Role of Magnetic resonance Imaging in diagnosis and localization of clinically suspected brachial plexopathies.

role of magnetic resonance

Abstract

BACKGROUND: Magnetic resonance imaging is popular method and widely used diagnostic technique in the management of brachial plexopathies. High resolution MRI can be especially useful in  pre operative assessment of traumatic injuries of brachial plexus.

OBJECTIVES:

To evaluate the role of MRI in diagnosis and localization of brachial plexus pathologies

• To corelate MRI findings with intra operative findings wherever possible

PARTICIPANTS: Patients suspected of having brachial plexopathy based on clinical and electrodiagnostic studies.

STUDY DESIGN: Prospective observational study.

METHODS: A total of 51 patients with brachial plexopathy underwent a dedicated MRI study. Clinical and electrodiagnostic tests were done in all patients. 25(49%) patients had history of trauma, 12(23.5) had history of different tumors, three (%) patients with history of radiation to the brachial plexus. 11 patients had no specific clinical history except for signs and symptoms related to brachial plexus, Total 30 patients underwent surgery and rest of patients were managed conservatively.

RESULTS:  Trauma (49%) was the most common cause of brachial plexopathy, followed by metastases (13.7%), thoracic outlet syndrome (11.8%), primary tumors (9.8), idiopathic neuritis (9.8%) and radiation plexopathy (5.9%). Among the patients who underwent surgery MRI findings were consistent with surgical findings in 73.3% of cases. MRI findings included oedema of brachial plexus in 35 patients, nerve disruption in 5 patients, pseudo meningocele in 9 patients and bony abnormalities in 17 patients.

CONCLUSION: MR imaging is an essential modality in assessment of brachial plexopathies and serves as a guide in management of most cases. Although not absolutely perfect it helps as a guiding light for surgical management of traumatic brachial plexopathies, and gives overview to the surgeon in management of tumors regarding its margins and relations. It is also effective in diagnosis of idiopathic neuritis and differentiating radiation plexopathy from metastatic involvement of brachial plexus.

 IMPLICATION: Presence of pseudo meningocele is specific of root avulsion injury and necessitates nerve transfer for repair.