title: Accuracy of abnormal paraspinal muscle findings on contrast-enhanced MR images as indirect signs of unilateral cervical root-avulsion injury.
abstract: OBJECTIVE
  To evaluate the accuracy of abnormal magnetic resonance (MR) findings in the paraspinal muscles as indirect signs of nerve-root avulsion injury.
  
  
  METHODS
  Forty-three consecutive patients suspected of having unilateral root-avulsion injury underwent MR imaging and were evaluated. Paraspinal muscles were evaluated for abnormal signal intensity on T1- and T2-weighted images, abnormal enhancement on images obtained after contrast material enhancement, and muscle volume loss. MR images were interpreted independently by two observers for interobserver variability. MR findings were compared with findings of root continuity, determined with a combination of surgery and clinical evaluation. Sensitivities, specificities, and kappa values of the findings were calculated.
  
  
  RESULTS
  Sensitivities of MR findings in the paraspinal muscles indicating root-avulsion injury were 88% (36 of 41 patients) for abnormal enhancement, 83% (34 of 41 patients) for high signal intensity on T2-weighted images, 37% (15 of 41 patients) for high signal intensity on T1-weighted images, and 71% (29 of 41 patients) for muscle volume loss. Specificities for all findings were 100% (two of two patients). Of the paraspinal muscles, findings in the multifidus muscle were the most accurate and provided the highest interobserver agreement (kappa = 0.81).
  
  
  CONCLUSIONS
  Contrast material-enhanced abnormal MR findings in the paraspinal muscles are accurate in indicating root-avulsion injuries, and abnormal enhancement in the multifidus muscle is the most accurate among paraspinal muscle findings.
authors: Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. naoto-tky@umin.ac.jp
authors: Naoto
authors: N
authors: Hayashi
authors: Tomohiko
authors: T
authors: Masumoto
authors: Osamu
authors: O
authors: Abe
authors: Shigeki
authors: S
authors: Aoki
authors: Kuni
authors: K
authors: Ohtomo
authors: Yasuhito
authors: Y
authors: Tajiri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation*; D009333:Neck / Q000294:innervation*; D012680:Sensitivity and Specificity; D013124:Spinal Injuries / Q000175:diagnosis*; D013126:Spinal Nerve Roots / Q000293:injuries*
chemical_list: D003287:Contrast Media