title: The diagnostic value of CT myelography, MR myelography, and both in neonatal brachial plexus palsy.
abstract: OBJECTIVE
  Although most infants with brachial plexus palsy recover function spontaneously, approximately 10-30% benefit from surgical treatment. Pre-operative screening for nerve root avulsions is helpful in planning reconstruction. Our aim was to compare the diagnostic value of CT myelography, MR myelography, and both against a surgical criterion standard for detection of complete nerve root avulsions in birth brachial plexus palsy.
  
  
  METHODS
  Nineteen patients who underwent a preoperative CT and/or MR myelography and subsequent brachial plexus exploration were included. Imaging studies were analyzed for the presence of abnormalities potentially predictive of nerve root avulsion. Findings of nerve root avulsion on surgical exploration were used as the criterion standard to assess the predictive value of imaging findings.
  
  
  RESULTS
  Ninety-five root levels were examined. When the presence of any pseudomeningocele was used as a predictor, the sensitivity was 0.73 for CT and 0.68 for MR imaging and the specificity was 0.96 for CT and 0.97 for MR imaging. When presence of pseudomeningocele with absent rootlets was used as the predictor, the sensitivity was 0.68 for CT and 0.68 for MR imaging and the specificity was 0.96 for CT and 0.97 for MR imaging. The use of both CT and MR imaging did not increase diagnostic accuracy. Rootlet findings in the absence of pseudomeningocele were not helpful in predicting complete nerve root avulsion.
  
  
  CONCLUSIONS
  Findings of CT and MR myelography were highly correlated. Given the advantages of MR myelography, it is now the single technique for preoperative evaluation of nerve root avulsion at our institution.
authors.affiliation: the Division of Plastic Surgery, Department of Surgery (R.T., K.A.K.-W.), the Seattle Children's Hospital, University of Washington, Seattle, Washington. raymond.tse@seattlechildrens.org.
authors.forename: R
authors.initials: R
authors.lastname: Tse
authors.affiliation: From the Department of Radiology (J.N.N., R.S.L., G.E.I.).
authors.forename: J N
authors.initials: JN
authors.lastname: Nixon
authors.affiliation: From the Department of Radiology (J.N.N., R.S.L., G.E.I.).
authors.forename: R S
authors.initials: RS
authors.lastname: Iyer
authors.affiliation: the Division of Plastic Surgery, Department of Surgery (R.T., K.A.K.-W.), the Seattle Children's Hospital, University of Washington, Seattle, Washington.
authors.forename: K A
authors.initials: KA
authors.lastname: Kuhlman-Wood
authors.affiliation: From the Department of Radiology (J.N.N., R.S.L., G.E.I.).
authors.forename: G E
authors.initials: GE
authors.lastname: Ishak
mesh_terms: D001917:Brachial Plexus / Q000000981:diagnostic imaging* / Q000473:pathology*; D020516:Brachial Plexus Neuropathies / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000209:etiology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009192:Myelography / Q000379:methods; D011843:Radiculopathy / Q000150:complications / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*