الفهرس 
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Abstract
The aim of the study was to evaluate the accuracy of brachial plexus MRI in the evaluation of traumatic brachial plexus injuries.
The study included 30 patients planned for brachial plexus reconstructive surgery following trauma from April 2019 to November 2021.
All patients underwent pre-operative MRI of the brachial plexus using 1.5T magnet utilizing axial T2-DRIVE sequence to visualize the intra-dural rootlets, 3D-STIR to evaluate the post-ganglionic brachial plexus segments. Diffusion tensor imaging (DTI), in addition to other conventional sequences.
We looked for signs of avulsion on T2-DRIVE (absent dural rootlets, pauci-rootlet appearance and thickened rootlets); the presence of pseudomeningoceles was noted as only an ancillary sign.
The post-ganglionic plexus was assessed for injuries in line with Sunderland classification of nerve injuries; specifically looking for ruptures (Sunderland grade V), neuromas in continuity (NIC, Sunderland grade IV) as well as the milder degrees of injuries, collectively classified as (Sunderland grades I-III).
Comparison against the gold standard of extra-dural brachial plexus exploration was done in 27 operated patients. 3 patients showed spontaneous recovery before surgery so the decision was not to operate. These three patients showed mild nerve injuries (Sunderland grades I-III) on MRI with neither avulsions, ruptures nor NICs.
Eighteen patients had root avulsions at surgery (nine of which also showed post-ganglionic injuries), eight showed isolated post-ganglionic injuries and one had normal brachial plexus exploration.
Thirty-nine avulsed roots were found at surgery (out of 119 explored in 27 patients). Pre-operative MRI accurately identified the specific avulsed roots in each patient. Two false-positive diagnoses of C5 and C6 avulsions were made in one patient. On MRI, absence of the rootlets was seen in 73.1% (n=30) of avulsions, pauci-rootlet appearance in 24.4% (n=10) and thickening of the rootlets in 2.4% (n=1). Pseudomeningoceles were found only in 68.3% (n=28) of avulsions. The overall sensitivity, specificity, PPV, NPV and accuracy of MRI were 100%, 97.5%, 95.1%, 100% and 98.3%, respectively.