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Magnetic resonance imaging in brachial plexus injury

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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

  1. Yoshikawa T, Hayashi N, Yamamoto S et al (2006) Brachial plexus injury: clinical manifestations, conventional imaging findings, and the latest imaging techniques. Radiographics 26:S133–S143

    Article  PubMed  Google Scholar 

  2. Rankine JJ (2004) Adult traumatic brachial plexus injury. Clin Radiol 59:767–774

    Article  PubMed  CAS  Google Scholar 

  3. Bertelli JA, Ghizoni MF (2003) 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 52:1385–1389

    Article  PubMed  Google Scholar 

  4. Nagano A (1998) Treatment of brachial plexus injury. J Orthop Sci 3:71–80

    Article  PubMed  CAS  Google Scholar 

  5. Chen L, Gu YD, Hu SN et al (2007) Contralateral C7 transfer for the treatment of brachial plexus root avulsions in children d a report of 12 cases. J Hand Surg Am 32:96–103

    Article  PubMed  CAS  Google Scholar 

  6. Sureka J, Cherian RA, Alexander M, Thomas BP (2009) MRI of brachial plexopathies. Clin Radiol 64:208–218

    Article  PubMed  CAS  Google Scholar 

  7. Bowen BC, Pattany PM, Saraf-Lavi E et al (2004) The brachial plexus: normal anatomy, pathology, and MR imaging. Neuroimaging Clin N Am 14:59–85

    Article  PubMed  Google Scholar 

  8. Rapoport S, Blair DN, McCarthy SM et al (1988) Brachial plexus: correlation of MR imaging with CT and pathologic findings. Radiology 167:161–165

    PubMed  CAS  Google Scholar 

  9. van Es HW, Bollen TL, van Heesewijk HPM (2010) MRI of the brachial plexus: a pictorial review. Eur J Radiol 74:391–402

    Article  PubMed  Google Scholar 

  10. Castillo M (2005) Imaging the anatomy of the brachial plexus: review and self-assessment modul. AJR Am J Roentgenol 185:S196–S204

    Article  PubMed  Google Scholar 

  11. Russo S, Lo Re G, Galia M, Reginelli A, Lo Greco V, D’Agostino T, La Tona G, Coppolino F, Grassi R, Midiri M, Lagalla R (2009) Videofluorography swallow study of patients with systemic sclerosis Radiologia Medica 114(6):948–959

    Google Scholar 

  12. Muto M, Perrotta V, Guarnieri G, Lavanga A, Vassallo P, Reginelli R, Rotondo A (2008) Vertebroplasty and kyphoplasty: friends or foes? Radiologia Medica 113(8):1171–1184

    Article  PubMed  CAS  Google Scholar 

  13. Cappabianca S, Colella G, Russo A, Pezzullo M, Reginelli A, Iaselli F, Rotondo A (2008) Maxillofacial fibrous dysplasia: personal experience with gadoliniumenhanced magnetic resonance imaging. Radiologia Medica 113(8):1198–1210

    Article  PubMed  CAS  Google Scholar 

  14. Chhabra A, Thawait GK, Soldatos T et al (2013) High-resolution 3T MR neurography of the brachial plexus and Its branches, with emphasis on 3D Imaging. AJNR 34:486–497

    Article  PubMed  CAS  Google Scholar 

  15. Demondion X, Boutry N, Drizenko A et al (2000) Thoracic outlet: anatomic correlation with MR imaging. AJR Am J Roentgenol 175:417–422

    Article  PubMed  CAS  Google Scholar 

  16. Aralasmak A, Karaali K, Cevikol C et al (2010) MR imaging findings in brachial plexopathy with thoracic outlet syndrome. AJNR Am J Neuroradiol 31:410–417

    Article  PubMed  CAS  Google Scholar 

  17. Striano P, Striano S, Servillo G (2007) Posterior reversible encephalopathy syndrome and spinal epidural haematoma in a hypertensive patient. Eur J Anaesthesiol 24(12):1065–1067

    Article  PubMed  CAS  Google Scholar 

  18. Elefante A, Caranci F, Del Basso De Caro ML, et al. (2013) Paravertebral high cervical chordoma. The Neuroradiol J 26(2):227–232

  19. Bowen BC, Seidenwurm DJ, For the Expert Panel on Neurologic Imaging (2008) Plexopathy. Am J Neuroradiol 29:400–402

    PubMed  CAS  Google Scholar 

  20. Hems TE, Birch R, Carlstedt T (1999) The role of magnetic resonance imaging in the management of traction injuries to the adult brachial plexus. J Hand Surg (Br) 24:550–555

    Article  CAS  Google Scholar 

  21. Pusiol T, Scialpi M (2013) Role of computed tomography in the preoperative diagnosis of giant benign solitary fibrous tumor pleura. Lung India 30(1):82–85

    Article  PubMed  Google Scholar 

  22. Macarini L, Murrone M, Marini S, Mocci A, Ettorre GC (2004) MRI in ACL reconstructive surgery with PDLLA bioabsorbable interference screws: evaluation of degradation and osteointegration processes of bioabsorbable screws]. Radiol Med. 107(1–2):47–57

    PubMed  Google Scholar 

  23. Romano A, Chiarenza A, Consoli U, Conticello C, Forte S, Uccello G, Vetro C, Cavalli M, Coppolino F, Palumbo GA, Di Raimondo F (2013) Intravenous injection of bortezomib, melphalan and dexamethasone in refractory and relapsed multiple myeloma. Ann Oncol 24(4), art. no. mds531, 1038–1044

    Google Scholar 

  24. van Es HW (2001) MRI of the brachial plexus. Eur Radiol 11:325–336

    Article  PubMed  Google Scholar 

  25. 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(Suppl. 3):277–284

    Google Scholar 

  26. Carvalho GA, 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

    Article  PubMed  CAS  Google Scholar 

  27. Hayashi N, Masumoto T, Abe O et al (2002) Accuracy of abnormal paraspinal muscle findings on contrast-enhanced MR images as indirect signs of unilateral cervical root-avulsion injury. Radiology 223:397–402

    Article  PubMed  Google Scholar 

  28. Bendszus M, Koltzenburg M (2001) Visualization of denervated muscle by gadolinium-enhanced MRI. Neurology 57:1709–1711

    Article  PubMed  CAS  Google Scholar 

  29. Hayashi N, Yamamoto S, Okubo T et al (1998) Avulsion injury of cervical nerve roots: enhanced intradural nerve roots at MR imaging. Radiology 206:817–822

    PubMed  CAS  Google Scholar 

  30. Gupta RK, Mehta VS, Banerji AK, Jain RK (1989) MR evaluation of brachial plexus injuries. Neuroradiology 31:377–381

    Article  PubMed  CAS  Google Scholar 

  31. Todd M, Shah GV, Mukherji SK (2004) MR imaging of brachial plexus. Top Magn Reson Imaging 15:113–125

    Article  PubMed  Google Scholar 

  32. Pinto A, Caranci F, Romano L et al (2012) Learning from errors in radiology: a comprehensive review. Semin Ultrasound CT MRI 33(4):379–382

    Article  Google Scholar 

  33. Cobby MJ, Leslie IJ, Watt I (1988) Cervical myelography of nerve root avulsion injuries using water-soluble contrast media. Br J Radiol 61:673–678

    Article  PubMed  CAS  Google Scholar 

  34. Nagano A, Ochiai N, Sugioka H et al (1989) Usefulness of myelography in brachial plexus injuries. J Hand Surg [Br] 14:59–64

    Article  CAS  Google Scholar 

  35. 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 Am J Roentgenol 167:1283–1287

    Article  PubMed  CAS  Google Scholar 

  36. Tsuchiya K, Katase S, Aoki C, Hachiya J (2003) Application of multi-detector row helical scanning to postmyelographic CT. Eur Radiol 13:1438–1443

    PubMed  Google Scholar 

  37. Caranci F, Brunese L, Reginelli A et al (2012) Neck neoplastic conditions in the emergency setting: role of multidetector Computed Tomography. Semin Ultrasound CT MRI 33(5):443–448

    Article  Google Scholar 

  38. Volle E, Assheuer J, Hedde JP, Gustorf-Aeckerle R (1992) Radicular avulsion resulting from spinal injury: assessment of diagnostic modalities. Neuroradiology 34:235–240

    Article  PubMed  CAS  Google Scholar 

  39. Gasparotti R, Ferraresi S, Pinelli L et al (1997) Three-dimensional MR Myelography of Traumatic injuries of the brachial plexus. AJNR Am J Neuroradiol 18:1733–1742

    PubMed  CAS  Google Scholar 

  40. Takahara T, Imai Y, Yamashita T et al (2004) Diffusion weighted whole body imaging with background body signal suppression (DWIBS): technical improvement using free breathing, STIR and high resolution 3D display. Radiat Med 22:275–282

    PubMed  Google Scholar 

  41. Tagliafico A, Calabrese M, Puntoni M et al (2011) Brachial plexus MR imaging: accuracy and reproducibility of DTI-derived measurements and fibre tractography at 3.0-T. Eur Radiol 21:1764–1771

    Article  PubMed  Google Scholar 

  42. Yoshioka N, Hayashi N, Akahane M et al (2006) Bezier surface reformation: an original visualization technique of cervical nerve roots on myelographic CT. Radiat Med 24(8):600–604

    Article  PubMed  Google Scholar 

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Conflict of interest

F. Caranci, F. Briganti, M. La Porta, G. Antinolfi, E. Cesarano, P. Fonio, L. Brunese, and F. Coppolino declare that they have no conflict of interest.

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The study described in this article did not include any procedures involving humans or animal.

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Correspondence to F. Caranci.

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Caranci, F., Briganti, F., La Porta, M. et al. Magnetic resonance imaging in brachial plexus injury. Musculoskelet Surg 97 (Suppl 2), 181–190 (2013). https://doi.org/10.1007/s12306-013-0281-0

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  • DOI: https://doi.org/10.1007/s12306-013-0281-0

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