Neonatal Magnetic Resonance Imaging Without Sedation Correlates With Injury Severity in Brachial Plexus Birth Palsy.
OBJECTIVE
Which infants with brachial plexus birth palsy (BPBP) should undergo microsurgical plexus reconstruction remains controversial. The current gold standard for the decision for plexus reconstruction is serial clinical examinations, but this approach obviates the possibility of early surgical treatment. We hypothesize that a new technique using 3-dimensional volumetric proton density magnetic resonance imaging (MRI) without sedation can evaluate the severity of BPBP injury earlier than serial clinical examinations.


METHODS
Infants were prospectively enrolled prior to 12 weeks of age and imaged using 3 Tesla MRI without sedation. Clinical scores were collected at all visits. The imaging findings were graded based on the number of injured levels and the severity of each injury, and a radiological score was calculated. All infants were followed at least until the decision for surgery was made based on clinical examination.


RESULTS
Nine infants completed the MRI scan and clinical follow-up. The average Toronto score at presentation was 4.4 out of 10 (range, 0-8.2); the average Active Movement Scale score was 50 out of 105 (range, 0-86). Four infants required surgery: 2 because of a flail limb and Horner syndrome and 2 owing to failure to recover antigravity elbow flexion by age 6 months. Radiological scores ranged from 0 to 18 out of a maximum score of 25. The average radiological score for those infants who required surgery was 12 (range, 6.5-18), whereas the average score for infants who did not require surgery was 3.5 (range, 0-8).


CONCLUSIONS
Three-dimensional proton density MRI can evaluate spinal nerve roots in infants without the need for radiation, contrast agents, or sedation. These data suggest that MRI can help determine the severity of injury earlier than clinical examination in infants with BPBP, although further study of a larger sample of infants with varying severity of disease is necessary.


METHODS
Diagnostic II.
Department of Orthopaedic Surgery, Shriners Hospitals for Children-Northern California, Sacramento, CA. Electronic address: andrea.bauer@childrens.harvard.edu.
Andrea S
AS
Bauer
Division of Neuroradiology, University of California Davis Medical Center, Sacramento, CA.
Peter Y
PY
Shen
Division of Neuroradiology, University of California Davis Medical Center, Sacramento, CA.
Anna E
AE
Nidecker
Division of Neuroradiology, University of California Davis Medical Center, Sacramento, CA.
Paul S
PS
Lee
Department of Orthopaedic Surgery, Shriners Hospitals for Children-Northern California, Sacramento, CA.
Michelle A
MA
James
D001720:Birth Injuries / Q000000981:diagnostic imaging*; D020516:Brachial Plexus Neuropathies / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D021621:Imaging, Three-Dimensional; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D012149:Restraint, Physical
D006993:Hypnotics and Sedatives
Brachial plexus birth palsy; MRI; neonatal brachial plexus palsy; obstetric brachial plexus palsy