Brooks James, Hardie Claire, Wade Ryckie, Teh Irvin, Bourke Grainne
Leeds Institute for Medical Research, University of Leeds, Leeds, LS2 9JT, United Kingdom.
Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, LS1 3EX, United Kingdom.
Br J Radiol. 2025 Jan 1;98(1165):36-44. doi: 10.1093/bjr/tqae214.
To determine the diagnostic accuracy of MRI for diagnosing nerve injury in brachial plexus birth injury (BPBI).
Electronic databases were searched from inception to February 15, 2023 for studies reporting the accuracy of MRI (index test) compared to surgical exploration (reference standard) in detecting the target conditions of: root avulsion, any nerve abnormality, and pseudomeningocele (as a marker of root avulsion) in children with BPBI. Meta-analysis using a bivariate model was performed where data allowed.
Eight studies met the inclusion criteria. In total, 116 children with BPBI were included. All included studies were at risk of bias. The mean sensitivity and mean specificity of MRI for detecting root avulsion was 68% (95% CI: 55%, 79%) and 89% (95% CI: 78%, 95%), respectively. Pseudomeningocele was not a reliable marker of avulsion. Data were too sparse to determine the diagnostic accuracy of MRI for any nerve abnormality.
At present, surgical exploration should remain as the diagnostic modality of choice for BPBI due to the modest diagnostic accuracy of MRI in detecting root avulsion. The diagnostic accuracy of MRI needs to be close to 100% as the results may determine whether a child undergoes invasive surgery.
Previous research regarding MRI in detecting BPBI is highly variable and prior to our study the overall diagnostic accuracy was unclear. Through conducting a systematic review and meta-analysis, we were able to reliably determine the overall sensitivity and specificity of MRI for detecting root avulsion.
确定磁共振成像（MRI）诊断臂丛神经产伤（BPBI）中神经损伤的诊断准确性。
检索电子数据库，时间范围从建库至2023年2月15日，查找报告MRI（索引测试）与手术探查（参考标准）相比，在检测BPBI患儿的以下目标情况时的准确性的研究：神经根撕脱、任何神经异常以及假性脊膜膨出（作为神经根撕脱的标志物）。在数据允许的情况下，使用双变量模型进行荟萃分析。
八项研究符合纳入标准。总共纳入了116例BPBI患儿。所有纳入研究均存在偏倚风险。MRI检测神经根撕脱的平均敏感性和平均特异性分别为68%（95%CI：55%，79%）和89%（95%CI：78%，95%）。假性脊膜膨出不是撕脱的可靠标志物。数据过于稀少，无法确定MRI对任何神经异常的诊断准确性。
目前，由于MRI在检测神经根撕脱方面的诊断准确性一般，手术探查仍应作为BPBI的首选诊断方式。由于结果可能决定患儿是否接受侵入性手术，MRI的诊断准确性需要接近100%。
先前关于MRI检测BPBI的研究差异很大，在我们的研究之前，总体诊断准确性尚不清楚。通过进行系统评价和荟萃分析，我们能够可靠地确定MRI检测神经根撕脱的总体敏感性和特异性。
