RadioGraphics
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

DOI: 10.1148/rg.26si065511
This Article
Right arrow Abstract Freely available
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Yoshikawa, T.
Right arrow Articles by Ohtomo, K.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Yoshikawa, T.
Right arrow Articles by Ohtomo, K.
Related Collections
Right arrow Magnetic Resonance Imaging
Right arrow Neuroradiology
Right arrow Computed Tomography

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

Takeharu Yoshikawa, MD, PhD, Naoto Hayashi, MD, PhD, Shinichi Yamamoto, MD, PhD, Yasuhito Tajiri, MD, PhD, Naoki Yoshioka, MD, PhD, Tomohiko Masumoto, MD, PhD, Harushi Mori, MD, Osamu Abe, MD, PhD, Shigeki Aoki, MD, PhD and Kuni Ohtomo, MD, PhD

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.

Figure 1
View larger version (20K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 1a.  (1a) Drawing illustrates N type myelographic findings in BPI. (Modified, with permission, from reference 13.) (1b–1d) Standard myelogram (1b), coronal reformatted CT myelographic image (1c), and source CT myelogram (1d) demonstrate a normal root sleeve and nerve roots.

 

Figure 1
View larger version (75K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 1b.  (1a) Drawing illustrates N type myelographic findings in BPI. (Modified, with permission, from reference 13.) (1b–1d) Standard myelogram (1b), coronal reformatted CT myelographic image (1c), and source CT myelogram (1d) demonstrate a normal root sleeve and nerve roots.

 

Figure 1
View larger version (80K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 1c.  (1a) Drawing illustrates N type myelographic findings in BPI. (Modified, with permission, from reference 13.) (1b–1d) Standard myelogram (1b), coronal reformatted CT myelographic image (1c), and source CT myelogram (1d) demonstrate a normal root sleeve and nerve roots.

 

Figure 1
View larger version (79K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 1d.  (1a) Drawing illustrates N type myelographic findings in BPI. (Modified, with permission, from reference 13.) (1b–1d) Standard myelogram (1b), coronal reformatted CT myelographic image (1c), and source CT myelogram (1d) demonstrate a normal root sleeve and nerve roots.

 

Figure 2
View larger version (8K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 2a.  (2a) Drawing illustrates A1 type myelographic findings in BPI. (Modified, with permission, from reference 13.) (2b–2d) Standard myelogram (2b), coronal reformatted CT myelographic image (2c), and source CT myelogram (2d) demonstrate a slightly deformed root sleeve and nerve roots. This lesion, like those in Figures 3–6, was clinically preganglionic.

 

Figure 2
View larger version (67K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 2b.  (2a) Drawing illustrates A1 type myelographic findings in BPI. (Modified, with permission, from reference 13.) (2b–2d) Standard myelogram (2b), coronal reformatted CT myelographic image (2c), and source CT myelogram (2d) demonstrate a slightly deformed root sleeve and nerve roots. This lesion, like those in Figures 3–6, was clinically preganglionic.

 

Figure 2
View larger version (71K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 2c.  (2a) Drawing illustrates A1 type myelographic findings in BPI. (Modified, with permission, from reference 13.) (2b–2d) Standard myelogram (2b), coronal reformatted CT myelographic image (2c), and source CT myelogram (2d) demonstrate a slightly deformed root sleeve and nerve roots. This lesion, like those in Figures 3–6, was clinically preganglionic.

 

Figure 2
View larger version (76K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 2d.  (2a) Drawing illustrates A1 type myelographic findings in BPI. (Modified, with permission, from reference 13.) (2b–2d) Standard myelogram (2b), coronal reformatted CT myelographic image (2c), and source CT myelogram (2d) demonstrate a slightly deformed root sleeve and nerve roots. This lesion, like those in Figures 3–6, was clinically preganglionic.

 

Figure 3
View larger version (6K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 3a.  (3a) Drawing illustrates A2 type myelographic findings in BPI. (Modified, with permission, from reference 13.) (3b, 3c) Standard myelogram (3b) and coronal reformatted CT myelographic image (3c) demonstrate obliteration of the tip of the root sleeve. Deformed nerve roots are also seen. (3d) Source CT myelogram depicts a deformed root sleeve and thickened nerve roots.

 

Figure 3
View larger version (61K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 3b.  (3a) Drawing illustrates A2 type myelographic findings in BPI. (Modified, with permission, from reference 13.) (3b, 3c) Standard myelogram (3b) and coronal reformatted CT myelographic image (3c) demonstrate obliteration of the tip of the root sleeve. Deformed nerve roots are also seen. (3d) Source CT myelogram depicts a deformed root sleeve and thickened nerve roots.

 

Figure 3
View larger version (58K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 3c.  (3a) Drawing illustrates A2 type myelographic findings in BPI. (Modified, with permission, from reference 13.) (3b, 3c) Standard myelogram (3b) and coronal reformatted CT myelographic image (3c) demonstrate obliteration of the tip of the root sleeve. Deformed nerve roots are also seen. (3d) Source CT myelogram depicts a deformed root sleeve and thickened nerve roots.

 

Figure 3
View larger version (55K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 3d.  (3a) Drawing illustrates A2 type myelographic findings in BPI. (Modified, with permission, from reference 13.) (3b, 3c) Standard myelogram (3b) and coronal reformatted CT myelographic image (3c) demonstrate obliteration of the tip of the root sleeve. Deformed nerve roots are also seen. (3d) Source CT myelogram depicts a deformed root sleeve and thickened nerve roots.

 

Figure 4
View larger version (6K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 4a.  (4a) Drawing illustrates A3 type myelographic findings in BPI. (Modified, with permission, from reference 13.) (4b, 4c) Standard myelogram (4b) and coronal reformatted CT myelographic image (4c) demonstrate obliteration of the tip of the root sleeve and the absence of nerve roots. (4d) Source CT myelogram also depicts the absence of nerve roots.

 

Figure 4
View larger version (55K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 4b.  (4a) Drawing illustrates A3 type myelographic findings in BPI. (Modified, with permission, from reference 13.) (4b, 4c) Standard myelogram (4b) and coronal reformatted CT myelographic image (4c) demonstrate obliteration of the tip of the root sleeve and the absence of nerve roots. (4d) Source CT myelogram also depicts the absence of nerve roots.

 

Figure 4
View larger version (72K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 4c.  (4a) Drawing illustrates A3 type myelographic findings in BPI. (Modified, with permission, from reference 13.) (4b, 4c) Standard myelogram (4b) and coronal reformatted CT myelographic image (4c) demonstrate obliteration of the tip of the root sleeve and the absence of nerve roots. (4d) Source CT myelogram also depicts the absence of nerve roots.

 

Figure 4
View larger version (78K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 4d.  (4a) Drawing illustrates A3 type myelographic findings in BPI. (Modified, with permission, from reference 13.) (4b, 4c) Standard myelogram (4b) and coronal reformatted CT myelographic image (4c) demonstrate obliteration of the tip of the root sleeve and the absence of nerve roots. (4d) Source CT myelogram also depicts the absence of nerve roots.

 

Figure 5
View larger version (5K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 5a.  (5a) Drawing illustrates D type myelographic findings in BPI. (Modified, with permission, from reference 13.) (5b) Standard myelogram demonstrates a root sleeve defect. (5c, 5d) Coronal reformatted CT myelographic image (5c) and source CT myelogram (5d) show a root sleeve defect. They also depict a traumatic meningocele, which was not visible at standard myelography (cf 5b). Intrathecal contrast material had not yet moved into the traumatic meningocele when standard myelography was performed but had filled the meningocele by the time CT myelography was performed.

 

Figure 5
View larger version (56K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 5b.  (5a) Drawing illustrates D type myelographic findings in BPI. (Modified, with permission, from reference 13.) (5b) Standard myelogram demonstrates a root sleeve defect. (5c, 5d) Coronal reformatted CT myelographic image (5c) and source CT myelogram (5d) show a root sleeve defect. They also depict a traumatic meningocele, which was not visible at standard myelography (cf 5b). Intrathecal contrast material had not yet moved into the traumatic meningocele when standard myelography was performed but had filled the meningocele by the time CT myelography was performed.

 

Figure 5
View larger version (79K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 5c.  (5a) Drawing illustrates D type myelographic findings in BPI. (Modified, with permission, from reference 13.) (5b) Standard myelogram demonstrates a root sleeve defect. (5c, 5d) Coronal reformatted CT myelographic image (5c) and source CT myelogram (5d) show a root sleeve defect. They also depict a traumatic meningocele, which was not visible at standard myelography (cf 5b). Intrathecal contrast material had not yet moved into the traumatic meningocele when standard myelography was performed but had filled the meningocele by the time CT myelography was performed.

 

Figure 5
View larger version (83K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 5d.  (5a) Drawing illustrates D type myelographic findings in BPI. (Modified, with permission, from reference 13.) (5b) Standard myelogram demonstrates a root sleeve defect. (5c, 5d) Coronal reformatted CT myelographic image (5c) and source CT myelogram (5d) show a root sleeve defect. They also depict a traumatic meningocele, which was not visible at standard myelography (cf 5b). Intrathecal contrast material had not yet moved into the traumatic meningocele when standard myelography was performed but had filled the meningocele by the time CT myelography was performed.

 

Figure 6
View larger version (13K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 6a.  (6a) Drawing illustrates M type myelographic findings in BPI. (Modified, with permission, from reference 13.) (6b–6d) Standard myelogram (6b), coronal reformatted CT myelographic image (6c), and source CT myelogram (6d) demonstrate a large traumatic meningocele.

 

Figure 6
View larger version (71K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 6b.  (6a) Drawing illustrates M type myelographic findings in BPI. (Modified, with permission, from reference 13.) (6b–6d) Standard myelogram (6b), coronal reformatted CT myelographic image (6c), and source CT myelogram (6d) demonstrate a large traumatic meningocele.

 

Figure 6
View larger version (72K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 6c.  (6a) Drawing illustrates M type myelographic findings in BPI. (Modified, with permission, from reference 13.) (6b–6d) Standard myelogram (6b), coronal reformatted CT myelographic image (6c), and source CT myelogram (6d) demonstrate a large traumatic meningocele.

 

Figure 6
View larger version (88K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 6d.  (6a) Drawing illustrates M type myelographic findings in BPI. (Modified, with permission, from reference 13.) (6b–6d) Standard myelogram (6b), coronal reformatted CT myelographic image (6c), and source CT myelogram (6d) demonstrate a large traumatic meningocele.

 

Figure 7
View larger version (122K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 7.  BPI with edema in the spinal cord. Axial T2-weighted MR image demonstrates a hyperintense area (arrow) in the spinal cord, a finding that suggests edema in the acute phase.

 

Figure 8
View larger version (129K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 8.  BPI with old hemorrhage in the spinal cord. Axial T2-weighted MR image demonstrates a hypointense area (arrow) in the spinal cord, a finding that indicates hemosiderin deposition on account of hemorrhage.

 

Figure 9
View larger version (112K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 9a.  BPI with avulsion within the spinal cord. (a) T2-weighted MR image shows a lesion (arrow) in the exit zone of the right ventral nerve root. The lesion has a signal intensity similar to that of cerebrospinal fluid. (b) CT myelogram shows a defect (arrow) in the same area, indicating avulsion within the spinal cord.

 

Figure 9
View larger version (97K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 9b.  BPI with avulsion within the spinal cord. (a) T2-weighted MR image shows a lesion (arrow) in the exit zone of the right ventral nerve root. The lesion has a signal intensity similar to that of cerebrospinal fluid. (b) CT myelogram shows a defect (arrow) in the same area, indicating avulsion within the spinal cord.

 

Figure 10
View larger version (136K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 10.  Root avulsion injury. Axial contrast material–enhanced T1-weighted MR image demonstrates marked enhancement of the left dorsal root (arrow), a finding that indicates functional impairment.

 

Figure 11
View larger version (172K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 11.  Root avulsion injury. Axial contrast-enhanced T1-weighted MR image demonstrates marked enhancement of the spinal cord surface at the right root exit zone (root stump) (arrow), a finding that is related to functional nerve root impairment.

 

Figure 12
View larger version (117K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 12a.  Root avulsion injury. (a) Axial T2-weighted MR image demonstrates areas of hyperintensity (arrowheads) in the right paraspinal muscles. (b) Axial contrast-enhanced T1-weighted MR image shows areas of marked enhancement (arrowheads) in the right paraspinal muscles, findings that are compatible with muscle denervation caused by root avulsion injury. (Fig 12 reprinted, with permission, from reference 23.)

 

Figure 12
View larger version (128K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 12b.  Root avulsion injury. (a) Axial T2-weighted MR image demonstrates areas of hyperintensity (arrowheads) in the right paraspinal muscles. (b) Axial contrast-enhanced T1-weighted MR image shows areas of marked enhancement (arrowheads) in the right paraspinal muscles, findings that are compatible with muscle denervation caused by root avulsion injury. (Fig 12 reprinted, with permission, from reference 23.)

 

Figure 13
View larger version (155K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 13.  Root avulsion injury. Coronal contrast-enhanced T1-weighted MR image shows marked enhancement in the left multifidus muscle (arrowheads). Abnormal enhancement in the multifidus muscle is the most accurate sign of root avulsion injury among paraspinal muscle findings. (Reprinted, with permission, from reference 23.)

 

Figure 14
View larger version (142K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 14.  Coronal MR myelographic image obtained with FIESTA clearly demonstrates all of the nerve roots (arrows).

 

Figure 15
View larger version (163K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 15a.  Root avulsion injury. (a, b) Coronal MR myelographic image obtained with FIESTA (a) and axial reformatted MR image (b) demonstrate absence of the left C5 nerve roots (arrow) due to avulsion. The right nerve roots (arrowheads) are intact. (c) CT myelogram also shows absence of the affected nerve roots (arrow) and the intact nerve roots on the unaffected side (arrowheads).

 

Figure 15
View larger version (69K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 15b.  Root avulsion injury. (a, b) Coronal MR myelographic image obtained with FIESTA (a) and axial reformatted MR image (b) demonstrate absence of the left C5 nerve roots (arrow) due to avulsion. The right nerve roots (arrowheads) are intact. (c) CT myelogram also shows absence of the affected nerve roots (arrow) and the intact nerve roots on the unaffected side (arrowheads).

 

Figure 15
View larger version (55K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 15c.  Root avulsion injury. (a, b) Coronal MR myelographic image obtained with FIESTA (a) and axial reformatted MR image (b) demonstrate absence of the left C5 nerve roots (arrow) due to avulsion. The right nerve roots (arrowheads) are intact. (c) CT myelogram also shows absence of the affected nerve roots (arrow) and the intact nerve roots on the unaffected side (arrowheads).

 

Figure 16
View larger version (70K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 16a.  Root avulsion injury. Axial reformatted MR image obtained with FIESTA (a) and CT myelogram (b) demonstrate large traumatic meningoceles (arrows) on the left side. The right nerve roots are intact on the CT myelogram (arrowheads in b) but are not clearly seen on the FIESTA image.

 

Figure 16
View larger version (50K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 16b.  Root avulsion injury. Axial reformatted MR image obtained with FIESTA (a) and CT myelogram (b) demonstrate large traumatic meningoceles (arrows) on the left side. The right nerve roots are intact on the CT myelogram (arrowheads in b) but are not clearly seen on the FIESTA image.

 

Figure 17
View larger version (129K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 17.  Diffusion-weighted neurogram clearly depicts the spinal cord and nerve roots.

 

Figure 18
View larger version (129K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 18.  BPI with postganglionic lesions. On a diffusion-weighted neurogram, the left C4 and C5 nerve roots are poorly visualized (circled) compared with the corresponding contralateral nerve roots.

 

Figure 19
View larger version (100K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 19.  Root avulsion injury. Bezier surface reformatted images from CT myelographic volume data (stereographic view) demonstrate avulsion injuries of the left C6 and C7 nerve roots with traumatic meningoceles. This view illustrates the actual shape and position of the curved surface. Note that entire nerve roots are clearly depicted in the intact regions.

 




HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
RADIOGRAPHICS RADIOLOGY RSNA JOURNALS ONLINE
Copyright © 2006 by the Radiological Society of North America.