeds.”
The case against DTI as evidence
A 2011 article in the Journal of the American Academy of Psychiatry and the Law concluded that “careful analysis of the DTI in mTBI literature, guided by Daubert criteria, suggests that, presently, the admission of DTI evidence in mTBI litigation is seldom appropriate.”[2] A 2022 follow-up by the lead author warned of “the potential for powerfully misleading testimony based on DTI interpretations.”[6]
The case for DTI as evidence
A 2023 review in the World Journal of Clinical Cases argued that clinical DTI at the chronic stage “is a valid methodology both clinically as well as forensically” and “should be admitted into evidence in personal injury trials if supported by a clinician.”[3]
How a court has ruled
In Marsh v. Celebrity Cruises, the U.S. District Court for the Southern District of Florida held that DTI satisfied the Daubert standard, finding it had been subject to peer review and publication and rejecting the argument that it was “junk science.”[4] Admissibility is decided case by case under the applicable rule. See expert witnesses.
Guidance for experts
A multidisciplinary consensus conference published in the American Journal of Neuroradiology advised that “if DTI or other nonspecific imaging findings are introduced into legal evidence, the expert should offer alternative explanations for the findings, including technical factors and normal variations.”[7]
Frequently asked questions
Will DTI prove I have a brain injury?
Not on its own. Experts disagree on how specific DTI findings are in mild TBI,[2][3] and NINDS describes DTI as a research method.[1]
Have courts allowed DTI evidence?
Yes, in some cases. A federal court in Florida admitted DTI under Daubert in Marsh v. Celebrity Cruises.[4]
This page provides general information from the sources listed below. It is not legal or medical advice, and reading it does not create an attorney-client or provider-patient relationship. Laws vary by state and change over time. See our legal disclaimer.
Sources
- National Institute of Neurological Disorders and Stroke. “Traumatic Brain Injury (TBI).” https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury-tbi
- Wortzel HS, Kraus MF, Filley CM, Anderson CA, Arciniegas DB. “Diffusion Tensor Imaging in Mild Traumatic Brain Injury Litigation.” Journal of the American Academy of Psychiatry and the Law, 2011;39(4):511-523. https://jaapl.org/content/39/4/511
- van Velkinburgh JC, Herbst MD, Casper SM. “Diffusion tensor imaging in the courtroom: Distinction between scientific specificity and legally admissible evidence.” World Journal of Clinical Cases, 2023. https://pubmed.ncbi.nlm.nih.gov/37469746/
- Lexology. Discussion of Marsh v. Celebrity Cruises (S.D. Fla. 2018) and DTI evidence under Daubert. https://www.lexology.com/library/detail.aspx?g=c1924c35-3266-4177-a608-4fb81e1c2adf
- Yuh EL, et al. “Magnetic resonance imaging improves 3-month outcome prediction in mild traumatic brain injury.” Annals of Neurology, 2013;73(2):224-235. https://pubmed.ncbi.nlm.nih.gov/23224915/
- Wortzel HS. “Advanced Neuroimaging and Mild Traumatic Brain Injury Litigation, Revisited.” Journal of the American Academy of Psychiatry and the Law, 2022;50(3):336. https://jaapl.org/content/50/3/336
- Meltzer CC, Sze G, Rommelfanger KS, et al. “Guidelines for the Ethical Use of Neuroimages in Medical Testimony: Report of a Multidisciplinary Consensus Conference.” American Journal of Neuroradiology, 2014. https://pmc.ncbi.nlm.nih.gov/articles/PMC7965800/
Sources last checked: October 11, 2026
