MR neurography in traumatic brachial plexopathy.
OBJECTIVE
Imaging of the brachial plexus has come a long way and has progressed from plain radiography to CT and CT myelography to MRI. Evolution of MR imaging sequences has enabled good visualization of the small components of the plexus. The purpose of our study was to correlate the results of MR neurography (MRN) in patients with traumatic brachial plexopathy with their operative findings. We wanted to determine the usefulness of MRN and how it influenced surgical planning and outcome.


METHODS
Twenty patients with features of traumatic brachial plexopathy who were referred to the MRI section of the Department of Radiology between September 2012 and January 2014 and subsequently underwent exploration were included in the study. MR neurography and operative findings were recorded at three levels of the brachial plexus-roots, trunks and cords.


RESULTS
Findings at the level of roots and trunks were noted in 14 patients each and at the level of the cords in 16 patients. 10 patients had involvement at all levels. Axillary nerve involvement as a solitary finding was noted in two patients. These patients were subsequently operated and their studies were assigned a score based on the feedback from the operating surgeons. The MRN study was scored as three (good), two (average) or one (poor) depending on whether the MR findings correlated with operative findings at all three levels, any two levels or at any one level, respectively.


CONCLUSIONS
MR neurography is an extremely useful modality to image the traumatized brachial plexus. It influences both surgical planning and outcome/prognosis.
Department of Radiology, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Lucknow 226 007, India. Electronic address: vshali77@yahoo.co.in.
Vaishali
V
Upadhyaya
Department of Plastic Surgery, King George Medical University, Shah Meena Road, Chowk, Lucknow 226 003, India.
Divya N
DN
Upadhyaya
Department of Plastic Surgery, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Lucknow 226 007, India.
Adarsh
A
Kumar
Department of Radiology, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Lucknow 226 007, India.
Ratni B
RB
Gujral
D000293:Adolescent; D000328:Adult; D001365:Axilla / Q000294:innervation / Q000473:pathology*; D001917:Brachial Plexus / Q000293:injuries / Q000473:pathology* / Q000503:physiopathology; D020516:Brachial Plexus Neuropathies / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods; D059348:Peripheral Nerve Injuries / Q000473:pathology* / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies
Brachial plexus; Magnetic resonance; Neurography