Successive Torts Resulting in a Single, Indivisible Injury: Plaintiffs, Prepare to Prove the Impossible

In most lawsuits, plaintiffs\u27 medical experts can accurately allocate plaintiffs\u27 injuries to a specific, causal factor. In some instances, however, two events may combine to cause an injury that is incapable of rational apportionment, even by the most learned medical expert. In such a case, the indivisible injury doctrine may relieve a plaintiff of the difficult burden of proving which tortfeasor caused her injuries. The indivisible injury doctrine, however, does not benefit all plaintiffs who have suffered an injury that cannot be apportioned. As illustrated by the instant case, certain plaintiffs must prove the impossible, namely, which tortfeasor caused their injuries, even though doing so may be a medical impossibility

The Influence of Spatial Registration on Detection of Cerebral Asymmetries Using Voxel-Based Statistics of Fractional Anisotropy Images and TBSS

The sensitivity of diffusion tensor imaging (DTI) for detecting microstructural white matter alterations has motivated the application of voxel-based statistics (VBS) to fractional anisotropy (FA) images (FA-VBS). However, detected group differences may depend on the spatial registration method used. The objective of this study was to investigate the influence of spatial registration on detecting cerebral asymmetries in FA-VBS analyses with reference to data obtained using Tract-Based Spatial Statistics (TBSS). In the first part of this study we performed FA-VBS analyses using three single-contrast and one multi-contrast registration: (i) whole-brain registration based on T2 contrast, (ii) whole-brain registration based on FA contrast, (iii) individual-hemisphere registration based on FA contrast, and (iv) a combination of (i) and (iii). We then compared the FA-VBS results with those obtained from TBSS. We found that the FA-VBS results depended strongly on the employed registration approach, with the best correspondence between FA-VBS and TBSS results when approach (iv), the “multi-contrast individual-hemisphere” method was employed. In the second part of the study, we investigated the spatial distribution of residual misregistration for each registration approach and the effect on FA-VBS results. For the FA-VBS analyses using the three single-contrast registration methods, we identified FA asymmetries that were (a) located in regions prone to misregistrations, (b) not detected by TBSS, and (c) specific to the applied registration approach. These asymmetries were considered candidates for apparent FA asymmetries due to systematic misregistrations associated with the FA-VBS approach. Finally, we demonstrated that the “multi-contrast individual-hemisphere” approach showed the least residual spatial misregistrations and thus might be most appropriate for cerebral FA-VBS analyses