RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1186/1749-7221-5-14
Advanced radiological work-up as an adjunct to decision in early reconstructive surgery in brachial plexus injuries[*]
Verantwortlicher Herausgeber dieser Rubrik:
Publikationsverlauf
13. April 2010
08. Juli 2010
Publikationsdatum:
19. September 2014 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00027212/201001/lookinside/thumbnails/10.1186-1749-7221-5-14-1.jpg)
Abstract
Background As 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.
Methods Seven 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.
Results The 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).
Conclusions The advanced optimized radiological work-up used showed high reliability and substantial agreement with the intraoperative findings in adult patients with brachial plexus injury.
*This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
-
References
- 1 Narakas AO. The treatment of brachial plexus injuries. Int Orthop 1985; 9 (1) 29-36 10.1007/BF00267034 4018968
- 2 Songcharoen P. Brachial plexus injury in Thailand: a report of 520 cases. Microsurgery 1995; 16 (1) 35-39 10.1002/micr.1920160110 7658965
- 3 Songcharoen P. Management of brachial plexus injury in adults. Scand J Surg 2008; 97 (4) 317-323 19211386
- 4 McKay Hart A, Brannstrom T, Wiberg M, Terenghi G. Primary sensory neurons and satellite cells after peripheral axotomy in the adult rat: timecourse of cell death and elimination. Exp Brain Res 2002; 142 (3) 308-318 10.1007/s00221-001-0929-0 11819038
- 5 Ma J, Novikov LN, Kellerth JO, Wiberg M. Early nerve repair after injury to the postganglionic plexus: an experimental study of sensory and motor neuronal survival in adult rats. Scand J Plast Reconstr Surg Hand Surg 2003; 37 (1) 1-9 10.1080/alp.37.1.1.9 12625387
- 6 Jivan S, Kumar N, Wiberg M, Kay S. The influence of pre-surgical delay on functional outcome after reconstruction of brachial plexus injuries. J Plast Reconstr Aesthet Surg 2009; 62 (4) 472-479 10.1016/j.bjps.2007.11.027 18485850
- 7 Wiberg M, Backman C, Wahlstrom P, Dahlin LB. Brachial plexus injuries in adults. Early reconstruction for better clinical results. Lakartidningen 2009; 106 (9) 586-590 19388449
- 8 Nagano A, Ochiai N, Sugioka H, Hara T, Tsuyama N. Usefulness of myelography in brachial plexus injuries. J Hand Surg Br 1989; 14 (1) 59-64 10.1016/0266-7681(89)90017-X 2926225
- 9 van Es HW. MRI of the brachial plexus. Eur Radiol 2001; 11 (2) 325-336 10.1007/s003300000644 11218035
- 10 Takahara T, Hendrikse J, Yamashita T, Mali WP, Kwee TC, Imai Y, Luijten PR. Diffusion-weighted MR neurography of the brachial plexus: feasibility study. Radiology 2008; 249 (2) 653-660 10.1148/radiol.2492071826 18796657
- 11 Yoshikawa T, Hayashi N, Yamamoto S, Tajiri Y, Yoshioka N, Masumoto T, Mori H, Abe O, Aoki S, Ohtomo K. Brachial plexus injury: clinical manifestations, conventional imaging findings, and the latest imaging techniques. Radiographics 2006; 26 (Suppl 1) 133-143 10.1148/rg.26si065511
- 12 Yoshioka N, Hayashi N, Akahane M, Yoshikawa T, Takeshita K, Ohtomo K. Bezier surface reformation: an original visualization technique of cervical nerve roots on myelographic CT. Radiat Med 2006; 24 (8) 600-604 10.1007/s11604-006-0067-5 17041800
- 13 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33 (1) 159-174 10.2307/2529310 843571
- 14 Carvalho GA, Nikkhah G, Matthies C, Penkert G, Samii M. Diagnosis of root avulsions in traumatic brachial plexus injuries: value of computerized tomography myelography and magnetic resonance imaging. J Neurosurg 1997; 86 (1) 69-76 10.3171/jns.1997.86.1.0069 8988084
- 15 Hems TE, Birch R, Carlstedt T. The role of magnetic resonance imaging in the management of traction injuries to the adult brachial plexus. J Hand Surg Br 1999; 24 (5) 550-555 10.1054/jhsb.1999.0234 10597930
- 16 Kataoka K, Kanje M, Dahlin LB. Induction of activating transcription factor 3 after different sciatic nerve injuries in adult rats. Scand J Plast Reconstr Surg Hand Surg 2007; 41 (4) 158-166 10.1080/02844310701318288 17701728
- 17 Saito H, Dahlin LB. Expression of ATF3 and axonal outgrowth are impaired after delayed nerve repair. BMC Neurosci 2008; 9: 88 10.1186/1471-2202-9-88 2556676 18801180
- 18 Saito H, Kanje M, Dahlin LB. Delayed nerve repair increases number of caspase 3 stained Schwann cells. Neurosci Lett 2009; 456 (1) 30-33 10.1016/j.neulet.2009.03.075 19429128
- 19 Martensson L, Gustavsson P, Dahlin LB, Kanje M. Activation of extracellular-signal-regulated kinase-1/2 precedes and is required for injury-induced Schwann cell proliferation. Neuroreport 2007; 18 (10) 957-961 10.1097/WNR.0b013e32819f8f27 17558277
- 20 Lindwall C, Dahlin L, Lundborg G, Kanje M. Inhibition of c-Jun phosphorylation reduces axonal outgrowth of adult rat nodose ganglia and dorsal root ganglia sensory neurons. Mol Cell Neurosci 2004; 27 (3) 267-279 15519242