Wade Ryckie G, Teh Irvin, Shelley David, Bains Robert D, Bedford James D, Homer Newton Lucy E, Ng Chye Yew, Bourke Grainne
Leeds Institute for Medical Research, University of Leeds, Leeds, UK; Department of Plastic, Reconstructive and Hand Surgery, Leeds Teaching Hospitals Trust, Leeds, UK.
Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Neuroimage Clin. 2025 May 21;47:103806. doi: 10.1016/j.nicl.2025.103806.
Root avulsion in patients with traumatic brachial plexus injury (tBPI) are common and MRI is used to help identify patients who need urgent reconstruction. Diffusion tensor MRI (DTI) generates proxy measures of nerve 'health' which are sensitive to myelination, axon diameter, fibre density and organisation. This prospective multicentre pilot study assessed the utility of DTI for detecting root avulsion in adults with acute traumatic brachial plexus injury.
Patients underwent DTI at 3 Tesla. Fractional anisotropy (FA) and radial diffusivity (RD) were extracted from spinal nerve roots. The reference standard was surgical exploration or surveillance if spontaneous recovery occurred preoperatively. Comparisons were made between spinal nerve root avulsions, in-continuity roots and the contralateral uninjured roots, using linear methods and 95% confidence intervals (CI) were computed.
14 males with tBPI (mean age 44 years, SD 14) were scanned at a mean 18 days post-injury (CI 15-21). Diffusion was more isotropic in avulsed roots; root avulsions had 12 % lower FA than injured in-continuity roots (CI 5-19) and 14 % lower FA (CI 7-21) than the contralateral uninjured side. Similarly, avulsed roots had higher radial diffusivity than injured in-continuity roots (mean difference 0·30 x10 mm/s [CI 0·01-0·60]) and contralateral uninjured roots (mean difference 0·36 x10 mm/s [CI 0·7-0·64]).
Diffusion tensor imaging appears to be sensitive to early microstructural changes in the distal stumps of avulsed roots in adults with tBPI. DTI may supplement morphological MRI to better identify patients who need early reconstruction.
创伤性臂丛神经损伤（tBPI）患者中神经根撕脱很常见，MRI用于帮助识别需要紧急重建的患者。扩散张量MRI（DTI）生成神经“健康”的替代指标，这些指标对髓鞘形成、轴突直径、纤维密度和组织结构敏感。这项前瞻性多中心试点研究评估了DTI在检测急性创伤性臂丛神经损伤成人患者神经根撕脱方面的效用。
患者在3特斯拉下接受DTI检查。从脊神经根提取分数各向异性（FA）和径向扩散率（RD）。参考标准是手术探查或如果术前发生自发恢复则进行监测。使用线性方法对脊神经根撕脱、连续神经根和对侧未受伤神经根进行比较，并计算95%置信区间（CI）。
14例tBPI男性患者（平均年龄44岁，标准差14）在受伤后平均18天（CI 15 - 21）接受扫描。撕脱神经根中的扩散更具各向同性；神经根撕脱的FA比受伤的连续神经根低12%（CI 5 - 19），比未受伤的对侧低14%（CI 7 - 21）。同样，撕脱神经根的径向扩散率高于受伤的连续神经根（平均差异0·30×10⁻³mm²/s [CI 0·01 - 0·60]）和对侧未受伤神经根（平均差异0·36×10⁻³mm²/s [CI 0·07 - 0·64]）。
扩散张量成像似乎对tBPI成人患者撕脱神经根远端残端的早期微观结构变化敏感。DTI可补充形态学MRI以更好地识别需要早期重建的患者。
