Modified Pathological Classification of Brachial Plexus Root Injury and Its MR Imaging Characteristics

Abstract

The authors described a modified pathological classification (PC) of brachial plexus injury (BPI) and its magnetic resonance (MR) imaging characteristics. The reliability and diagnostic accuracy of MR imaging for detecting nerve injury was discussed. Between 2006 and 2010, 86 patients with BPI were managed surgically in our department. Their preoperative MR images and surgical findings were analyzed retrospectively. The PC of BPI was classified into five types: (I) nerve root injury in continuity (including Sunderland grade I-IV injury); (II) postganglionic spinal nerve rupture with or without proximal stump; (III) preganglionic root injury (visible); (IV) preganglionic nerve root injury and postganglionic spinal nerves injury; (V) preganglionic root injury (invisible). The main MR imaging characteristics of BPI included traumatic meningocele, displacement of spinal cord, the absence of nerve root, "Black line" sign, nerve root/trunk injury in continuity, and thickening and edema of nerve root. The accuracy of MR imaging for detecting C5, C6, C7, C8, and T1 nerve roots injury were 93.3, 95.2, 92.3, 84, and 74.4%, respectively. The modified PC provides a detailed description of nerve root injury in BPI, and MR imaging technique is a reliable method for detecting nerve root 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 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).…”

“…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 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. and J.C.R.W.)…”

Diagnostic Accuracy of Three Sensory Tests for Diagnosis of Sensory Disturbances

“…Third, sensation is a complex physiological and psychological processes; it is also related to the patient's cognitive state. Our patients suffered from brachial plexus injury, which is a serious problem in hand surgery, [34][35][36][37] and severity of the injured limb may affect the patient's judgment of sensation in the contralateral limb. Because of the complexity and range of manifestations observable in patients with sensory disturbances, Walk et al 1 had developed a comprehensive There are some limitations of the current study.…”