Purpose or Case Report: Brachial plexus is a relatively common site of pediatric nerve pathology. This study was aimed at evaluation of utility of MRI and USG in the localization of brachial plexus injury in infants
Methods & Materials: This prospective study was conducted in a tertiary level hospital. A total of 34 infants who presented to the Pediatric Neurology OPD with signs and symptoms suggestive of brachial plexus injury were included in the study. Clinical examination, Electrophysiological study (EPS) and imaging using MRI (3 Tesla Scanner- Achieva, Philips) and USG (Supersonic Imagine, Aixplorer, France) were performed in all the 34 patients. Inter-rater agreement (k) between clinical findings and MRI; EPS findings and MRI; USG and MRI findings were determined in all patients using STATA/SE14.0 software. MRI and USG findings were correlated with intraoperative findings in the 8 subjects who underwent surgical management. Also, the quality of various MRI sequences and their diagnostic efficacy were compared and the significance of difference, if any, was tested using Fischer exact test
Results: The commonest findings of preganglionic injury and post ganglionic injury were pseudomeningocele and nerve thickening respectively. The agreement between clinical findings and MRI was 'almost perfect' (k=0.89); between MRI and EPS was 'substantial' (k= 0.76). There was 'substantial' agreement between MRI and USG in detecting neuromas that were involving all the three trunks of brachial plexus (k=0.79).Among the MRI sequences 3D STIR was found to be superior for the detection of postganglionic injuries (p<0.05)
Conclusions: The role of imaging in brachial plexopathy is trifold.
- Locating the site of injury, defining the extent of injury and detection of denervation changes
- Ultrasound imaging can detect post ganglionic injury, but fare poorly in detecting preganglionic injury
- MRI is superior in detection of both preganglionic and post ganglionic injuries