Abstract
Background
Detailed evaluation of a brachial plexus birth injury is important for treatment planning.
Objective
To determine the diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury.
Materials and methods
Included in the study were 31 children with perinatal brachial plexus injury who underwent surgical intervention. All patients had cervical and brachial plexus MRI. The standard of reference was the combination of intraoperative (1) surgical evaluation and (2) electrophysiological studies (motor evoked potentials, MEP, and somatosensory evoked potentials, SSEP), and (3) the evaluation of histopathological neuronal loss. MRI findings of cord lesion, pseudomeningocele, and post-traumatic neuroma were correlated with the standard of reference. Diagnostic performance characteristics including sensitivity and specificity were determined.
Results
From June 2001 to March 2004, 31 children (mean age 7.3 months, standard deviation 1.6 months, range 4.8–12.1 months; 19 male, 12 female) with a brachial plexus birth injury who underwent surgical intervention were enrolled. Sensitivity and specificity of an MRI finding of post-traumatic neuroma were 97% (30/31) and 100% (31/31), respectively, using the contralateral normal brachial plexus as the control. However, MRI could not determine the exact anatomic area (i.e. trunk or division) of the post-traumatic brachial plexus neuroma injury. Sensitivity and specificity for an MRI finding of pseudomeningocele in determining exiting nerve injury were 50% and 100%, respectively, using MEP, and 44% and 80%, respectively, using SSEP as the standard of reference. MRI in infants could not image well the exiting nerve roots to determine consistently the presence or absence of definite avulsion.
Conclusion
In children younger than 18 months with brachial plexus injury, the MRI finding of pseudomeningocele has a low sensitivity and a high specificity for nerve root avulsion. MRI and MR myelography cannot image well the exiting nerve roots to determine consistently the presence or absence of avulsion of nerve roots. The MRI finding of post-traumatic neuroma has a high sensitivity and specificity in determining the side of the brachial plexus injury but cannot reveal the exact anatomic area (i.e. trunk or division) involved. The information obtained is, however, useful to the surgeon during intraoperative evaluation of spinal nerve integrity for reconstruction.
Similar content being viewed by others
References
Nakamura T, Yabe Y, Horiuchi Y, et al (1997) Magnetic resonance myelography in brachial plexus injury. J Bone Joint Surg Br 79:764–769
Doi K, Otsuka K, Okamoto Y, et al (2002) Cervical nerve root avulsion in brachial plexus injuries: magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography. J Neurosurg 96 [3 Suppl]:277–284
Walker A, Chaloupka J, de Lotbiniere A, et al (1996) Detection of nerve rootlet avulsion on CT myelography in patients with birth palsy and brachial plexus injury after trauma. AJR 167:1283–1287
Carvalho G, Nikkhah G, Matthies C, et al (1997) Diagnosis of root avulsions in traumatic brachial plexus injuries: value of computerized tomography myelography and magnetic resonance imaging. J Neurosurg 86:69–76
Amrami K, Port J (2005) Imaging the brachial plexus. Hand Clin 21:25–37
Grossman J, DiTaranto P, Price A, et al (2004) Multidisciplinary management of brachial plexus birth injuries: the Miami experience. Semin Plast Surg 18:4
Enzinger FM, Weiss SW (1988) Soft tissue tumors, 2nd edn. Mosby, St. Louis, pp 719–780
Gasparotti R, Ferraresi S, Pinelli L, et al (1997) Three-dimensional MR myelography of traumatic injuries of the brachial plexus. AJNR 18:1733–1742
Ochi M, Ikuta Y, Watanabe M, et al (1994) The diagnostic value of MRI in traumatic brachial plexus injury. J Hand Surg Br 19:55–59
Blum U, Friedburg H, Ott D (1989) Traktionsverletzungen des plexus brachialis: radiologische diagnostik mit myelo-CT und MR. Rofo 151:702–705
Francel P, Koby M, Park T, et al (1995) Fast spin-echo magnetic resonance imaging for radiological assessment of neonatal brachial plexus injury. J Neurosurg 83:461–466
Acknowledgements
We acknowledge the important work done by Esperanza Pacheco, MD, and Martha Ballesteros, MD, in the interpretation of the MRI studies.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Medina, L.S., Yaylali, I., Zurakowski, D. et al. Diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury. Pediatr Radiol 36, 1295–1299 (2006). https://doi.org/10.1007/s00247-006-0321-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-006-0321-0