Diagnosing traumatic brain injury (TBI)
Traumatic brain injuries pose a significant challenge to the insurance industry, with symptoms ranging from short-term concussion to long-term cognitive deficits. TBIs are often complex, high-value claims that can be difficult to validate. The growing use of advanced imaging has important implications for claims evaluation, rehabilitation as well as risk management. This is only going to become ever more so if imaging becomes an established cornerstone of TBI classification as anticipated by the new CBI-M (clinical, biomarkers, imaging and modifiers) classification system currently being trialled in the US.TBI classification
A TBI can be classified as mild, moderate, or severe and the clinical presentation may not always align with imaging results. Mild TBI, or concussion, accounts for a significant number of cases and is particularly difficult to prove objectively using traditional diagnostics. Examples of these scenarios include:
- Prolonged disability despite normal imaging;
- Disputes over causation and pre-existing conditions;
- Subjective symptom reporting (e.g. headaches, memory loss).
Traditional imaging tools and limitations
- CT scans: CT scans quickly identify issues like bleeding or fractures. However, they often appear normal in mild TBI cases.
- MRI scans: MRI scans are more sensitive than CT scans for detecting subtle injuries, though standard MRI may still fail to show an injury in patients reporting persistent symptoms.
These limitations can lead to uncertainty where a claimant is alleging ongoing impairment, but the imaging is inconclusive, complicating claim resolution and opening the door to exaggeration or inappropriate rehabilitation provision being recommended by well-meaning professionals.
Emerging imaging techniques
Given these limitations, there are some emerging technologies to provide the medical field with more accurate results and conclusive evidence to diagnose mild TBIs. These include:
- Diffusion Tensor Imaging (DTI): An advanced form of MRI, which maps the diffusion of water molecules in brain tissue, making it easier to visualise white matter disruption. This is particularly useful in mild TBI cases such as concussion where traditional imaging can appear normal.
- Susceptibility-Weighted Imaging (SWI): An MRI technique highly sensitive to blood products, iron, and calcium, providing enhanced contrast for detecting microbleeds and vascular abnormalities. SWI is particularly useful in evaluating brain function involving memory, attention, language, and emotion, often impaired by brain injury. This method is increasingly used in forensic investigations and within military settings to detect subtle brain trauma.
- Functional MRI (fMRI): Offers insight into functional and metabolic changes post-injury. This technique measures brain activity by detecting changes in blood oxygenation (BOLD signal) which in turn will reveal how different brain regions are functioning and possibly affecting tasks involving memory, attention, language and emotion. It can also detect disrupted connectivity in brain networks, helping practitioners track how the brain re-organises function post injury which can assist with rehabilitation and providing a more accurate prognosis.
- AI-Augmented Imaging Analysis: Artificial intelligence is increasingly used to detect subtle changes in brain structure and function. AI algorithms can detect subtle lesions, microbleeds, and white matter abnormalities that could be missed by human reviewers or conventional analysis. AI tools are being trained to predict recovery outcomes, cognitive deficits, or risk of chronic complications based on early imaging features. However, widespread use of AI in neuroimaging might raise issues around data privacy, algorithm transparency, and clinical validation.
Conclusion
The landscape of TBI diagnosis and classification is shifting, with advanced imaging offering critical clarity where subjectivity once ruled. For insurers, these tools provide an opportunity to improve the fairness and accuracy of claims evaluation, reduce exposure to fraudulent or exaggerated claims and support more informed decision-making across litigation, rehabilitation and reserves.
Clinical signs remain a crucial component of TBI diagnosis and classification, and the growing importance of biomarkers is also recognised in the new CBI-M classification system. However, advanced imaging ought to assist in validating legitimate claims that previously lacked objective support. High-end imaging technologies are expensive and clear medical guidelines and pre-certification policies are needed to manage the justification and cost to use them. The advanced imaging techniques discussed in this article remain a work in progress, but it is certainly a fast-paced developing area which will assist all parties involved in litigating TBI claims.
If you would like to discuss the issues raised in this article further, or speak with us regarding any other aspect of brain injury cases, please do not hesitate to get in touch with our specialist team.
