Diagnostic Accuracy of the Magnetic Resonance Imaging in Adult Post-Ganglionic Brachial Plexus Traumatic Injuries: A Systematic Review and Meta-Analysis

Abstract

Background: Traumatic brachial plexus injuries are rare but serious consequences of major traumas. Pre-ganglionic lesions are considered irreparable, while post-ganglionic injuries can be potentially treated if an early diagnosis is available. Pre-surgical diagnosis is important to distinguish low-grade from high-grade lesions and to identify their location. The aim of the review is to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in the identification of adult post-ganglionic lesions due to traumatic brachial plexus injuries, compared to intraoperative findings. Methods: Research on the main scientific electronic databases was conducted. Studies of adults with traumatic post-ganglionic brachial plexus injuries were included. The index test was preoperative MRI and the reference standard was surgical exploration. Pooled sensitivity and specificity were calculated. Results: Four studies were included for the systematic review, of which three articles met the inclusion criteria for the meta-analysis. Pooled sensitivity and pooled specificity values resulted high. The sensitivity value is associated with a high heterogeneity index of the selected literature. Conclusion: MRI can be considered, despite the limits, the gold standard exam in morphological evaluation of brachial plexus injuries, particularly in the diagnosis of post-ganglionic traumatic injuries.

Magnetic Resonance Accuracy in the Diagnosis of Anterior Talo-Fibular Ligament Acute Injury: A Systematic Review and Meta-Analysis

“…Considering this small variability, a specific analysis of the diagnostic accuracy of acute ATFL lesions with varying MRI field strength was not carried out. Furthermore, it is reported that there are no significant differences in the diagnostic performance of MRI using a 3 T magnet rather than a 1.5 T one; significant advantages can only be obtained with a field strength of 7 T, which provides better depiction of ankle anatomy, fluid depositions, and cartilage defects [54][55][56][57]. All the selected studies except for Wei Tan et al described the MRI protocols used, which showed substantial homogeneity: T2-weighted Turbo Spin Echo acquired in the axial plane was employed as the main sequence for a better visualization of the ATFL, using a section thickness of 3-4 mm with an interslice gap of 10%, with the only exception being Verhaven et al, in which a 3D-FSP sequence with a section thickness of 1 mm was employed.…”

Lesiones del plexo braquial en adultos: Una revisión narrativa de la literatura

“…Current evidence suggests that imaging and electrodiagnostic methods still lack precision in diagnosing nerve root conditions. [11][12][13][14] To date, the gold standard for the diagnosis of brachial plexus injuries is surgical exploration. 12,13 Radiography: after ruling out associated injuries, request a chest radiograph to assess the elevation of the hemidiaphragm resulting from potential damage to the phrenic nerve and detect any rib fractures, which can influence the choice of nerves for transfer.…”

“…Según la evidencia actual, los métodos de imágenes y electrodiagnósticos todavía carecen de precisión para diagnosticar el estado de las raíces nerviosas. [11][12][13][14] Hasta el momento, el estándar de oro para el diagnóstico de las lesiones del plexo braquial es la exploración quirúrgica. 12,13 Radiografías: luego de descartar lesiones asociadas, se debe solicitar una radiografía de tórax para evaluar el ascenso del hemidiafragma por una posible lesión del nervio frénico.…”

“…Hoy en día, el estudio de elección para estas lesiones es la RM de columna cervical. 11,19 Sus principales ventajas por sobre la TAC con mielografía son que es un estudio no invasivo, que permite la visualización de estructuras blandas adyacentes y lesiones postganglionares, además que ha demostrado mejor sensibilidad y especificidad en estudios recientes. 20 Estudios electrodiagnósticos: los estudios con electromiografía y velocidad de conducción ayudan a orientar en el diagnóstico de lesiones preganglionares.…”

Neuroimaging Applications for Diagnosis and Therapy of Pathologies in the Central and Peripheral Nervous System

“…Several diagnostic tools for BP injury are currently available, with MRI considered one of the best for the assessment of both peripheral nerve pathology and adjacent soft tissue and musculature [ 4 ]. In a review study, Leigheb et al [ 5 ] provided evidence to further support the use of MRI for pre-surgical diagnosis of BP injury. Through a meta-analysis on a set of recent studies combining MRI with intraoperative findings, Leigheb and colleagues evaluated the diagnostic accuracy of MRI for post-ganglionic lesions.…”