Detection of Root Avulsion in the Dominant C7 Obstetric Brachial Plexus Lesion: Experience with Three-dimensional Constructive Interference in Steady-state Magnetic Resonance Imaging and Electrophysiology

Abstract

3D CISS MRI provides good images of anterior and posterior spinal roots in infants with obstetric brachial plexus lesions. Images seem to allow accurate prediction of root avulsion in the majority of patients. In this study, electrodiagnostics were of limited value.

The Diagnostic Value of CT Myelography, MR Myelography, and Both in Neonatal Brachial Plexus Palsy

“…In our study, MR myelography was equal to and perhaps better than CT myelography for the prediction of complete nerve root avulsions on surgical exploration, and we found no benefit to the combined use of CT and MR imaging over MR myelography alone. This outcome supports the findings of several prior studies that evaluated the diagnostic performance of MR myelography alone 25,[39][40][41][42][43][44] and is further evidence that with the current technique, MR myelography may be capable of replacing CT myelography in the preoperative assessment of infants with neonatal brachial plexus palsy. In addition, MR imaging has the advantage of evaluating the intrinsic signal intensity and integrity of the spinal cord in better detail compared with CT.…”

“…30,31 Its predictive value for detecting nerve root avulsions has been evaluated [32][33][34][35] and has been found to have similar 36,37 or greater 38 value compared with CT myelography in adults. MR myelography has also been evaluated in neonatal brachial plexus palsy 25,[39][40][41][42][43][44] but is yet to be widely adopted. Medina et al 43 demonstrated good sensitivity and specificity for the detection of extraforaminal neuromas by using an MR imaging-based technique, but sensitivity for the detection of findings reflecting proximal nerve root avulsions, particularly characterization of the nerve roots themselves, was poor.…”

“…23,24 MR myelography can be performed without injection of contrast and is a promising alternative. 17,25 However, the performance of MR myelography for predicting nerve root avulsion is not yet established 26 in neonatal brachial plexus injury, and the diagnostic value of MR myelography has yet to be compared with CT myelography in this setting. The purpose of this study was to determine the predictive value of CT myelography, MR myelography, and both CT and MR myelography for detecting complete nerve root avulsions in neonatal brachial plexus palsy, by using a surgical criterion standard.…”

Obstetric Brachial Plexus Lesions: CT Myelography

“…However, few MR studies in OBPLs and adult brachial traumatic plexopathies have actually reported observation of the roots from the spinal cord by using three-dimensional T2-weighted sequences (21)(22)(23). Most of these reports focused only on the presence of pseudocysts ( 11,(24)(25)(26)(27). However, the presence of avulsions cannot be ruled out in the absence of a pseudocyst ( 23,26,28,29 ).…”

High-Resolution MRI Evaluation of Neonatal Brachial Plexus Palsy: A Promising Alternative to Traditional CT Myelography

“…To date, however, there are only a few reports contained in the literature examining the utility of MR imaging for nerve root avulsions and none looking specifically at NBPP. [7][8][9][10][11] The reports contain scant imaging examples of nerve root avulsion, and many of the images are not convincingly diagnostic. 12 Most of the reports focus on the use of a heavily T2-weighted 3D sequence, referred to under various names on the basis of the specific manufacturer, such as 3D CISS (constructive interference in steady state), 3D True-FISP (fast imaging with steady-state precession), FIESTA (fast imaging employing steadystate acquisition), and DRIVE (driven equilibrium) sequences.…”