Doi Kazuteru, Otsuka Ken, Okamoto Yukinori, Fujii Hiroshi, Hattori Yasunori, Baliarsing Amresh S
Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Japan.
J Neurosurg. 2002 Apr;96(3 Suppl):277-84. doi: 10.3171/spi.2002.96.3.0277.
The authors describe a new magnetic resonance (MR) imaging technique to demonstrate the status of the cervical nerve roots involved in brachial plexus injury. They discuss the accuracy and reproducibility of a MR imaging-derived classification for diagnosis of nerve root avulsion compared with those of myelography combined with computerized tomography (CT) myelography.
The overlapping coronal-oblique slice MR imaging procedure was performed in 35 patients with traumatic brachial plexus injury and 10 healthy individuals. The results were retrospectively evaluated and classified into four major categories (normal rootlet, rootlet injuries, avulsion, and meningocele) after confirming the diagnosis by surgical exploration with or without spinal evoked potential (EP) measurements and by referring to myelography and CT myelography findings. The reliability and reproducibility of the MR imaging-based classification was prospectively assessed by eight independent observers, and its diagnostic accuracy was compared with that of traditional myelography/CT myelography classification, correlated with surgical and spinal EP findings in another 50 cervical roots in 10 patients with traumatic brachial plexus injury.
In the retrospective study in which MR imaging and myelography/CT myelography findings involving 175 cervical roots in 35 patients were compared, the sensitivity of detection of the cervical nerve root avulsion was the same (92.9%) with both modalities. In the prospective study, interobserver reliability and intraobserver reproducibility showed that there was no statistically significant difference between MR imaging and myelography/CT myelography and that their accuracy for detecting cervical root avulsion was the same as that in the retrospective study. The overlapping coronal-oblique slice MR imaging technique is a reliable and reproducible method for detecting nerve root avulsion. The information provided by this modality enabled the authors to assess the roots of the brachial plexus and provided valuable data for helping to decide whether to proceed with exploration, nerve repair, primary reconstruction, or other imaging modalities.
作者描述了一种新的磁共振（MR）成像技术，用于显示臂丛神经损伤所累及的颈神经根状态。他们讨论了与脊髓造影联合计算机断层扫描（CT）脊髓造影相比，MR成像衍生分类法诊断神经根撕脱的准确性和可重复性。
对35例创伤性臂丛神经损伤患者和10名健康个体进行重叠冠状斜位切片MR成像检查。回顾性评估结果，并在通过手术探查（有或无脊髓诱发电位（EP）测量）并参考脊髓造影和CT脊髓造影结果确诊后，将其分为四大类（正常神经根丝、神经根丝损伤、撕脱和脊膜膨出）。由八名独立观察者对基于MR成像的分类的可靠性和可重复性进行前瞻性评估，并将其诊断准确性与传统脊髓造影/CT脊髓造影分类的准确性进行比较，并与另外10例创伤性臂丛神经损伤患者的50条颈神经根的手术和脊髓EP结果相关联。
在一项回顾性研究中，比较了35例患者175条颈神经根的MR成像和脊髓造影/CT脊髓造影结果，两种检查方式检测颈神经根撕脱的敏感性相同（92.9%）。在前瞻性研究中，观察者间可靠性和观察者内可重复性表明，MR成像与脊髓造影/CT脊髓造影之间无统计学显著差异，且它们检测颈神经根撕脱的准确性与回顾性研究相同。重叠冠状斜位切片MR成像技术是检测神经根撕脱的可靠且可重复的方法。这种检查方式提供的信息使作者能够评估臂丛神经根，并为帮助决定是否进行探查、神经修复、一期重建或其他成像检查方式提供了有价值的数据。
