Takeharu Yoshikawa MD, Presenter: Nothing to Disclose

Naoto Hayashi MD, Abstract Co-Author: Nothing to Disclose

Yasuhito Tajiri MD, Abstract Co-Author: Nothing to Disclose

Shigeki Aoki MD, Abstract Co-Author: Nothing to Disclose

Harushi Mori MD, Abstract Co-Author: Nothing to Disclose

Kuni Ohtomo MD, Abstract Co-Author: Nothing to Disclose

Osamu Abe MD, PhD, Abstract Co-Author: Nothing to Disclose

Yoshitaka Masutani PhD, Abstract Co-Author: Nothing to Disclose

Tomohiko Masumoto MD, Abstract Co-Author: Nothing to Disclose

Akira Kunimatsu MD, Abstract Co-Author: Nothing to Disclose

Haruyasu Yamada MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

The purpose of this study is to examine clinical feasibility of MR myelography using fast imaging employing steady state acquisition (FIESTA) sequence to assess preganglionic nerve roots in patients with brachial plexus injuries (BPIs).

Ten volunteers and 17 patients with traumatic BPIs underwent MR myelography using FIESTA on a 1.5-T superconductive MR unit. MR myelography of the cervical and upper thoracic spine was obtained in a coronal plane. We paid attention to the ventral and dorsal roots of the bilateral sides from C4 to T1 levels. In the volunteer studies, we evaluated visibility of each nerve root on a three-point scale: 3 (excellent), 2 (good) or 1 (poor). In the evaluation of MR myelographic images of the patients, we rated condition of each nerve root on a five-point scale: 5 (definitely normal), 4 (probably normal), 3 (inconclusive), 2 (probably injured) or 1 (definitely injured). All of 17 patients underwent CT myelography after conventional myelography, and we also rated condition of each preganglionic nerve root based on CT myelography findings on the same scale system to estimate coincidence of MR myelography and CT myelography.

MR myelography using FIESTA demonstrated clearly most of the nerve roots in the volunteer studies. In the visibility evaluation, 93.7% of nerve roots were rated as excellent, 5.0% as good and 1.3% as poor. In six of 17 patients (Group 1), all nerve roots were distinctly visualized and we could determine whether each root was injured or not. In four patients (Group 2), we could evaluate the presence of injury in most of the nerve roots (equal to or more than 20 roots in 24 roots). In the remaining seven patients (Group 3), however, we could estimate less than 20 roots because of artifacts or spinal canal stenosis caused by large traumatic pseudomeningoceles. With regard to coincidence of the two modalities, weighted kappa value was 0.89 in Group 1, 0.71 in Group 2, and 0.42 in Group 3. The overall weighted kappa value was 0.65.

MR myelography can replace a part of CT myelography examinations in evaluation of traumatic BPIs, but CT myelography is still necessary in a certain number of patients.

Yoshikawa, T, Hayashi, N, Tajiri, Y, Aoki, S, Mori, H, Ohtomo, K, Abe, O, Masutani, Y, Masumoto, T, Kunimatsu, A, Yamada, H, et al, , Can MR Myelography Using FIESTA Replace CT Myelography to Assess Preganglionic Nerve Roots in Traumatic Brachial Plexus Injuries?.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4413080.html