Medina L Santiago, Yaylali Ilker, Zurakowski David, Ruiz Jennifer, Altman Nolan R, Grossman John A I
Division of Neuroradiology, Department of Radiology, Brain Institute, Health Outcomes, Policy, and Economics (HOPE) Center, Miami Children's Hospital, Miami, FL, USA.
Pediatr Radiol. 2006 Dec;36(12):1295-9. doi: 10.1007/s00247-006-0321-0. Epub 2006 Oct 7.
Detailed evaluation of a brachial plexus birth injury is important for treatment planning.
To determine the diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury.
Included in the study were 31 children with perinatal brachial plexus injury who underwent surgical intervention. All patients had cervical and brachial plexus MRI. The standard of reference was the combination of intraoperative (1) surgical evaluation and (2) electrophysiological studies (motor evoked potentials, MEP, and somatosensory evoked potentials, SSEP), and (3) the evaluation of histopathological neuronal loss. MRI findings of cord lesion, pseudomeningocele, and post-traumatic neuroma were correlated with the standard of reference. Diagnostic performance characteristics including sensitivity and specificity were determined.
From June 2001 to March 2004, 31 children (mean age 7.3 months, standard deviation 1.6 months, range 4.8-12.1 months; 19 male, 12 female) with a brachial plexus birth injury who underwent surgical intervention were enrolled. Sensitivity and specificity of an MRI finding of post-traumatic neuroma were 97% (30/31) and 100% (31/31), respectively, using the contralateral normal brachial plexus as the control. However, MRI could not determine the exact anatomic area (i.e. trunk or division) of the post-traumatic brachial plexus neuroma injury. Sensitivity and specificity for an MRI finding of pseudomeningocele in determining exiting nerve injury were 50% and 100%, respectively, using MEP, and 44% and 80%, respectively, using SSEP as the standard of reference. MRI in infants could not image well the exiting nerve roots to determine consistently the presence or absence of definite avulsion.
In children younger than 18 months with brachial plexus injury, the MRI finding of pseudomeningocele has a low sensitivity and a high specificity for nerve root avulsion. MRI and MR myelography cannot image well the exiting nerve roots to determine consistently the presence or absence of avulsion of nerve roots. The MRI finding of post-traumatic neuroma has a high sensitivity and specificity in determining the side of the brachial plexus injury but cannot reveal the exact anatomic area (i.e. trunk or division) involved. The information obtained is, however, useful to the surgeon during intraoperative evaluation of spinal nerve integrity for reconstruction.
对臂丛神经产伤进行详细评估对于治疗方案的制定很重要。
确定MRI和磁共振脊髓造影在臂丛神经产伤婴儿中的诊断效能。
本研究纳入31例接受手术干预的围产期臂丛神经损伤患儿。所有患者均进行了颈椎和臂丛神经MRI检查。参考标准为术中（1）手术评估、（2）电生理研究（运动诱发电位，MEP，和体感诱发电位，SSEP）以及（3）组织病理学神经元丢失评估的综合结果。脊髓损伤、假性脊膜膨出和创伤后神经瘤的MRI表现与参考标准进行相关性分析。确定包括敏感性和特异性在内的诊断效能特征。
2001年6月至2004年3月，纳入31例接受手术干预的臂丛神经产伤患儿（平均年龄7.3个月，标准差1.6个月，范围4.8 - 12.1个月；男19例，女12例）。以对侧正常臂丛神经作为对照，创伤后神经瘤的MRI表现的敏感性和特异性分别为(97%)（(30/31)）和(100%)（(31/31)）。然而，MRI无法确定创伤后臂丛神经瘤损伤的确切解剖区域（即干或束）。以MEP为参考标准，假性脊膜膨出的MRI表现在确定神经根损伤方面的敏感性和特异性分别为(50%)和(100%)；以SSEP为参考标准，敏感性和特异性分别为(44%)和(80%)。婴儿的MRI对穿出神经根的成像效果不佳，无法始终确定是否存在明确的撕脱伤。
在18个月以下的臂丛神经损伤儿童中，假性脊膜膨出的MRI表现对神经根撕脱伤的敏感性低、特异性高。MRI和磁共振脊髓造影对穿出神经根的成像效果不佳，无法始终确定神经根是否存在撕脱伤。创伤后神经瘤的MRI表现在确定臂丛神经损伤的侧别方面具有高敏感性和特异性，但无法揭示所涉及的确切解剖区域（即干或束）。然而，所获得的信息在术中评估脊神经完整性以进行重建时对外科医生是有用的。
