Modified Pathological Classification of Brachial Plexus Root Injury and Its MR Imaging Characteristics

Abstract

The authors described a modified pathological classification (PC) of brachial plexus injury (BPI) and its magnetic resonance (MR) imaging characteristics. The reliability and diagnostic accuracy of MR imaging for detecting nerve injury was discussed. Between 2006 and 2010, 86 patients with BPI were managed surgically in our department. Their preoperative MR images and surgical findings were analyzed retrospectively. The PC of BPI was classified into five types: (I) nerve root injury in continuity (including Sunderland grade I–IV injury); (II) postganglionic spinal nerve rupture with or without proximal stump; (III) preganglionic root injury (visible); (IV) preganglionic nerve root injury and postganglionic spinal nerves injury; (V) preganglionic root injury (invisible). The main MR imaging characteristics of BPI included traumatic meningocele, displacement of spinal cord, the absence of nerve root, “Black line” sign, nerve root/trunk injury in continuity, and thickening and edema of nerve root. The accuracy of MR imaging for detecting C5, C6, C7, C8, and T1 nerve roots injury were 93.3, 95.2, 92.3, 84, and 74.4%, respectively. The modified PC provides a detailed description of nerve root injury in BPI, and MR imaging technique is a reliable method for detecting nerve root injury.

Keywords

brachial plexus - root injury - pathological - classification - MR imaging

• References

• 1 Terzis JK, Kostas I, Soucacos PN. Restoration of shoulder function with nerve transfers in traumatic brachial plexus palsy patients. Microsurgery 2006; 26 (4) 316-324
• 2 Nagano A. Treatment of brachial plexus injury. J Orthop Sci 1998; 3 (1) 71-80
• 3 Alnot JY. Traumatic paralysis of the brachial plexus: preoperative problems and therapeutic indications. In: Terzis JK, , ed. Microreconstruction of Nerve Injuries. Philadelphia, PA: WB Saunders; 1987: 325-345
• 4 Millesi H. Brachial plexus lesions: classification and operative technique. In: Tubiana R, , ed. The Hand. Philadelphia, PA: WS Saunders; 1988: 645-655
• 5 Terzis JK, Vekris MD, Soucacos PN. Outcomes of brachial plexus reconstruction in 204 patients with devastating paralysis. Plast Reconstr Surg 1999; 104 (5) 1221-1240
• 6 Chuang DCC. Adult brachial plexus injuries. In: Mathes SJ, Hentz VR, , eds. Plastic Surgery. Vol 7. Philadelphia, PA: Saunders Elsevier; 2006: 515-538
• 7 Todd M, Shah GV, Mukherji SK. MR imaging of brachial plexus. Top Magn Reson Imaging 2004; 15 (2) 113-125
• 8 Howe FA, Filler AG, Bell BA, Griffiths JR. Magnetic resonance neurography. Magn Reson Med 1992; 28 (2) 328-338
• 9 Du R, Auguste KI, Chin CT, Engstrom JW, Weinstein PR. Magnetic resonance neurography for the evaluation of peripheral nerve, brachial plexus, and nerve root disorders. J Neurosurg 2010; 112 (2) 362-371
• 10 van Es HW, Bollen TL, van Heesewijk HP. MRI of the brachial plexus: a pictorial review. Eur J Radiol 2010; 74 (2) 391-402
• 11 Posniak HV, Olson MC, Dudiak CM, Wisniewski R, O'Malley C. MR imaging of the brachial plexus. AJR Am J Roentgenol 1993; 161 (2) 373-379
• 12 Bilbey JH, Lamond RG, Mattrey RF. MR imaging of disorders of the brachial plexus. J Magn Reson Imaging 1994; 4 (1) 13-18
• 13 van Es HW. MRI of the brachial plexus. Eur Radiol 2001; 11 (2) 325-336
• 14 Zhang ZW, Song LJ, Meng QF , et al. Segmented echo planar MR imaging of the brachial plexus with inversion recovery magnetization preparation at 3.0T. J Magn Reson Imaging 2008; 28 (2) 440-444
• 15 Songcharoen P, Shin AY. Brachial plexus injury: acute diagnosis and treatment. In: Berger RA, Weis APC, , ed. Hand Surgery. Philadelphia, PA: Lippincott, Williams & Wilkins; 2004: 1005-1025
• 16 Moran SL, Steinmann SP, Shin AY. Adult brachial plexus injuries: mechanism, patterns of injury, and physical diagnosis. Hand Clin 2005; 21 (1) 13-24
• 17 Flores LP. The importance of the preoperative clinical parameters and the intraoperative electrophysiological monitoring in brachial plexus surgery. Arq Neuropsiquiatr 2011; 69 (4) 654-659
• 18 Sureka J, Cherian RA, Alexander M, Thomas BP. MRI of brachial plexopathies. Clin Radiol 2009; 64 (2) 208-218
• 19 Gao MY, Liang BL, Xu YB , et al. The diagnostic value of MRI in traumatic brachial plexus injury. Chinese J Traumatol 1999; 15 (2) 151-152
• 20 Li XC, Chen JY, Shen J , et al. The relationship between MRI manifestations and the function recovery of the brachial plexus injuries. Chinese J Med Imaging 2005; 13 (6) 419-422
• 21 Martinoli C, Gandolfo N, Perez MM , et al. Brachial plexus and nerves about the shoulder. Semin Musculoskelet Radiol 2010; 14 (5) 523-546
• 22 Linda DD, Harish S, Stewart BG, Finlay K, Parasu N, Rebello RP. Multimodality imaging of peripheral neuropathies of the upper limb and brachial plexus. Radiographics 2010; 30 (5) 1373-1400
• 23 Hayes CE, Tsuruda JS, Mathis CM, Maravilla KR, Kliot M, Filler AG. Brachial plexus: MR imaging with a dedicated phased array of surface coils. Radiology 1997; 203 (1) 286-289
• 24 Qayyum A, MacVicar AD, Padhani AR, Revell P, Husband JE. Symptomatic brachial plexopathy following treatment for breast cancer: utility of MR imaging with surface-coil techniques. Radiology 2000; 214 (3) 837-842
• 25 Bradley LJ, Wilhelm T, King RH, Ginsberg L, Orrell RW. Brachial plexus hypertrophy in chronic inflammatory demyelinating polyradiculoneuropathy. Neuromuscul Disord 2006; 16 (2) 126-131