Pediatric Radiology

, Volume 38, Issue 2, pp 159–163

Magnetic resonance neurography in children with birth-related brachial plexus injury

  • Alice B. Smith
  • Nalin Gupta
  • Jonathan Strober
  • Cynthia Chin
Original Article

Abstract

Background

Magnetic resonance neurography (MRN) enables visualization of peripheral nerves. Clinical examination and electrodiagnostic studies have been used in the evaluation of birth-related brachial plexus injury. These are limited in their demonstration of anatomic detail and severity of injury.

Objective

We investigated the utility of MRN in evaluating birth-related brachial plexus injury in pediatric patients, and assessed the degree of correlation between MRN findings and physical examination and electromyographic (EMG) findings.

Materials and methods

The MRN findings in 11 infants (age 2 months to 20 months) with birth-related brachial plexus injury were evaluated. A neuroradiologist blinded to the EMG and clinical examination findings reviewed the images. Clinical history, examination, EMG and operative findings were obtained.

Results

All infants had abnormal imaging findings on the affected side: seven pseudomeningoceles, six neuromas, seven abnormal nerve T2 signal, four nerve root enlargement, and two denervation changes. There was greater degree of correlation between MRN and physical examination findings (kappa 0.6715, coefficient of correlation 0.7110, P < 0.001) than between EMG and physical examination findings (kappa 0.5748, coefficient of correlation 0.5883, P = 0.0012).

Conclusion

MRN in brachial plexus trauma enables localization of injured nerves and characterization of associated pathology. MRN findings demonstrated a statistically significant correlation with physical examination and EMG findings, and might be a useful adjunct in treatment planning.

Keywords

Brachial plexus injury Magnetic resonance neurography Infants 

References

  1. 1.
    Laurent JP, Lee RT (1994) Birth-related upper brachial plexus injuries in infants: operative and nonoperative approaches. J Child Neurol 9:111–117PubMedCrossRefGoogle Scholar
  2. 2.
    Kay SP (1998) Obstetrical brachial palsy. Br J Plast Surg 51:43–50PubMedGoogle Scholar
  3. 3.
    Laurent JP, Lee R, Shenaq S et al (1993) Neurosurgical correction of upper brachial plexus birth injuries. J Neurosurg 79:197–203PubMedGoogle Scholar
  4. 4.
    Abbott R, Abbott M, Alzate J et al (2004) Magnetic resonance imaging of obstetrical brachial plexus injuries. Childs Nerv Syst 20:720–725PubMedGoogle Scholar
  5. 5.
    Chauhan SP, Rose CH, Gherman RB et al (2005) Brachial plexus injury: a 23-year experience from a tertiary center. Am J Obstet Gynecol 192:1795–1800PubMedCrossRefGoogle Scholar
  6. 6.
    Al-Qattan MM, Clarke HM, Curtis CG (1995) Klumpke’s birth palsy: does it really exist? J Hand Surg 20:19–23CrossRefGoogle Scholar
  7. 7.
    Waters PM (2005) Update on management of pediatric brachial plexus palsy. J Pediatr Orthop 25:116–126PubMedCrossRefGoogle Scholar
  8. 8.
    Pitt M, Vredeveld J (2005) The role of electromyography in the management of the brachial plexus palsy of the newborn. Clin Neurophysiol 116:1756–1761PubMedCrossRefGoogle Scholar
  9. 9.
    Todd M, Shah GV, Mukherji SK (2004) MR imaging of brachial plexus. Top Magn Reson Imaging 15:113–125PubMedCrossRefGoogle Scholar
  10. 10.
    Gasparotti R, Ferraresi S, Pinelli L et al (1997) Three-dimensional MR myelography of traumatic injuries of the brachial plexus. AJNR 18:1733–1742PubMedGoogle Scholar
  11. 11.
    Walker AT, Chaloupka JC, de Lotbiniere AC et al (1996) Detection of nerve rootlet avulsion on CT myelography in patients with birth palsy and brachial plexus injury after trauma. AJR 167:1283–1287PubMedGoogle Scholar
  12. 12.
    Colon AJ, Vredeveld JW, Blaauw G et al (2003) Extensive somatosensory innervation in infants with obstetric brachial palsy. Clin Anat 16:25–29PubMedCrossRefGoogle Scholar
  13. 13.
    Vredeveld JW, Blaauw G, Slooff AC et al (2000) The findings in paediatric obstetric brachial palsy differ from those in older patients: a suggested explanation. Dev Med Child Neurol 42:158–161PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Alice B. Smith
    • 1
    • 4
  • Nalin Gupta
    • 2
  • Jonathan Strober
    • 3
  • Cynthia Chin
    • 1
  1. 1.Department of NeuroradiologyUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Department of NeurosurgeryUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Department of Pediatric NeurologyUniversity of California, San FranciscoSan FranciscoUSA
  4. 4.Department of RadiologyUniversity of California, San FranciscoSan FranciscoUSA

Personalised recommendations