Abstract
Background: Computed tomography myelography (CTM) has been broadly adopted as the ‘gold standard’ imaging technique in the diagnosis of nerve root avulsion injuries in traumatic brachial plexopathies. CTM has the distinct advantage of better spatial resolution than magnetic resonance imaging (MRI); however, this technique is invasive and can result in significant patient discomfort. MRI, therefore, seems relatively more advantageous as it is less invasive (requires no lumbar puncture), lacks radiation exposure, has no adverse reactions related to intrathecal contrast agents and confers excellent soft-tissue contrast. Objectives: To compare the sensitivity and specificity of MRI with CTM in the diagnosis of preganglionic nerve root avulsion injuries in adults with traumatic brachial plexopathies at the Inkosi Albert Luthuli Central Hospital.Method: A retrospective comparative analysis was performed on 16 adult patients with traumatic preganglionic brachial plexopathies who underwent both MRI and CTM at Inkosi Albert Luthuli Central Hospital. Radiologists experienced in both CTM and MRI interpreted the data and a comparison was made using CTM as the gold standard. Results: The sensitivity and specificity for MRI detecting preganglionic nerve root avulsion injuries and pseudomeningoceles was 82% and 100% respectively. The interobserver agreement between CTM and MRI for the detection of preganglionic nerve root avulsion injuries was 81.25% (Kappa = 0.77) and 87.5% (Kappa = 0.84) for the detection of pseudomeningoceles. Conclusion: MRI was as sensitive as CTM at detecting preganglionic nerve root avulsion injuries and pseudomeningoceles of spinal nerve roots C7–T1 of the brachial plexus. Some mild discrepancies existed at the C5 and C6 nerve root levels. Owing to the invasiveness of the procedure and resultant patient discomfort, CTM should be reserved for complicated cases or for patients with contraindications to MRI.
Highlights
The brachial plexus is a complex network of nerves that originate in the neck and is formed from the ventral rami of C5 to T1
All imaging was considered to be of diagnostic quality except for one computed tomography myelography (CTM) study that was interpreted as being of ‘poor quality’
This was owing to the fact that contrast did not reach the cervical spine post fluoroscopic infiltration and was not visualised on the CTM images
Summary
The brachial plexus is a complex network of nerves that originate in the neck and is formed from the ventral rami of C5 to T1. Motorcycle accidents are the most common cause of all brachial plexus injuries in adults resulting from forced traction applied to the nerves (C5–T1) of the brachial plexus. The head and shoulders are forced apart and cause either nerve root avulsion injuries or stretch/rupture injuries. Differentiating between preganglionic and postganglionic brachial plexopathies is a crucial distinction as it determines patient management. Computed tomography myelography (CTM) has been broadly adopted as the ‘gold standard’ imaging technique in the diagnosis of nerve root avulsion injuries in traumatic brachial plexopathies. CTM has the distinct advantage of better spatial resolution than magnetic resonance imaging (MRI); this technique is invasive and can result in significant patient discomfort. MRI, seems relatively more advantageous as it is less invasive (requires no lumbar puncture), lacks radiation exposure, has no adverse reactions related to intrathecal contrast agents and confers excellent soft-tissue contrast
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
