Abstract
The most common indications for magnetic resonance imaging (MRI) of the brachial plexus (BP) are traumatic injuries. The role of MRI of the BP has increased because of recent trends favoring earlier surgery. Determining preganglionic vs. postganglionic injury is essential, as different treatment strategies are required. Thus, MRI of the BP should be supplemented with cervical spine MRI to assess the intradural part of the spinal nerves, including highly T2-weighted techniques. Acute preganglionic injuries usually manifest as various combinations of post-traumatic pseudomeningocele, the absence of roots, deformity of nerve root sleeves, displacement of the spinal cord, hemorrhage in the spinal canal, presence of scars in the spinal canal, denervation of the back muscles, and syrinx. Spinal nerve root absence is more specific than pseudomeningocele on MRI. Acute postganglionic injuries can present as lesions in continuity or tears. The following signs indicate injury to the BP: side-to-side difference, swelling, partial, or total BP rupture. Injury patterns and localization are associated with the mechanism of trauma, which implies a significant role for MRI in the work-up of patients.The identification and description of traumatic lesions involving the brachial plexus need to be systematic and detailed. Using an appropriate MRI protocol, obtaining details about the injury, applying a systematic anatomical approach, and correlating imaging findings to relevant clinical data to make a correct diagnosis. Information about the presence or suspicion of root avulsion should always be provided.
Highlights
The current article is focused on diagnostic imaging with magnetic resonance (MRI) and its role in diagnosing common brachial plexus (BP) traumatic in juries from the perspectives of both radiologists and surgeons
magnetic resonance imaging (MRI) of the BP should be supplemented with cervical spine MRI to assess the intradural part of the spinal nerves, including highly T2-weighted techniques
Acute preganglionic injuries usually manifest as various combinations of post-traumatic pseudomeningocele, the absence of roots, deformity of nerve root sleeves, displacement of the spinal cord, hemorrhage in the spinal canal, presence of scars in the spinal canal, denervation of the back muscles, and syrinx
Summary
The current article is focused on diagnostic imaging with magnetic resonance (MRI) and its role in diagnosing common BP traumatic in juries from the perspectives of both radiologists and surgeons. The importance of MRI of the BP has been growing, fueled by an increased number of clinical indications and new trends in the early surgical treatment of BP injuries [1]. No spontaneous recovery is possible in root avulsion, while in post ganglionic injury, depending on the severity, patients can often obtain useful function without surgical intervention. Indications for performing a BP MRI for trauma are broad and not fully defined, ranging from adult traumatic injuries, such as high or low-energy injuries with stretching of the nerves or a neck injury asso ciated with weakness of the upper limb muscles and paresthesia on the same side, to obstetric BP palsy (OBPP) that is present immediately after birth with weakness or lack of shoulder abduction, elbow flexion and a flail upper limb in some cases [6]
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