CT myelography performed to assess for preganglionic lumbosacral nerve root 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. CT Abdomen and Pelvis There is no relevant literature to support the use of CT abdomen and pelvis in the evaluation of traumatic lumbosacral plexopathy. However, this test is often used in the setting of major blunt trauma (in which lumbosacral plexus injuries are most common), and can detect many of the associated findings such as pelvic fractures or hematomas. The role of imaging in the setting of major blunt trauma is addressed in the ACR Appropriateness Plexopathy FDG-PET/CT Whole Body There is no relevant literature to support the use of FDG-PET/CT in the evaluation of traumatic lumbosacral plexopathy. MRI Lumbosacral Plexus Lumbosacral plexus MRI has been shown to be superior to CT in the evaluation of traumatic lumbosacral plexopathy because of its inherently better soft-tissue contrast and good spatial resolution. MRI can directly assess the postganglionic lumbosacral plexus and can confirm whether nerve integrity is maintained, differentiating minor stretching injuries from complete nerve disruptions [4]. Lumbosacral plexus MRI can also delineate other post- traumatic complications that may contribute to symptoms of plexopathy, such as regional soft-tissue hematoma, edema, inflammation, avulsion fracture, tendinopathy, traumatic neuromas, and scarring [8]. MRI to assess the extent of injury should be ideally delayed until approximately 1 month after the initial trauma to allow time for resolution of hemorrhage and edema that can obscure the lumbosacral plexus acutely. MRI with and without IV contrast usually does not provide significant additional information over MRI without IV contrast for the initial imaging of acute traumatic lumbosacral plexopathy, though the addition of contrast can help differentiate between vascular structures and nerves.
Plexopathy. CT myelography performed to assess for preganglionic lumbosacral nerve root 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. CT Abdomen and Pelvis There is no relevant literature to support the use of CT abdomen and pelvis in the evaluation of traumatic lumbosacral plexopathy. However, this test is often used in the setting of major blunt trauma (in which lumbosacral plexus injuries are most common), and can detect many of the associated findings such as pelvic fractures or hematomas. The role of imaging in the setting of major blunt trauma is addressed in the ACR Appropriateness Plexopathy FDG-PET/CT Whole Body There is no relevant literature to support the use of FDG-PET/CT in the evaluation of traumatic lumbosacral plexopathy. MRI Lumbosacral Plexus Lumbosacral plexus MRI has been shown to be superior to CT in the evaluation of traumatic lumbosacral plexopathy because of its inherently better soft-tissue contrast and good spatial resolution. MRI can directly assess the postganglionic lumbosacral plexus and can confirm whether nerve integrity is maintained, differentiating minor stretching injuries from complete nerve disruptions [4]. Lumbosacral plexus MRI can also delineate other post- traumatic complications that may contribute to symptoms of plexopathy, such as regional soft-tissue hematoma, edema, inflammation, avulsion fracture, tendinopathy, traumatic neuromas, and scarring [8]. MRI to assess the extent of injury should be ideally delayed until approximately 1 month after the initial trauma to allow time for resolution of hemorrhage and edema that can obscure the lumbosacral plexus acutely. MRI with and without IV contrast usually does not provide significant additional information over MRI without IV contrast for the initial imaging of acute traumatic lumbosacral plexopathy, though the addition of contrast can help differentiate between vascular structures and nerves.