Three-dimensional MR myelography of traumatic injuries of the brachial plexus

PURPOSE: To determine the diagnostic accuracy of three-dimensional MR myelography in the
evaluation of traumatic injuries of the brachial plexus. METHODS: Twenty patients with clinical
and electromyographic evidence of traumatic brachial plexopathy were examined with threedimensional
MR myelography, conventional cervical myelography, and CT myelography 1 to 9
months after trauma. Three-dimensional MR myelography was performed on a 1.5-T MR unit with
a constructive interference in steady state (CISS) technique. For each patient, maximum intensity
myelographic projections and multiplanar reconstruction reformatted 1-mm axial sections were
obtained from the same 3-D data set. Three-dimensional MR myelographic findings were compared
with findings at cervical myelography and CT myelography. Surgical findings were available
for comparison in 13 patients. RESULTS: Three-dimensional MR myelography enabled detection
of meningoceles with avulsed or intact nerve roots, partial or complete radicular avulsions without
disruption of the thecal sac, dural sleeve abnormalities, and dural scars. Assuming cervical
myelography and CT myelography as the standards of reference, 3-D MR myelography showed
89% sensitivity, 95% specificity, and 92% diagnostic accuracy in the evaluation of nerve root
integrity. CONCLUSION: Three-dimensional MR myelography can show the majority of traumatic
lesions that involve the proximal portion of the brachial plexus in a single rapid examination. On the
basis of our findings, we propose this technique as a screening examination for patients with
traumatic brachial plexus palsy.