Clarifying the Robust Foundation for and Appropriate Use of DTI in mTBI Patients

As clinicians and scientists, we believe scientific evidence and prudent clinical practice form the proper basis for determining the utility of diagnostic measures, which should subsequently inform forensic use. The misleading and often entirely unsubstantiated opinions and positions of Wortzel et al., in opposition to DTI as a useful measure in mTBI, are at odds with the clear consensus of the scientific literature regarding mTBI, its clinical assessment and natural history. The authors' critique contains numerous errors. We will focus on four areas: (1) the clinical reality of mTBI (2) the true substance of the scientific evidence supporting use of DTI in mTBI, (3) the authors' erroneous and off-target opinions regarding DTI analysis and (4) critical appraisal and integration of clinical information for diagnosis of mTBI.