Abstract
BackgroundThe authors describe a new computerized tomography (CT) myelography technique with coronal and oblique coronal view to demonstrate the status of the cervical nerve rootlets involved in brachial plexus injury. They discuss the value of this technique for diagnosis of nerve root avulsion compared with CT myelography with axial view.MethodsCT myelography was performed with penetration of the cervical subarachnoid space by the contrast medium. Then the coronal and oblique coronal reconstructions were created. The results of CT myelography were evaluated and classified with presence of pseudomeningocele, intradural ventral nerve rootlets, and intradural dorsal nerve rootlets. The diagnosis was by extraspinal surgical exploration with or without spinal evoked potential measurements and choline acetyl transferase activity measurement in 25 patients and recovery by a natural course in 3 patients. Its diagnostic accuracy was compared with that of CT myelography with axial view, correlated with surgical findings or a natural course in 57 cervical roots in 28 patients.ResultsCoronal and oblique coronal views were superior to axial views in visualization of the rootlets and orientation of the exact level of the root. Sensitivity and specificity for coronal and oblique coronal views of unrecognition of intradural ventral and dorsal nerve root shadow without pseudomeningocele in determining pre-ganglionic injury were 100% and 96%, respectively. There was no statistically significant difference between coronal and oblique coronal views and axial views.ConclusionThe information by the coronal and oblique coronal slice CT myelography enabled the authors to assess the rootlets of the brachial plexus and provided valuable data for helping to decide whether to proceed with exploration, nerve repair, primary reconstruction.
Highlights
The authors describe a new computerized tomography (CT) myelography technique with coronal and oblique coronal view to demonstrate the status of the cervical nerve rootlets involved in brachial plexus injury
We describe a new CT myelography technique with coronal and oblique coronal view, focusing on the shadows of the rootlets
Myelography was performed by cervical puncture employing 10 ml of water-soluble contrast medium using a concentration of 240 mg/ml Iotrolan (Isovist(R) Inj. 240., Bayer Yakuhin, Ltd., Osaka, Japan)
Summary
The authors describe a new computerized tomography (CT) myelography technique with coronal and oblique coronal view to demonstrate the status of the cervical nerve rootlets involved in brachial plexus injury. They discuss the value of this technique for diagnosis of nerve root avulsion compared with CT myelography with axial view. Doi et al [3]reported the overlapping coronal-oblique slices MRI technique, which provide clear image of the rootlets and ganglia. Accuracy of this technique is same as that of myelography/CT myelography. Despite the advent of MRI, which has replaced other imaging techniques for evaluation of almost all disease of the spine, conventional myelography and CT myelography are still considered the first-choice examinations in the evaluation of brachial plexus injury [4]
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More From: Journal of Brachial Plexus and Peripheral Nerve Injury
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