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Brachial Plexus Injury: Clinical Manifestations, Conventional Imaging Findings, and the Latest Imaging Techniques¹

¹ From the Department of Computational Diagnostic Radiology and Preventive Medicine (T.Y., N.H.) and the Department of Radiology (T.M., H.M., O.A., S.A., K.O.), University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan; the Department of Rehabilitation for Movement Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, Tokorozawa City, Saitama, Japan (S.Y.); the Department of Orthopedics, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan (Y.T.); and the Department of Radiological Sciences, International University of Health and Welfare, Otawara City, Tochigi, Japan (N.Y.). Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received March 13, 2006; revision requested April 24 and received May 25; accepted June 9. All authors have no financial relationships to disclose. Address correspondence to T.Y. (e-mail: takeharu-yoshikawa{at}umin.ac.jp).

Brachial plexus injury (BPI) is a severe neurologic injury that causes functional impairment of the affected upper limb. Imaging studies play an essential role in differentiating between preganglionic and postganglionic injuries, a distinction that is crucial for optimal treatment planning. Findings at standard myelography, computed tomographic (CT) myelography, and conventional magnetic resonance (MR) imaging help determine the location and severity of injuries. MR imaging sometimes demonstrates signal intensity changes in the spinal cord, and enhancement of nerve roots and paraspinal muscles at MR imaging indicates the presence of root avulsion injuries. New techniques including MR myelography, diffusion-weighted neurography, and Bezier surface reformation can also be useful in the evaluation and management of BPI. MR myelography with state-of-the-art technology yields remarkably high-quality images, although it cannot replace CT myelography entirely. Diffusion-weighted neurography is a cutting-edge technique for visualizing postganglionic nerve roots. Bezier surface reformation allows the depiction of entire intradural nerve roots on a single image. CT myelography appears to be the preferred initial imaging modality, with standard myelography and contrast material–enhanced MR imaging being recommended as additional studies. Work-up will vary depending on the equipment used, the management policy of peripheral nerve surgeons, and, most important, the individual patient.

© RSNA, 2006

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