Role of FIESTA combined with conventional MRI in the evaluation of traumatic brachial plexus roots injury

MR neurography in traumatic brachial plexopathy

“…With 3D CISS sequence (3 dimensional constructive interference in steady state), a diagnostic accuracy of 88% was reported by Abul-Kasim et al in the assessment of root injury with sensitivity of 90% and specificity of 87% [11]. El Mogy et al have reported an accuracy of 93.8% in the evaluation of root injury using FIESTA (fast imaging employing steady-state acquisition) combined with conventional MR imaging [14]. In the current study, lesions of three portions of the brachial plexus were evaluated, namely roots, trunks and cords.…”

A Complex Component of the Nervous System: Brachial Plexus

“…MRN is a special type of MRI that is tissue specific and capable of eliciting the morphological features of nerves, such as their caliber, continuity, and relation to nearby structures such as nerves, muscles and bones, as well as pathological features of the nerves(e.g., nerve fibrosis, inflammation, and edema) (Figure 7). The term MRN is used when the imaging is done for the peripheral nerves, while in the case of the central nervous system, the terms "tractography" and "diffuse tensor imaging" are used [27]. MRN findings include disruptions of the course of the proximal elements at the scalene triangle, fibrous band entrapments affecting the C8 and T1 spinal nerves and the lowertrunk of the brachial plexus, gross distortions of the mid-plexus, hyperintensity consistent with nerve irritation at the level of the first rib, and distal plexus hyperintensity.…”

“…MRN findings include disruptions of the course of the proximal elements at the scalene triangle, fibrous band entrapments affecting the C8 and T1 spinal nerves and the lowertrunk of the brachial plexus, gross distortions of the mid-plexus, hyperintensity consistent with nerve irritation at the level of the first rib, and distal plexus hyperintensity. Notably, three-dimensional (3D) reconstructions of the MRN images yield more information than the two dimensional (2D) images by 28%, and this is greatest with the brachial plexus; therefore, 3D reconstructions are considered an essential part of diagnostic interpretations [27]. Du et al, [28] showed that MRN provided more diagnostic information than electrodiagnostic studies and concluded that MRN is best used when MRI and electrodiagnostic studies are unavailing regarding spinal or peripheral nerve pathology, if MRI shows multilevel disease and electro-diagnostic studies are unable to confirm these results, and in patients who are unable to undergo electrodiagnostic studies (i.e., patients on anti-coagulants or a coexistent disease that reduces accuracy such as diabetes) [29].…”

“…Also to be noted is that MRN can detect pathologies in a specific anatomical location (brachial plexus and peripheral nerves), but not in different locations at the same time [28]. Ordering errors are mainly due to the fact that many referring physicians are not familiar with nerve imaging [27].…”

Update and review on the basics of brachial plexus imaging

“…In the case of large meningoceles, some nerve roots may not be clearly visualized because of the lesions; therefore, the nerve roots that are invisible cannot be deemed normal or injured [18]. Finally, the difficulty in determining the exact level of injury and the inclusion of vertebral arteries and the spinal venous plexus in myelographic images may disturb the image and the interpretation obtained [26]. Considering the aforementioned flaws, MRM is not the method of choice for traumatic injuries and cannot replace CTM as the gold standard since the latter can help overcome these obstacles [18].…”