Magnetic Resonance Imaging in Brachial Plexus Injury

Overview

Journal Musculoskelet Surg

Date 2013 Aug 17

PMID 23949940

Citations 31

Authors

F Caranci

F Briganti

M La Porta

G Antinolfi

E Cesarano

P Fonio

L Brunese

F Coppolino

Affiliations

Soon will be listed here.

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.

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References

Muto M, Perrotta V, Guarnieri G, Lavanga A, Vassallo P, Reginelli R . Vertebroplasty and kyphoplasty: friends or foes?. Radiol Med. 2008; 113(8):1171-84. DOI: 10.1007/s11547-008-0301-6. View

WALKER A, Chaloupka J, de Lotbiniere A, Wolfe S, Goldman R, Kier E . Detection of nerve rootlet avulsion on CT myelography in patients with birth palsy and brachial plexus injury after trauma. AJR Am J Roentgenol. 1996; 167(5):1283-7. DOI: 10.2214/ajr.167.5.8911196. View

Caranci F, Brunese L, Reginelli A, Napoli M, Fonio P, Briganti F . Neck neoplastic conditions in the emergency setting: role of multidetector computed tomography. Semin Ultrasound CT MR. 2012; 33(5):443-8. DOI: 10.1053/j.sult.2012.06.011. View

Bowen B, Pattany P, Saraf-Lavi E, Maravilla K . The brachial plexus: normal anatomy, pathology, and MR imaging. Neuroimaging Clin N Am. 2004; 14(1):59-85, vii-viii. DOI: 10.1016/j.nic.2003.12.002. View

Tsuchiya K, Katase S, Aoki C, Hachiya J . Application of multi-detector row helical scanning to postmyelographic CT. Eur Radiol. 2003; 13(6):1438-43. DOI: 10.1007/s00330-002-1748-9. View

Demondion X, Boutry N, Drizenko A, Paul C, Francke J, Cotten A . Thoracic outlet: anatomic correlation with MR imaging. AJR Am J Roentgenol. 2000; 175(2):417-22. DOI: 10.2214/ajr.175.2.1750417. View

Doi K, Otsuka K, Okamoto Y, Fujii H, Hattori Y, Baliarsing A . Cervical nerve root avulsion in brachial plexus injuries: magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography. J Neurosurg. 2002; 96(3 Suppl):277-84. DOI: 10.3171/spi.2002.96.3.0277. View

Gupta R, Mehta V, Banerji A, Jain R . MR evaluation of brachial plexus injuries. Neuroradiology. 1989; 31(5):377-81. DOI: 10.1007/BF00343859. View

Bendszus M, Koltzenburg M . Visualization of denervated muscle by gadolinium-enhanced MRI. Neurology. 2001; 57(9):1709-11. DOI: 10.1212/wnl.57.9.1709. View

10.

Bertelli J, Ghizoni M . Brachial plexus avulsion injury repairs with nerve transfers and nerve grafts directly implanted into the spinal cord yield partial recovery of shoulder and elbow movements. Neurosurgery. 2003; 52(6):1385-9; discussion 1389-90. DOI: 10.1227/01.neu.0000065134.21334.d7. View

11.

Cappabianca S, Colella G, Russo A, Pezzullo M, Reginelli A, Iaselli F . Maxillofacial fibrous dysplasia: personal experience with gadoliniumenhanced magnetic resonance imaging. Radiol Med. 2008; 113(8):1198-210. DOI: 10.1007/s11547-008-0329-7. View

12.

Tagliafico A, Calabrese M, Puntoni M, Pace D, Baio G, Neumaier C . Brachial plexus MR imaging: accuracy and reproducibility of DTI-derived measurements and fibre tractography at 3.0-T. Eur Radiol. 2011; 21(8):1764-71. DOI: 10.1007/s00330-011-2100-z. View

13.

Hayashi N, Yamamoto S, Okubo T, Yoshioka N, Shirouzu I, Abe O . Avulsion injury of cervical nerve roots: enhanced intradural nerve roots at MR imaging. Radiology. 1998; 206(3):817-22. DOI: 10.1148/radiology.206.3.9494507. View

14.

Pusiol T, Scialpi M . Role of computed tomography in the preoperative diagnosis of giant benign solitary fibrous tumor pleura. Lung India. 2013; 30(1):82-5. PMC: 3644848. DOI: 10.4103/0970-2113.106128. View

15.

Rapoport S, Blair D, McCarthy S, Desser T, Hammers L, Sostman H . Brachial plexus: correlation of MR imaging with CT and pathologic findings. Radiology. 1988; 167(1):161-5. DOI: 10.1148/radiology.167.1.3347719. View

16.

Russo S, Lo Re G, Galia M, Reginelli A, Lo Greco V, DAgostino T . Videofluorography swallow study of patients with systemic sclerosis. Radiol Med. 2009; 114(6):948-59. DOI: 10.1007/s11547-009-0416-4. View

17.

Elefante A, Caranci F, Del Basso De Caro M, Peca C, Guadagno E, Severino R . Paravertebral high cervical chordoma. A case report. Neuroradiol J. 2013; 26(2):227-32. PMC: 5228733. DOI: 10.1177/197140091302600214. View

18.

Hayashi N, Masumoto T, Abe O, Aoki S, Ohtomo K, Tajiri Y . Accuracy of abnormal paraspinal muscle findings on contrast-enhanced MR images as indirect signs of unilateral cervical root-avulsion injury. Radiology. 2002; 223(2):397-402. DOI: 10.1148/radiol.2232010857. View

19.

Aralasmak A, Karaali K, Cevikol C, Uysal H, Senol U . MR imaging findings in brachial plexopathy with thoracic outlet syndrome. AJNR Am J Neuroradiol. 2009; 31(3):410-7. PMC: 7963963. DOI: 10.3174/ajnr.A1700. View

20.

Carvalho G, Nikkhah G, Matthies C, Penkert G, Samii M . Diagnosis of root avulsions in traumatic brachial plexus injuries: value of computerized tomography myelography and magnetic resonance imaging. J Neurosurg. 1997; 86(1):69-76. DOI: 10.3171/jns.1997.86.1.0069. View