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Abstract
BackgroundAs neurophysiologic tests may not reveal the extent of brachial plexus injury at the early stage, the role of early radiological work-up has become increasingly important. The aim of the study was to evaluate the concordance between the radiological and clinical findings with the intraoperative findings in adult patients with brachial plexus injuries.MethodsSeven consecutive male patients (median age 33; range 15-61) with brachial plexus injuries, caused by motor cycle accidents in 5/7 patients, who underwent extensive radiological work-up with magnetic resonance imaging (MRI), computed tomography myelography (CT-M) or both were included in this retrospective study. A total of 34 spinal nerve roots were evaluated by neuroradiologists at two different occasions. The degree of agreement between the radiological findings of every individual nerve root and the intraoperative findings was estimated by calculation of kappa coefficient (К-value). Using the operative findings as a gold standard, the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the clinical findings and the radiological findings were estimated.ResultsThe diagnostic accuracy of radiological findings was 88% compared with 65% for the clinical findings. The concordance between the radiological findings and the intraoperative findings was substantial (К = 0.76) compared with only fair (К = 0.34) for the clinical findings. There were two false positive and two false negative radiological findings (sensitivity and PPV of 0.90; specificity and NPV of 0.87).ConclusionsThe advanced optimized radiological work-up used showed high reliability and substantial agreement with the intraoperative findings in adult patients with brachial plexus injury.
Highlights
The most common cause of closed brachial plexus injuries in adults is a motorcycle accident (70%) [1,2]
Myelography was the reliable [8] and the most used methods in the radiological work-up of brachial plexus injuries prior to the era of sectional imaging, its use nowadays should only be restricted to patients with contraindication to magnetic resonance imaging (MRI)
The main limitation of this technique is lack of depiction of cervical nerves above the level of the C5 nerve. Another radiological modality that is used in the evaluation of brachial plexus is the computed tomography following myelography (CT-M)
Summary
The most common cause of closed brachial plexus injuries in adults is a motorcycle accident (70%) [1,2]. The main limitation of this technique is lack of depiction of cervical nerves above the level of the C5 nerve Another radiological modality that is used in the evaluation of brachial plexus is the computed tomography following myelography (CT-M). A new modality that recently showed high feasibility in the assessment of cervical nerve roots is Bezier surface technique, which enables reformatting volumetric data obtained at CT-myelography to depict the individual nerve root in a single image [11,12]. Most of these modalities are new and their role in the work-up of brachial plexus injury is not yet well established. The aim of the study was to evaluate the concordance between the radiological and clinical findings with the intraoperative findings in adult patients with brachial plexus injuries
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