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The diagnostic value of MRI in traumatic brachial plexus injury
1Department of Orthopaedic Surgery, Hiroshima University School of Medicine, Japan.
Abstract:
Findings in 34 patients with traumatic brachial plexus injury documented by surgical exploration and intra-operative somatosensory-evoked potentials were correlated with findings on myelography and magnetic resonance imaging (MRI) to determine whether MRI can identify nerve root avulsion. The coronal and sagittal planes were not able to demonstrate avulsion of the individual nerve roots. The axial and axial oblique planes did provide useful information to determine which nerve root was avulsed in the upper plexus, although it was difficult to clearly delineate the lower cervical rootlets. The accuracy of MRI was 73% for C5 and 64% for C6 and that of myelography 63% for C5 and 64% for C6. Thus, the diagnostic accuracy of MRI for upper nerve roots was slightly superior to myelography. Although its primary diagnostic value is limited to the upper nerve roots whose avulsion is relatively difficult to diagnose by myelography, MRI can provide useful guidance in the waiting period prior to surgical exploration after brachial plexus injury.
Insights
Magnetic resonance imaging (MRI) shows promise in diagnosing traumatic brachial plexus injuries, particularly upper nerve root avulsions. While not perfect, MRI offers slightly better accuracy than myelography for these specific injuries.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Traumatic brachial plexus injuries can result in significant functional deficits.
- Accurate diagnosis of nerve root avulsion is crucial for surgical planning and patient outcomes.
- Conventional imaging modalities have limitations in visualizing nerve root avulsions.
Purpose of the Study:
- To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in identifying nerve root avulsions in patients with traumatic brachial plexus injuries.
- To compare the efficacy of MRI with myelography in diagnosing these injuries.
Main Methods:
- Retrospective analysis of 34 patients with traumatic brachial plexus injury.
- Correlation of surgical findings and intra-operative somatosensory-evoked potentials with pre-operative MRI and myelography.
- Assessment of diagnostic accuracy of MRI and myelography for specific nerve roots (C5, C6).
Main Results:
- MRI, particularly in axial and axial oblique planes, provided useful information for upper plexus nerve root avulsions.
- MRI accuracy was 73% for C5 and 64% for C6.
- Myelography accuracy was 63% for C5 and 64% for C6, indicating MRI's slightly superior diagnostic capability for upper roots.
Conclusions:
- MRI offers slightly superior diagnostic accuracy compared to myelography for upper nerve root avulsions in traumatic brachial plexus injuries.
- While visualization of lower cervical rootlets remains challenging, MRI provides valuable guidance during the pre-operative waiting period.
- MRI is a valuable tool for assessing traumatic brachial plexus injuries, aiding in surgical decision-making.