Magnetic resonance imaging in brachial plexus injury

Abstract

Brachial plexus injury represents the most severe nerve injury of the extremities. While obstetric brachial plexus injury has showed a reduction in the number of cases due to the improvements in obstetric care, brachial plexus injury in the adult is an increasingly common clinical problem. The therapeutic measures depend on the pathologic condition and the location of the injury: Preganglionic avulsions are usually not amenable to surgical repair; function of some denervated muscles can be restored with nerve transfers from intercostals or accessory nerves and contralateral C7 transfer. Postganglionic avulsions are repaired with excision of the damaged segment and nerve autograft between nerve ends or followed up conservatively. Magnetic resonance imaging is the modality of choice for depicting the anatomy and pathology of the brachial plexus: It demonstrates the location of the nerve damage (crucial for optimal treatment planning), depicts the nerve continuity (with or without neuroma formation), or may show a completely disrupted/avulsed nerve, thereby aiding in nerve-injury grading for preoperative planning. Computed tomography myelography has the advantage of a higher spatial resolution in demonstration of nerve roots compared with MR myelography; however, it is invasive and shows some difficulties in the depiction of some pseudomeningoceles with little or no communication with the dural sac.

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

“…The post-ganglionic plexus can be evaluated by MRI with findings suggesting neuropraxia, axonotmesis or neurotmesis30. Nerve discontinuity on MRI implied retraction of distal nerves after rupture, disappearance of local nerve structure, and replacement by scar tissue or hematoma.…”

Ultrasound imaging of brachial plexus trauma in gunshot injury

“…The use of CT and/or MRI to assess brachial plexus injury is more conventional and widespread. CT myelography provides appropriately high spatial resolution necessary to image preganglionic nerve roots, but is invasive and poorly characterizes postganglionic trauma . MRI generates multiplanar images and high‐contrast resolution in soft tissues, and has been shown to have significant clinical impact in the evaluation of patients with brachial plexus neuropathies .…”

“…Electrodiagnostic (EDx) studies are commonly used to identify damaged nerves as a result of an injury and provide prognostic information both pre‐ and postoperatively . Although computed tomography (CT) myelography and MRI are both commonly used for preoperative imaging evaluation of brachial plexus trauma, MRI is the modality of choice for imaging the postganglionic brachial plexus . Still, the postganglionic brachial plexus components can be imaged and evaluated using ultrasound (US).…”

Differentiation of Pre- and Postganglionic Nerve Injury Using MRI of the Spinal Cord

“…[3, 23, 24] The current diagnostic MRI protocols in clinical use are largely based on the imaging of nerve roots, together with the detection of indirect signs of injury. [25, 26] Although constant methodological improvements are being made, due to artifacts and certain interferences, the currently available MRI protocols are yet not considered reliable in the diagnostics of brachial plexus injury. [6]…”