Diffusion Tensor Imaging for Diagnosing Root Avulsions in Traumatic Adult Brachial Plexus Injuries: A Proof-of-Concept Study

Wade, Ryckie G.; Tanner, Steven F.; Teh, Irvin; Ridgway, John P.; Shelley, David; Chaka, Brian; Rankine, James J.; Andersson, Gustav; Wiberg, Mikael; Bourke, Gráinne

doi:10.3389/fsurg.2020.00019

Cited by 19 publications

(29 citation statements)

References 39 publications

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“…After reviewing 27 full texts, 15 were excluded (Supplementary materials) and 9 articles (of 9 unique studies) were included [18,[21][22][23][24][25][26][27][28] (Fig. 2).…”

Section: Resultsmentioning

confidence: 99%

Diffusion tensor imaging of the roots of the brachial plexus: a systematic review and meta-analysis of normative values

Wade

Whittam

Teh

et al. 2020

Clin Transl Imaging

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Purpose Diffusion tensor magnetic resonance imaging (DTI) characterises tissue microstructure and provides proxy measures of myelination, axon diameter, fibre density and organisation. This may be valuable in the assessment of the roots of the brachial plexus in health and disease. Therefore, there is a need to define the normal DTI values. Methods The literature was systematically searched for studies of asymptomatic adults who underwent DTI of the brachial plexus. Participant characteristics, scanning protocols, and measurements of the fractional anisotropy (FA) and mean diffusivity (MD) of each spinal root were extracted by two independent review authors. Generalised linear modelling was used to estimate the effect of experimental conditions on the FA and MD. Meta-analysis of root-level estimates was performed using Cohen’s method with random effects. Results Nine articles, describing 316 adults (1:1 male:female) of mean age 35 years (SD 6) were included. Increments of ten diffusion sensitising gradient directions reduced the mean FA by 0.01 (95% CI 0.01, 0.03). Each year of life reduced the mean MD by 0.03 × 10–3 mm2/s (95% CI 0.01, 0.04). At 3-T, the pooled mean FA of the roots was 0.36 (95% CI 0.34, 0.38; I2 98%). The pooled mean MD of the roots was 1.51 × 10–3 mm2/s (95% CI 1.45, 1.56; I2 99%). Conclusions The FA and MD of the roots of the brachial plexus vary according to experimental conditions and participant factors. We provide summary estimates of the normative values in different conditions which may be valuable to researchers and clinicians alike.

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“…After reviewing 27 full texts, 15 were excluded (Supplementary materials) and 9 articles (of 9 unique studies) were included [18,[21][22][23][24][25][26][27][28] (Fig. 2).…”

Section: Resultsmentioning

confidence: 99%

Diffusion tensor imaging of the roots of the brachial plexus: a systematic review and meta-analysis of normative values

Wade

Whittam

Teh

et al. 2020

Clin Transl Imaging

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“…However, to be able to differentiate healthy from diseased or injured sections of nerve, it is necessary to define the normative DTI parameters and tractography conditions for the brachial plexus. To date, six studies report the findings of DTI tractography of the brachial plexus in healthy adults (Vargas et al 2010;Tagliafico et al 2011;Gasparotti et al 2013;Oudeman et al, 2018;Wade et al, 2020;Su et al 2019 ; Table S1) but a wide array of step angles was used to reconstruct tracts representing the pre-and postganglionic brachial plexus. Vargas et al (2010) used a 30° step angle and reconstructed the C5-T1 roots in all volunteers, although the C5 roots were not apparent in their published tractograms.…”

Section: Discussionmentioning

confidence: 99%

“…Anatomical studies provide limited information on the geometry of the brachial plexus, which manifest in the wide variety of step angles (14° to 70°) used in DTI studies of the brachial plexus to date (Vargas et al 2010;Tagliafico et al 2011;Gasparotti et al 2013;Oudeman et al, 2018;Wade et al, 2020;Su et al 2019). The need for precise and detailed geometric information, which can be translated to clinical diffusion tensor tractography, represents the rationale for this study.…”

Section: Introductionmentioning

confidence: 99%

The Geometry of the roots of the Brachial Plexus

et al. 2020

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“…Previous studies have shown the feasibility of DTI tractography of the brachial plexus in adults [3][4][5][6][7][8] and others have shown the reproducibility of DTI metrics without tractography 9,10 . Tagliafico 4 and Vargas 3 used different FA thresholds for tractography across patients, citing thresholds of 0.15 +/− 0.05 but it is unclear how and from where these values were measured, and what the +/− 0.05 represents.…”

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confidence: 99%

“…Tagliafico 4 does not report the frequency of propagated tracts whilst Vargas 3 propagated C5-T1 tracts in all healthy volunteers. Conversely, work from our group 8 and Oudeman 5 used fixed FA thresholds of 0.06 and 0.1, respectively. Oudeman 5 reconstructed fibres representing the C5-C8 root in all cases, but in 52% of datasets, the 1 st thoracic root was not reconstructed.…”

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confidence: 99%

Fractional anisotropy thresholding for deterministic tractography of the roots of the brachial plexus

Wade

Teh

Andersson

et al. 2021

Sci Rep

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Diffusion tensor imaging (DTI) metrics, such as the fractional anisotropy (FA) and estimates of diffusivity are sensitive to the microstructure of peripheral nerves and may be displayed as tractograms. However, the ideal conditions for tractography of the roots of the brachial plexus are unclear, which represents the rationale for this study. Ten healthy adults were scanned using a Siemens Prisma (3T) and single-shot echo-planar imaging (b-value 0/1000 s/mm2, 64 directions, 2.5 mm3 with 4 averages; repeated in opposing phase encoding directions). Susceptibility correction and tractography were performed in DSI Studio by two independent raters. The effect of FA thresholding at increments of 0.01 (from 0.04 to 0.10) were tested. The mean FA varied between subjects by 2% (95% CI 1%, 3%). FA thresholds of 0.04, 0.05 and 0.06 all propagated 96% of tracts representing the roots; thresholding at 0.07 yielded 4% fewer tracts (p = 0.2), 0.08 yielded 11% fewer tracts (p = 0.008), 0.09 yielded 15% fewer tracts (p = 0.001) and 0.1 yielded 20% fewer tracts (p < 0.001). There was < 0.1% inter-rater variability in the measured FA and 99% agreement for tractography (κ = 0.92, p < 0.001). The fractional anisotropy thresholds required to generate tractograms of the roots of the brachial plexus appears to be lower than those used in the brain. We provide estimates of the probability of generating true tracts for each spinal nerve root of the brachial plexus, at different fractional anisotropy thresholds.

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Diffusion Tensor Imaging for Diagnosing Root Avulsions in Traumatic Adult Brachial Plexus Injuries: A Proof-of-Concept Study

Cited by 19 publications

References 39 publications

Diffusion tensor imaging of the roots of the brachial plexus: a systematic review and meta-analysis of normative values

Diffusion tensor imaging of the roots of the brachial plexus: a systematic review and meta-analysis of normative values

The Geometry of the roots of the Brachial Plexus

Fractional anisotropy thresholding for deterministic tractography of the roots of the brachial plexus

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