3-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 pl exus. METHODS: Twenty patients with clinical and electromyographic evi dence of traumatic brachial plexopathy were examined with three-dimens ional MR myelography, conventional cervical myelography, and CT myelog raphy 1 to 9 months after trauma, Three-dimensional MR myelography was performed on a 1,5-T MR unit with a constructive interference in stea dy state (CISS) technique. For each patient, maximum intensity myelogr aphic projections and multiplanar reconstruction reformatted 1-mm axia l sections were obtained from the same 3-D data set, Three-dimensional MR myelographic findings were compared with findings at cervical myel ography and CT myelography. Surgical findings were available for compa rison in 13 patients, RESULTS: Three-dimensional MR myelography enable d detection of meningoceles with avulsed or intact nerve roots, partia l or complete radicular avulsions without disruption of the thecal sac , dural sleeve abnormalities, and dural scars, Assuming cervical myelo graphy and CT myelography as the standards of reference, 3-D MR myelog raphy showed 89% sensitivity, 95% specificity, and 92% diagnostic accu racy in the evaluation of nerve root integrity. CONCLUSION: Three-dime nsional 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.