Petrasic et al [64] in retrospective review of 23 patients presenting with chronic pelvic pain and/or dysfunction and clinically suspected chronic cauda equina syndrome who underwent MRI lumbosacral plexus found that 78% of patients had a change in diagnosis and 81% had a change in management from the MRI findings. MRI with and without IV contrast can be useful for detecting and characterizing several of the etiologies in the differential diagnosis of nontraumatic lumbosacral plexopathy and may provide additional information over MRI without IV contrast in this setting. MRI Pelvis There is no relevant literature to support the use of MRI of the pelvis (without dedicated plexus imaging) in the evaluation of nontraumatic lumbosacral plexopathy. CT Myelography Cervical Spine CT myelography provides high-resolution imaging capable of detecting traumatic cervical nerve root avulsions and pseudomeningocele formation and can evaluate for other spinal traumatic injuries, such as fracture, hematoma, or cerebrospinal fluid leak [70]. However, CT myelography can only evaluate for preganglionic nerve root injury and does not directly visualize the postganglionic brachial plexus. Therefore, MRI brachial plexus is preferred over CT myelography cervical spine as the first-line imaging test to evaluate for postganglionic brachial plexus injury. CT myelography performed to assess for cervical nerve root avulsion injury should be ideally delayed until approximately 1 month after the initial trauma to allow time for resolution of hemorrhage and formation of a pseudomeningocele [28,68]. Plexopathy FDG-PET/CT Whole Body There is no relevant literature to support the use of FDG-PET/CT in the evaluation of traumatic brachial plexopathy. MRI Brachial Plexus Brachial plexus MRI is considered superior to CT in the evaluation of traumatic brachial plexopathy because of its inherently better soft-tissue contrast and good spatial resolution [6,9,10,27].
Plexopathy. Petrasic et al [64] in retrospective review of 23 patients presenting with chronic pelvic pain and/or dysfunction and clinically suspected chronic cauda equina syndrome who underwent MRI lumbosacral plexus found that 78% of patients had a change in diagnosis and 81% had a change in management from the MRI findings. MRI with and without IV contrast can be useful for detecting and characterizing several of the etiologies in the differential diagnosis of nontraumatic lumbosacral plexopathy and may provide additional information over MRI without IV contrast in this setting. MRI Pelvis There is no relevant literature to support the use of MRI of the pelvis (without dedicated plexus imaging) in the evaluation of nontraumatic lumbosacral plexopathy. CT Myelography Cervical Spine CT myelography provides high-resolution imaging capable of detecting traumatic cervical nerve root avulsions and pseudomeningocele formation and can evaluate for other spinal traumatic injuries, such as fracture, hematoma, or cerebrospinal fluid leak [70]. However, CT myelography can only evaluate for preganglionic nerve root injury and does not directly visualize the postganglionic brachial plexus. Therefore, MRI brachial plexus is preferred over CT myelography cervical spine as the first-line imaging test to evaluate for postganglionic brachial plexus injury. CT myelography performed to assess for cervical nerve root avulsion injury should be ideally delayed until approximately 1 month after the initial trauma to allow time for resolution of hemorrhage and formation of a pseudomeningocele [28,68]. Plexopathy FDG-PET/CT Whole Body There is no relevant literature to support the use of FDG-PET/CT in the evaluation of traumatic brachial plexopathy. MRI Brachial Plexus Brachial plexus MRI is considered superior to CT in the evaluation of traumatic brachial plexopathy because of its inherently better soft-tissue contrast and good spatial resolution [6,9,10,27].