Hung Nguyen Duy, Duc Nguyen Minh, Xoan Nguyen Thi, Doan Ngo Van, Huyen Tran Thi Thanh, Dung Le Thanh
Department of Radiology, Hanoi Medical University, Hanoi, Vietnam.
Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam.
Ann Neurosci. 2020 Jul;27(3-4):124-130. doi: 10.1177/0972753120963299. Epub 2020 Nov 18.
This study aimed to evaluate the diagnostic function of 3-Tesla (T) magnetic resonance imaging (MRI) during the assessment of brachial plexus injury (BPI), in comparison with intraoperative findings.
A retrospective study was performed on 60 patients (47 men and 13 women), who had clinical manifestations of BPI, underwent 3T MRI of the brachial plexus, and were surgically treated at the Viet Duc and Vinmec Times City hospitals, in Hanoi, Vietnam, from March 2016 to December 2019. Preganglionic and postganglionic lesion features were identified on MRI. The diagnostic function of MRI features for the determination of BPI was evaluated and correlated with intraoperative findings.
The root avulsion and pseudomeningocele preganglionic injuries were observed in 57% and 43% of MRIs, respectively, and were commonly observed at the C7 and C8 roots. Nerve disruption and never edema were observed in 47.56% and 33.53% of MRIs, respectively, and were commonly observed at the C5 and C6 roots. The sensitivity, specificity, accuracy, positive prognostic value, and negative prognostic value of 3T MRI were 64.12%, 92.90%, 80.33%, 87.50%, and 76.96%, respectively, for the diagnosis of total avulsion, and 68.52%, 83.33%, 80.67%, 47.44%, and 92.34%, respectively, for the diagnosis of nerve disruption.
MRI offers valuable details regarding the location, morphology, and severity of both preganglionic and postganglionic injuries during the preoperative diagnosis of BPI. However, this modality played a moderate diagnostic role. Therefore, 3T MRI should be used as a supplemental evaluation, coupled with clinical tests and electromyography, to determine the most appropriate treatment strategies for BPI patients.
本研究旨在评估3特斯拉（T）磁共振成像（MRI）在臂丛神经损伤（BPI）评估中的诊断功能，并与术中所见进行比较。
对2016年3月至2019年12月期间在越南河内的越德医院和万美时代城医院接受手术治疗的60例有BPI临床表现且接受了臂丛神经3T MRI检查的患者（47例男性和13例女性）进行回顾性研究。在MRI上识别节前和节后病变特征。评估MRI特征对BPI诊断的诊断功能，并与术中所见进行关联。
分别在57%和43%的MRI中观察到神经根撕脱和假性脊膜膨出节前损伤，常见于C7和C8神经根。分别在47.56%和33.53%的MRI中观察到神经中断和神经水肿，常见于C5和C6神经根。3T MRI对完全撕脱诊断的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为64.12%、92.90%、80.33%、87.50%和76.96%，对神经中断诊断的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为68.52%、83.33%、80.67%、47.44%和92.34%。
MRI在BPI术前诊断中提供了有关节前和节后损伤的位置、形态和严重程度的有价值细节。然而，这种检查方式发挥的诊断作用中等。因此，3T MRI应作为一种补充评估手段，结合临床检查和肌电图，以确定BPI患者最合适的治疗策略。
