Diagnostic Value and Surgical Implications of the 3D DW-SSFP MRI On the Management of Patients with Brachial Plexus Injuries

Abstract

Three-dimensional diffusion-weighted steady-state free precession (3D DW-SSFP) of high-resolution magnetic resonance has emerged as a promising method to visualize the peripheral nerves. In this study, the application value of 3D DW-SSFP brachial plexus imaging in the diagnosis of brachial plexus injury (BPI) was investigated. 33 patients with BPI were prospectively examined using 3D DW-SSFP MR neurography (MRN) of brachial plexus. Results of 3D DW-SSFP MRN were compared with intraoperative findings and measurements of electromyogram (EMG) or somatosensory evoked potentials (SEP) for each injured nerve root. 3D DW-SSFP MRN of brachial plexus has enabled good visualization of the small components of the brachial plexus. The postganglionic section of the brachial plexus was clearly visible in 26 patients, while the preganglionic section of the brachial plexus was clearly visible in 22 patients. Pseudomeningoceles were commonly observed in 23 patients. Others finding of MRN of brachial plexus included spinal cord offset (in 16 patients) and spinal cord deformation (in 6 patients). As for the 3D DW-SSFP MRN diagnosis of preganglionic BPI, the sensitivity, the specificity and the accuracy were respectively 96.8%, 90.29%, and 94.18%. 3D DW-SSFP MRN of brachial plexus improve visualization of brachial plexus and benefit to determine the extent of injury.

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

“…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. 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%).…”

“…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).…”

“…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). The time from injury to exploratory surgery was reported in four studies (59,60,66,67) and also varied, with a median delay of 67 days (IQR: 52-74 days; range, 6-399 days).…”

“…The results of the risk of bias and applicability assessment are summarized in Figure 2. 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.…”

“…Study characteristics are presented in Table 1 and Table E1 (online). Studies originated from the United Kingdom (44,66), Sweden (59), China (63,67), Japan (61,62,65), Belgium (43), Italy (64), and Thailand (60). All studies were small, with a median sample size of 23 (interquartile range [IQR]: 9-31; range, 7-86), and had been performed between 1992 and 2016.…”