Use of Magnetic Resonance Imaging to Diagnose Brachial Plexus Injuries

Abstract

Objective:To compare magnetic resonance imaging and intraoperative findings in patients diagnosed with traumatic injury to the brachial plexus. Methods:Patients with a diagnosis of traumatic injury to the brachial plexus admitted to the hand and microsurgery outpatient consult of the Hospital das Clínicas at the University of São Paulo were selected during December 2016. A total of three adult patients with up to six months of injury who underwent surgical treatment were included in the study. A diffusion-weighted sequence magnetic resonance protocol and fluid-sensitive volumetric reformatting sequence were applied. The magnetic resonance results were compared with the diagnoses obtained from the injuries observed during the surgery. The study was double-blind (surgeon and radiologist). Results:A descriptive correlation was found between the magnetic resonance imaging results and the diagnostic findings from the surgeries, for both pre- and post-ganglionic injuries. Conclusion:Magnetic resonance imaging has shown to be a promising diagnostic method in preoperative assessment of brachial plexus lesions; it is less invasive than other common methods, showing not only avulsion lesions but also localized postganglionic lesions in the supra- and infraclavicular region. Level of Evidence III; Diagnostic studies - Investigating a diagnostic test.

Traumatic brachial plexus injury rehabilitation using neuromuscular electrical muscle stimulation in a polytrauma patient

“…While there is little empirical evidence for the rehabilitation of brachial plexus polytrauma patients, there is more support for the diagnostic accuracy of MRI assessment in this patient population. Our findings are in accordance with previous authors4 who reported the use of MRI imaging correlated highly with diagnostic surgery in preganglionic lesions. These findings gave us confidence that the predictive chances of recovery would be high as the lesion was found to be neurapraxia and not full nerve damage.…”

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

“…Our review had limitations. While 20 potentially relevant articles were identified, data extraction was impossible for nine articles (50)(51)(52)(53)(54)(55)(56)(57)(58). Retrospective studies of medical tests tend to report inflated estimates of diagnostic accuracy (68); our review included four retrospective studies (59,60,66,67) and seven articles that incompletely described the time frames between injury, imaging, and surgery.…”

“…Eightysix full texts were retrieved, of which 66 were excluded for the following reasons: narrative review (n = 24), no reference standard (n = 17), case report (n = 7), opinion piece (n = 4), no preoperative MRI (n = 3), a systematic review (n = 1), a survey of brachial plexus imaging (n = 1), or irrelevant (n = 9). Nine articles were later excluded (50-58) because of missing outcome data (50,(53)(54)(55)(56)58), inability to disaggregate results (52,57), and a report of root avulsion within a series of patients with other nerve injuries that was treated as a case report (51). Ultimately, 11 articles (11 studies) (43,44,59-67) were included.…”

Introductory Chapter: Brachial Plexus Injuries - Past, Present, and Future

“…The treatment strategy is based on the mechanism of injury [54], the findings of the physical and neurological examinations [57], and the results of the complementary diagnostic tests (electrodiagnostic studies [58], magnetic resonance imaging [59], and ultrasonography [60]). This last one is relatively inexpensive and can be made available to places with very limited resources [61].…”

“…Computerized myelo-tomography was used in the past to diagnose the nerve root avulsions, but nowadays it has been replaced by magnetic resonance imaging [59,[64][65][66].…”