MRI can identify traumatic nerve root avulsions, which are crucial to detect in order to plan surgical reconstruction and determine prognosis [66]. Wade et al [71] studied 29 consecutive patients requiring brachial plexus exploration following trauma and found that brachial plexus MRI had a diagnostic accuracy of 79% for detecting C5 to T1 nerve root avulsion and that pseudomeningocele as a surrogate marker for root avulsion had a diagnostic accuracy of 68%. MRI can also directly assess the postganglionic brachial plexus and can confirm whether nerve integrity is maintained, differentiating minor stretching injuries from complete nerve disruptions [66]. Tagliafico et al [44], in a blinded retrospective review, studied 38 patients who received brachial plexus MRI for traumatic plexopathy and found a sensitivity of 84%, specificity 91%, positive predictive value of 91%, negative predictive value of 83%, and accuracy of 87% when compared to the reference standard of surgical findings and clinical follow-up. Fuzari et al [69] performed a systematic review of 3 articles reporting diagnostic accuracy of MRI for traumatic brachial plexus injury and found that the studies lacked methodological rigor, thus concluding that more rigorous research should be conducted in this area. Research is ongoing into new MRI sequences that might improve evaluation of traumatic brachial plexopathy, but these are not routinely performed outside of a research setting. For example, diffusion tensor imaging and tractography have been under investigation and show promise in the evaluation of nerve injury and disruption of nerve microstructure [69]. Brachial plexus MRI can also delineate other post-traumatic complications that may contribute to symptoms of plexopathy, such as regional soft-tissue hematoma, traumatic neuromas, and scarring.
Plexopathy. MRI can identify traumatic nerve root avulsions, which are crucial to detect in order to plan surgical reconstruction and determine prognosis [66]. Wade et al [71] studied 29 consecutive patients requiring brachial plexus exploration following trauma and found that brachial plexus MRI had a diagnostic accuracy of 79% for detecting C5 to T1 nerve root avulsion and that pseudomeningocele as a surrogate marker for root avulsion had a diagnostic accuracy of 68%. MRI can also directly assess the postganglionic brachial plexus and can confirm whether nerve integrity is maintained, differentiating minor stretching injuries from complete nerve disruptions [66]. Tagliafico et al [44], in a blinded retrospective review, studied 38 patients who received brachial plexus MRI for traumatic plexopathy and found a sensitivity of 84%, specificity 91%, positive predictive value of 91%, negative predictive value of 83%, and accuracy of 87% when compared to the reference standard of surgical findings and clinical follow-up. Fuzari et al [69] performed a systematic review of 3 articles reporting diagnostic accuracy of MRI for traumatic brachial plexus injury and found that the studies lacked methodological rigor, thus concluding that more rigorous research should be conducted in this area. Research is ongoing into new MRI sequences that might improve evaluation of traumatic brachial plexopathy, but these are not routinely performed outside of a research setting. For example, diffusion tensor imaging and tractography have been under investigation and show promise in the evaluation of nerve injury and disruption of nerve microstructure [69]. Brachial plexus MRI can also delineate other post-traumatic complications that may contribute to symptoms of plexopathy, such as regional soft-tissue hematoma, traumatic neuromas, and scarring.