Detection of Root Avulsion in Traumatic and Obstetric Brachial Plexus Lesions by High-Resolution 3D Constructive Interference in Steady State MRI

Thomas Schmidt, MD1, Christian Heinen, MD1, Maria Pedro, MD1, Gregor Antoniadis, PhD, MD1, Thomas Kretschmer, PhD, MD1, Ralph Kunig, MD1

1Oldenburg, Germany

Keywords: diagnosis, magnetic resonance imaging, trauma, Peripheral Nerve, brachial plexus injury

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     Reliable detection of root avulsions in preoperative assessment of traumatic and obstetric brachial plexus injuries is mandatory to avoid ineffective operative repair.
     This study demonstrates the feasibility of 3D constructive interference in steady state (CISS) MRI in the preoperative evaluation of brachial plexus injuries (BPI).
     Preoperative 3D-CISS at 1.5T was applied in a total of 84 brachial plexus in 40 patients ( 4 female, 36 male, mean age 36 years) with traumatic BPI and two infants with obstetric BPI.
     A dataset of 44 slices was acquired in the coronal plane (slice thickness 1.0 mm, voxel size 0.7 x 0.7 mm, acquisition time 4 minutes). Multiplanar reconstruction were calculated in a curved-coronar, transforaminal and axial plane. MRI for infants was performed under sedation at the day of surgery.
     The quality of the 3D CISS MRI studies was good even in the infant group. Delineation of ventral and dorsal rootlets was feasible in all cases. Partial or complete avulsion of one or more roots were detected in 28 patients (70%). The level of C6, C7 and C8 were mostly affected. However root involvement was definitely excluded in 12 patients (30%) and the two infants. Prediction of root continuity was doubtful in only 2 cases due to the presence of extensive dural tethering of the cord associated by loss of T2 contrast.
     This is a retrospective study.
     3D CISS MRI allows a noninvasive and accurate prediction of root avulsion with excellent image quality in the majority of patients with traumatic and potentially obstetric brachial plexus lesions.


Project Roles:

T. Schmidt (), C. Heinen (), M. Pedro (), G. Antoniadis (), T. Kretschmer (), R. Kunig ()