Avulsion injury of cervical nerve roots: enhanced intradural nerve roots at MR imaging.

Hayashi, Nobuko; Yamamoto, Shinichi; Okubo, Toshiteru; Yoshioka, Naoki; Shirouzu, Ichiro; Abe, Osamu; Ohtomo, Kazuyoshi; Sasaki, Yoshiichi; Nagano, Akira

doi:10.1148/radiology.206.3.9494507

Cited by 36 publications

(21 citation statements)

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“…127 (59,60,63,65,66) reported the accuracy of MRI for patients and nerves; two studies (43,44) reported results only at the patient level; three studies (62,64,67) reported the accuracy with the nerve as the exclusive unit of analysis; and the unit of analysis was unclear in one study (61), so it did not contribute to summary estimates. With the patient as the unit of analysis (43,44,59,60,63,65,66), 104 of 144 patients (median, 72%; IQR: 53%-86%) had at least one root avulsion.…”

Section: Key Resultsmentioning

confidence: 99%

“…With the patient as the unit of analysis (43,44,59,60,63,65,66), 104 of 144 patients (median, 72%; IQR: 53%-86%) had at least one root avulsion. With the nerve as the unit of analysis (59,60,(62)(63)(64)(65)(66)(67), 583 of 918 roots were avulsed (median, 55%; IQR: 38%-71%). The time from injury to MRI was reported in six studies (44,59,60,63,65,66) and varied considerably, with a median delay of 36 days (IQR: 26-66 days; range, 0-840 days).…”

Section: Key Resultsmentioning

confidence: 99%

“…Six studies (43,60,61,(63)(64)(65) were at unclear risk of selection bias because the sampling strategy was unclear or because patients were inappropriately excluded. The study by Hayashi et al (62) was at high risk of selection bias because of the retrospective exclusion of (an unknown number of) patients whose MRI images were suboptimal. The study by Yang et al (67) was also at high risk of selection bias because they Methodologic Quality Assessment The risk of bias and the applicability of included studies was assessed by two authors (R.G.W.…”

Section: Risk Of Bias and Applicability Concernsmentioning

confidence: 99%

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MRI for Detecting Root Avulsions in Traumatic Adult Brachial Plexus Injuries: A Systematic Review and Meta-Analysis of Diagnostic Accuracy

Wade¹,

Takwoingi²,

Wormald

et al. 2019

Radiology

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T raumatic brachial plexus injuries affect 1% of patients involved in major trauma (1). Brachial plexus injuries may cause permanent disability (2-6), pain (6-8), psychologic morbidity (9,10), and reduced quality of life (2,4,11). Early reconstructive nerve surgery is associated with better functional recovery in the upper limb (2,3,11,12), which improves quality of life (4). Nerve reconstruction for patients with root avulsion(s) is a clinical priority for several reasons. After root avulsion, the cell bodies of motor neurons in the spinal cord recede (4,5,12,13), so the limb never reanimates spontaneously. Because reimplantation of avulsed roots yields no meaningful recovery (14-16), nerve transfers are performed, which significantly improves function (11,17-20). Nerve transfers are relatively minor and cost-effective procedures (21,22) with low morbidity (20,23-25). Furthermore, 95% of patients with traumatic brachial plexus injuries have neuropathic pain (6), and the evolving evidence suggests that early reconstructive nerve surgery reduces cortical reorganization and thus neuropathic or phantom limb pain (26-28). Therefore, correctly identifying patients with root avulsions is of paramount importance. MRI is the best noninvasive test for brachial plexus injuries (29). MRI is superior to nerve and muscle electrophysiology studies (30), US (31-34), and intraoperative somatosensory-evoked potentials (35). Currently, MRI

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Section: Key Resultsmentioning

confidence: 99%

Section: Key Resultsmentioning

confidence: 99%

Section: Risk Of Bias and Applicability Concernsmentioning

confidence: 99%

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MRI for Detecting Root Avulsions in Traumatic Adult Brachial Plexus Injuries: A Systematic Review and Meta-Analysis of Diagnostic Accuracy

Wade¹,

Takwoingi²,

Wormald

et al. 2019

Radiology

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“…It is caused by simultaneous traction of the arm and lateral flexion of head to the opposite direction, the most common situation to cause such injury being road traffic accident followed by birth injury, fall of heavy object over shoulder and very rarely missile injuries or sharp stab injuries though they are more likely to cause distal plexus injuries. Nerve root avulsions are more commonly accompanied by traumatic pseudomeningocele formation 3 , which can however rarely exist without any nerve root avulsions (Fig 1A, 1B & 1C). Conversely nerve root avulsions can occur without pseudomeningocele formation.…”

Section: Discussionmentioning

confidence: 99%

Newer MR Imaging Techniques in Traumatic Brachial Plexopathies

Disawal¹,

Bakde²

2016

IJMRP

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Introduction: The aim of this study was to identify, localize and characterize various traumatic brachial plexus pathologies with the help of newer MR techniques. MRI enables the differentiation of preganglionic from postganglionic injuries, a distinction that is critical in management decisions. Materials & Methods: 34 patients presenting with traction injuries of the brachial plexus were included in the study. T1W and T2W coronal, sagittal and axial images of the cervical spine and oblique coronal images of the brachial plexus were obtained with 2 mm thickness with Diffusion Weighted Imaging with Background Suppression and Fat saturation Contrast Enhanced T1 Weighted transverse and oblique-coronal scan. Ethical committee clearance for the study was obtained. Results:The results were classified into 4 major categories (normal rootlet, rootlet injuries, avulsion, and meningocele).The results were compared with surgical findings, intraoperative neurophysiology and subsequent clinical progress. Surgery for exploration and repair have been performed in 30 of 34 patients scanned. Evidence of root avulsion was seen in 24 patients. There were no false positives. MRI underestimated the number of individual roots avulsed; sensitivity was 94%. Post-ganglionic injuries were seen in 8 cases. 4 patients, in whom T1WI and T2WI were normal, were found to have

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“…[1][2][3] The recent advent of multidetector CT scanners enables us to obtain data with high spatial resolution along a spine. 4 However, the large number of thinslice images generated from myelographic CT would make the qualitative and quantitative diagnosis of the injured individual nerve roots a challenging task for radiologists if they evaluated each image one by one.…”

Section: Introductionmentioning

confidence: 99%

Bezier surface reformation: an original visualization technique of cervical nerve roots on myelographic CT

et al. 2006

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Avulsion injury of cervical nerve roots: enhanced intradural nerve roots at MR imaging.

Abstract: Although visualization of nerve roots is a problem, enhanced MR imaging is a noninvasive means of obtaining anatomic information and unique physiologic information on injured intradural nerve roots.

Cited by 36 publications

References 0 publications

MRI for Detecting Root Avulsions in Traumatic Adult Brachial Plexus Injuries: A Systematic Review and Meta-Analysis of Diagnostic Accuracy

MRI for Detecting Root Avulsions in Traumatic Adult Brachial Plexus Injuries: A Systematic Review and Meta-Analysis of Diagnostic Accuracy

Newer MR Imaging Techniques in Traumatic Brachial Plexopathies

Bezier surface reformation: an original visualization technique of cervical nerve roots on myelographic CT

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