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BỘ GIÁO DỤC VÀ ĐÀO TẠO BỘ QUỐC PHÒNG
SCIENTIFIC RESEARCH INSTITUTE OF CLINICAL
MEDICINE 108
NGUYEN NGOC TRUNG
RESEARCH ON VISUAL CHARACTERISTICS AND
VALUE OF MRI IN THE DIAGNOSIS OF
TRAUMATIC BRACHIAL PLEXUS INJURY
Specialisation: Image Diagnostics
Code: 62.72.01.66
SUMMARY OF THE DISSERTATION OF MEDICINE
HA NOI - 2019
THE DISSERTATION WAS ACCOMPLISHER
SCIENTIFIC RESEARCH INSTITUTE OF CLINICAL MEDICINE 108
Supervisors:
1. Lam Khanh, Associate Professor, Doctor
2. Tran Van Riep, Associate Professor, Doctor
Reviewer 1:
Reviewe 2:
Reviewe 3:
The dissertation defence before the Institutional Board takes
place at....
Scienifically archived at:
1. National library
2. Scientific Research Institute of Clinical Medicine 108
1
INTRODUCTION
Brachial plexus occurs when one or more nerve roots are removed
from the spinal cord at the base, or the nerves are stretched, cut, collapsed,
inserted. squeezing ... out of the hole. Brachial plexus injuries due to
traumatic injury tend to increase, mainly due to traffic accidents.
Worldwide studies such as Oliveira CM (2015), Jain DK (2012) all
confirmed the main cause of traffic accidents (78.7 and 94%). In Vietnam,
according to NC of Ho Huu Luong (1992), the incidence of neck spine
injuries was high (60-70%). According to Le Van Doan (2013), Brachial
plexus injuries due to traumatic injuries are not rare and the main cause
is traffic accidents.
In the world and in Vietnam, there have been some researches of
MRI of brachial plexus injuries due to traumatic injury. However, these
studies do not have a multifaceted assessment of injury due to disease
limitation. Based on the above situation, we conducted a study entitled
"Research on visual characteristics and value of MRI in the diagnostic of
traumatic brachial plexus injury" with two objectives:
1. Characterization of imaging of brachial plexus injuries due to
traumatic injury on 3 Tesla MRI.
2. Determine the value of the 3 Tesla MRI in Diagnosis of brachial
plexus injuries versus surgery.
Dessertation novelty: The study is the first one in Vietnam to
apply 3 Telsa MRI in the evaluation of traumatic brachial plexus injury.
Contribution to Image Diagnostics: A new diagnostic technique
is developed.
Contribution to Treatment: The study assesses systematic
brachial plexus injury and simultaneously indicates the correlation
between clinic and image diagnostics, thus assisting clinical practitioners
in the determination of an appropriate treatment policy to recover
effectively the patients’ functions.
Thesis structure
The dissertation consists of 124 pages: Question 2 pages, overview
36 pages; Subject and methodology 15 pages; Results 31 pages;
Comment 37 pages; Conclusion 2 pages; Recommendation: 1 page. The
thesis consists of 41 tables, 45 figures, 7 graphs, 119 references
(Vietnamese: 18; 101)
2
Chapter 1
OVERVIEW DOCUMENT
1.1. The role of MRI in the diagnosis of brachial plexus injuries
MRI is a visualization method based on the principle of putting
the body into a strong magnetic field to synchronize the direction of
motion of the hydrogen atoms in the water molecules and then use a radio
frequency antenna Low to activate the tissues in the body, hydrogen
atoms will resonate and emit signals. In the magnetically stable magnetic
field, the radio frequency will vary according to the purpose of the survey,
the target group of the various organs (parenchyma, muscle, fat, water,
blood vessels, etc.). The emitted signal is picked up by the antenna and
transmitted to the signal processing computer and the control computer,
whereby the image of the body structure is displayed.
With the new high-powered MRI camera, the Gyroscan Achieva 3 Tesla
from Phillips (The Netherlands), uses T2W of Vista Sense with the help
of 3D rendering and rendering software, the root, stem, bundle, and part
of the branches are separated, while separating the rotifer with other
complex structures in the neck.
1.2. Situation of MRI in diagnosis of traumatic brachial plexus injury
Early in the world, there were some researches related MRI
traumatic brachial plexus injury, namely Blair DN et al (1987), Bilbey JH
et al (1994). Authors Cejas DC (2015) and Fan YL (2016) conclude that
MRI is a useful supplement to clinical diagnosis, helping to select the best
course of treatment for patients.
In Vietnam, as we know, only a few published results of the
group of authors of 108 Military Central Hospital, namely Dinh Hoang
Long (2012) concluded that MRI and surgical outcome were highly
relevant (80.6%) after comparisons.
Chapter 2
OBJECTIVES AND RESEARCH METHODS
2.1. Research subjects and methods
The study was conducted on 60 patients who were examined
and treated at the 108 Military Central Hospital from January 2012 to
December 2014.
3
2.1.1. Standard selection
- Patients with a history of trauma, traumatic events with paralysis or
paralysis and clinical examination and determination of lesions and
symptoms of MRI Tesla 3.
- Being treated for traumatic brachial plexus injury at the Military
Orthopedic Trauma Institute, 108 Military Central Hospital and a surgery
document describing the lesions of traumatic brachial plexus injury
according to the medical records of this study.
2.1.2. Exclusion criteria
Patients who is suffering from traumatic brain injury, but not
due to traumatic injury, but due to medical disease, multiple injuries.
Patients who do not agree to participate in this study. Patients who are not
recorded in the medical records.
2.1.3. Sample size
p(1 p)
n Z2(1 / 2)
2
Instead of the formula we have n = 48 patients.
2.2. Research Methods
A prospective, cross-sectional descriptive study comparing the
diagnosis of brachial plexus injuries on MRI 3 Tesla befor surgery with
postoperative diagnosis.
2.2.2. Research content
2.2.2.1. General characteristics of brachial plexus injuries: Age,
gender, causes of injury, combined injury, place of injury, time from
illness to imaging, duration from illness to surgery.
2.2.2.2. Image of brachial plexus injuries on MRI
In combination with the diagnostic criteria of some authors, we
propose to investigate 10 signs of brachial plexus injuries on MRI 3 Tesla
as follows: spinal cord stenosis, oedema from preganglionic, root
avulsion, pseudomeningocele, diarrhea (root, trunk, cords), swelling
(root, trunk, cords), Rupture in the sheath (root, trunk, cords),
Incomplete rupture, rupture (root, trunk, cords), atrophy
- The above-mentioned brachial plexus injuries are described
in the following positions: divided by anatomy and T1W vertical, T2W
longitudinal, T2W horizontal, T2-weighted, T2-weighted, T2-weighted,
myelography ), MIP and 3D
- Location of marrow and root, trunk, cords on all MRI
4
2.2.2.3. Results diagnosis of surgeon
- Results of root, trunk and cords according to the surgeon: root avulsion
(including pseudomeningocele), rupture (root, trunk, cords)
2.2.2.4. Comparing the diagnosis of MRI with surgery based on two
signs: root avulsion (including pseudomeningocele), rupture (root, trunk,
cords)
2.2.3. Tools
MRI Gyroscan Achieva 3 Tesla camera from Phillips
(Netherlands) located in the Department of Diagnostic Imaging, 108
Hospital with coil NeuroVascular NV-16.
2.2.5. Image and data processing
- Patients' MRI images are stored as DICOM 3.0 and PNG images. The
images are based on the Vista sense software from Phillips (The
Netherlands).
MRI readings are saved as Word files. Statistical data is stored in a
computer in Excel format and then processed using SPSS 16.0.
- The algorithms used in the study: Statistics describing the frequency of
occurrence of signs of brachial plexus injuries (10 signs) by absolute
number and percentage on each type of pulse and section to find out Rules
related to position, number, level of injury, injury mechanism and the
advantages of each type of image. Compare the results of the diagnosis
of MRI brachial plexus injuries with results in surgery. Calculate the
suitability, sensitivity, specificity of CHT in the diagnosis of localization,
the number of lesions compared with the diagnosis of surgeon.
5
Study map
6
Chapter 3
RESEARCH RESULTS
3.1. General characteristics of patients with brachial plexus injuries
- Brachial plexus injuries is mainly in young and in men: mean age 28.8
± 11.8 years, male / female = 29.
- Causes of brachial plexus injuries are mainly caused by traffic accidents,
accounting for 76.7%. the left brachial plexus injuries > right. Most are
without combined lessions (88.3%).
- The majority of patients (43.3%) were given MRI for a period of 30 -
<90 days after injury. 43.4% of patients underwent surgery during 90 -
<180 days (3-6 months) after injury.
3.2. Picture of resonance from traumatic Brachial plexus injuries
3.2.1. Damage on T1W images
Table 3.2. Change the spinal curve
Patient Percentage
Number
symptom (%)
Loss natural spinal curve 3 5,0
No change 57 95,0
Vertebral body injury 0 0,0
Total 60 100
3.2.2. Damage on T2W vertical image
Table 3.3. Myelo and root injuries on T2W images
C5 C6 C7 C8 T1
Location
(%) (%) (%) (%) (%)
Damage
1 2 1 0 0
Spinal cord stenosis
1,7 3,3 1,7 0 0
Oedema from 4 4 2 1 0
preganglionic 6,6 6,6 3,3 1,7 0
2 10 26 19 9
Pseudomeningocele
3,3 16,7 43,3 31,7 15,0
54 44 31 40 51
No damage
90,0 73,3 51,7 66,7 85,0
7
3.2.3. Damage on T2W intraocular image
Table 3.4. Myelo and root injuries of brachial plexus on the
horizontal T2W image
Total
C5 C6 C7 C8 T1 (300
Location
root of
Damage
(%) (%) (%) (%) (%) 60
patients)
0 0 1 0 0 1
Spinal cord stenosis
0 0 0,3 0 0 0,3
Oedema from 4 0 2 1 0 7
preganglionic 1,3 0 0,7 0,3 0 2,3
7 10 14 11 6 48
Root avulsion
2,3 3,3 4,7 3,7 2,0 16,0
3 9 27 20 9 68
Pseudomeningocele
1,0 3,0 9,0 6,7 3,0 22,7
2 2 1 0 1 6
Diarrhea
0,7 0,7 0,3 0 0,3 2,0
12 10 8 7 5 42
Swelling
4,0 3,4 2,7 2,4 1,7 14,2
Rupture in the 1 0 0 0 0 1
sheath 0,3 0 0 0 0 0,3
Incomplete 0 0 1 1 0 2
rupture 0 0 0,3 0,3 0 0,7
27 31 31 26 19 134
Rupture
9,0 10,3 10,3 8,7 6,3 44,7
14 11 10 19 30 84
No damage
4,7 3,7 3,3 6,3 10 28,0
Table 3.5. Trunk injury on T2W horizontal
Total
Upper Middle
Lower (180
Location trunk trunk
trunk trunks of
Số lượng
(%) 60
Damage (%) (%)
patients)
1 0 0 1
Diarrhea
0,6 0 0 0,6
8
11 9 7 27
Swelling
6,1 5 3,9 15,0
Rupture in the 1 0 0 1
sheath 0,6 0 0 0,6
14 5 4 23
Rupture
7,8 2,8 2,2 12,8
35 47 50 132
No damage
19,4 26,1 27,8 73,3
Table 3.6. Cord Injuries of brachial plexus on T2W images
Total
Location Outside Inside Behind (180
cord cord cord cords of
(%) (%) (%) 60
Damage patients)
Spinal cord 21 20 22 63
stenosis 11,7 11,1 12,2 35,0
4 2 3 9
Rupture
2,2 1,1 1,7 5,0
1 0 0 1
Atrophy
0,6 0 0 0,6
34 38 35 107
No damage 18,9 21,1 19,4 59,4
3.2.4. Damage on T2W horizontal line image
Table 3.7. Myelo and root injuries on T2W horizontal line image
Total
Location
(300
C5 C6 C7 C8 T1
roots of
(%) (%) (%) (%) (%)
60
Damage
patients)
1 1 0 0 0 2
Spinal cord stenosis
0,3 0,3 0 0 0 0,7
7 10 14 11 6 48
Root avulsion
2,3 3,3 4,7 3,7 2 16,0
2 9 27 20 9 67
Pseudomeningocele
0,7 3,0 9,0 6,7 3,0 22,3
2 2 1 0 1 6
Diarrhea
0,7 0,7 0,3 0 0,3 2,0
9
12 9 8 7 5 41
Swelling
4,0 3,0 2,7 2,3 1,7 13,7
Incomplete 0 1 1 1 0 3
rupture 0 0,3 0,3 0,3 0 1,0
27 30 31 26 19 133
Rupture
9,0 10,0 10,3 8,7 6,3 44,3
15 12 10 19 30 86
No damage
5,0 4,0 3,3 6,3 10,0 28,7
Table 3.8. Trunk injuries on the T2W images cut horizontal
Total
Upper Middle
Lower (180
Location trunk trunk
trunk trunks of
Số lượng
(%) 60
Damage (%) (%)
patients)
1 0 0 1
Diarrhea
0,6 0 0 0,6
11 9 7 27
Swelling
6,1 5,0 3,9 15,0
Rupture in the 1 0 0 1
sheath 0,6 0 0 0,6
14 6 4 24
Rupture
4,7 3,3 2,2 13,3
35 46 50 131
No damage
19,4 25,6 27,8 72,8
Table 3.9. Cords injuries on the T2W image of horizontal cut
Total
Location Outside Inside Behind
(180 cords
cord cord cord
of 60
Damage (%) (%) (%)
patients)
21 20 22 63
Diarrhea
11,7 11,1 12,2 35,0
4 2 3 9
Rupture
2,2 1,1 1,7 5,0
1 0 0 1
Atrophy
0,6 0 0 0,6
34 38 35 107
No damage
18,9 21,1 19,4 59,4
10
3.2.5. Damage on T2W Vista Sense Photo Intersection
Table 3.10. Mycelo and root injuries on T2W Vista-Sense image
Total
Location (300
C5 C6 C7 C8 T1
roots of
(%) (%) (%) (%) (%)
Damage 60
patients)
1 2 1 0 0 4
spinal cord stenosis
0,3 0,7 0,3 0 0 1,3
Oedema from 4 4 2 1 0 11
preganglionic 1,3 1,3 0,7 0,3 0 3,7
7 10 14 11 6 48
Root avulsion
2,3 3,3 4,7 3,7 2,0 16,0
2 4 27 20 9 62
Pseudomeningocele
0,7 1,3 9,0 6,7 3,0 20,7
12 10 8 7 5 42
Swelling
4 3,4 1,6 2,4 1,7 14,0
Rupture in the 4 0 0 0 0 4
sheath 1,3 0 0 0 0 1,3
Incomplete 0 1 1 1 0 3
rupture 0 0,3 0,3 0,3 0 1,7
24 31 31 26 19 131
Rupture
8,0 10,3 10,3 8,7 6,3 43,7
14 10 10 19 30 83
No damage
4,7 3,3 3,3 6,3 10 27,7
Table 3.11. Trunk injuries on photos T2W Vista- Sense cut off
Total
Upper Middle
Lower (180
trunk trunk
Location trunk trunks of
Số lượng
Damage (%) 60
(%) (%)
patients)
1 0 0 1
Diarrhea
0,6 0 0 0,6
11 9 7 27
Swelling
6,1 5,0 3,9 15,0
Rupture in the 1 0 0 1
sheath 0,6 0 0 0,6
11
15 5 4 24
Rupture
8,3 2,8 2,2 13,3
34 47 50 131
No damage
18,9 26,1 27,8 72,8
Table 3.12. Cords injuries on the T2W Vista-Sense cut
Total
Location Outside Inside Behind (180
cord cord cord cords of
Damage (%) (%) (%) 60
patients)
21 20 22 63
Swelling
11,7 11,1 12,2 35,0
4 2 3 9
Rupture
2,2 1,1 1,7 5,0
1 0 0 1
Atrophy
0,6 0 0 0,6
34 38 35 107
No damage
18,9 21,1 19,4 59,4
3.2.6. Damage of Mycelo and root on mycelography
Table 3.13. Mycelo and root injuries on mycelography
Damage No damage Total
Locati
Amou percenta Amou percenta Amou percenta
on
nt ge nt ge nt ge
C5 2 3,3 58 96,7 60 100
C6 9 15,0 51 85,0 60 100
C7 27 45,0 33 55,0 60 100
C8 20 33,3 40 66,7 60 100
T1 9 15,0 51 85,0 60 100
Total 67 22,3 233 77,7 300 100
12
3.2.7. Damaged on image MIP
Table 3.14. Mycelo and root injury of brachial plexus on MIP
Total
Location (300
C5 C6 C7 C8 T1
roots of
(%) (%) (%) (%) (%)
Damage 60
patients)
7 10 14 10 5 46
Root avulsion
2,3 3,3 4,7 3,3 1,7 15,3
2 10 27 13 8 60
Pseudomeningocele
0,7 3,3 9,0 4,3 2,7 20,0
2 2 1 0 1 6
Diarrhea
0,7 0,7 0,3 0 0,3 2,3
6 4 3 3 2 18
Swelling
2,0 1,3 1,0 1,0 0,7 6,0
27 29 30 25 19 130
Rupture
9,0 9,7 10,0 8,3 6,3 43,3
18 15 12 22 32 99
No damage
6,0 5,0 4,0 7,3 10,7 33,0
Table 3.15. Trunk injuries on MIP image
Total
Upper Middle
Location Lower (180
trunk trunk
trunk trunks of
Số lượng
Damage (%) 60
(%) (%)
patients)
1 0 0 1
Diarrhea
0,6 0 0 0,6
6 4 3 13
Swelling
3,3 2,2 1,7 7,2
13 4 3 20
Rupture
7,2 2,2 1,7 11,1
41 53 55 149
No damage
22,8 29,4 30,6 82,8
13
Table 3.16. Cord injuries on MIP image
Total
Location Outside Inside Behind (180
cord cord cord cords of
Damage (%) (%) (%) 60
patients)
13 12 13 38
Swelling
7,2 6,7 7,2 21,1
4 2 3 9
Rupture
2,2 1,1 1,7 5,0
1 0 0 1
Atrophy
0,6 0 0 0,6
42 46 44 132
No damage
23,3 25,6 24,4 73,3
3.2.8. Damaged on MPR image
Table 3.17. Mycelo and root injuries of brachial plexus on MPR
image
Total
Location (300
C5 C6 C7 C8 T1
roots of
(%) (%) (%) (%) (%)
Damage 60
patients)
7 10 14 10 5 46
Root avulsion
2,3 3,3 4,7 3,3 1,7 15,3
2 9 27 19 8 65
Pseudomeningocele
0,7 3,0 9,0 6,3 2,7 21,7
2 2 1 0 1 6
Diarrhea
0,7 0,7 0,3 0 0,3 2,0
12 9 8 7 5 41
Swelling
4,0 3,0 2,7 2,3 1,7 13,7
Incomplete 0 1 1 1 0 3
rupture 0 0,3 0,3 0,3 0 1,0
26 29 30 26 19 130
Rupture
8,7 9,7 10,0 8,7 6,3 43,3
16 12 10 19 30 87
No damage
5,3 4,0 3,3 6,3 10,0 29,0
14
Table 3.18. Trunk injuries on MPR image
Total
Upper Middle
Lower (180
Location trunk trunk
trunk trunks of
Damage Số lượng
(%) 60
(%) (%)
patients)
1 0 0 1
Diarrhea
0,6 0 0 0,6
11 9 7 27
Swelling
6,1 5,0 3,9 15,0
15 5 4 24
Rupture
8,3 2,8 2,2 13,3
35 47 50 132
No damage
19,4 26,1 27,8 73,3
Table 3.19. Cord injury on MPR image
Total
Location Outside Inside Behind (180
cord cord cord cords of
Damage (%) (%) (%) 60
patients)
21 20 22 63
Swelling
11,7 11,1 12,2 35,0
4 2 3 9
Rupture
2,2 1,1 1,7 5,0
1 0 0 1
Atrophy
0,6 0 0 0,6
34 38 35 107
No damage
18,9 21,1 19,4 59,4
15
3.2.9. Damaged on 3D image
Table 3.20. Mycelo and root injuries of brachial plexus on 3D images
Total
Location (300
C5 C6 C7 C8 T1
roots of
(%) (%) (%) (%) (%)
Damage 60
patients)
7 10 13 9 5 44
Root avulsion
2,3 3,3 4,3 3,0 1,7 14,7
2 9 26 20 10 67
Pseudomeningocele
0,7 3,0 8,7 6,7 3,3 22,3
1 1 1 0 1 4
Diarrhea
0,3 0,3 0,3 0 0,3 1,3
11 8 7 7 5 38
Swelling
3,7 2,7 2,3 2,3 1,7 12,7
Rupture in the 1 0 0 0 0 1
sheath 0,3 0 0 0 0 0,3
Incomplete 0 0 1 1 0 2
rupture 0 0 0,3 0,3 0 0,7
26 31 30 26 19 132
Rupture
8,7 10,3 10,0 8,7 6,3 44,0
17 13 12 19 30 91
No damage
5,7 4,3 4,0 6,3 10,0 30,3
Table 3.21. Trunk injuries on 3D images
Total
Upper Middle
Lower (180
Location trunk trunk
trunk trunks of
Damage Số lượng
(%) 60
(%) (%)
patients)
9 7 6 22
Swelling
5,0 3,9 3,3 12,2
15 5 4 24
Rupture
8,3 2,8 2,2 13,3
38 49 51 138
No damage
21,1 27,2 28,3 76,7
16
Table 3.22. Cord injuries on 3D image
Total
Location Outside Inside Behind (180
cord cord cord cords of
Damage (%) (%) (%) 60
patients)
21 20 22 63
Swelling
11,7 11,1 12,2 35,0
4 1 2 7
Rupture
2,2 0,6 1,1 3,9
1 0 0 1
Atrophy
0,6 0 0 0,6
34 39 36 109
No damage
18,9 21,7 20,0 60,6
3.2.10. Brachial plexus injury on the root, trunk and cord on MRI
Table 3.23. Position of myocardial and Root injury of brachial plexus
on MRI
Damage No damage Total
Locati
Amou percenta Amou percenta Amou percenta
on
nt ge nt ge nt ge
C5 46 76,6 14 23,4 60 100
C6 49 81,6 11 18,4 60 100
C7 51 85,0 9 15,0 60 100
C8 43 76,2 17 28,3 60 100
T1 31 51,7 29 48,3 60 100
Total 220 73,33 80 26,67 300 100
Table 3.24. Position of trunk injury of brachial plexus on MRI
Damage No damage Total
Locati
Amou percenta Amou percenta Amou percenta
on
nt ge nt ge nt ge
Upper 18 30,0 42 70,0 60 100
Middle 12 20,0 48 80,0 60 100
Lower 13 21,7 47 78,3 60 100
Total 43 23,9 137 76,1 180 100
17
Table 3.25. Position of bord injury of brachial plexus on MRI
Damage No damage Total
Locati
Amou percenta Amou percenta Amou percenta
on
nt ge nt ge nt ge
Outside 26 43,3 34 56,7 60 100
Inside 21 35,0 39 65,0 60 100
Behind 25 41,7 35 58,3 60 100
Total 72 40,0 108 60,0 180 100
3.2.11. Image of brachial plexus injury on MRI
Table 3.26. Mycelo and root injury of brachial plexus on MRI
Total
Location (300
C5 C6 C7 C8 T1
roots of
(%) (%) (%) (%) (%)
Damage 60
patients)
1 2 1 0 0 4
Spinal cord stenosis
0,3 0,7 0,3 0 0 1,3
Oedema from 4 4 2 1 0 11
preganglionic 1,3 1,3 0,7 0,3 0 3,7
7 10 14 11 6 48
Root avulsion
2,3 3,3 4,7 3,7 10 16,0
2 10 26 20 9 67
Pseudomeningocele
0,7 3,3 8,7 6,7 3,0 22,3
2 2 1 0 1 6
Diarrhea
0,7 0,7 0,3 0 0,3 2,0
12 10 8 7 5 42
Swelling
4,0 3,3 2,7 2,3 1,7 14,0
Rupture in the 1 0 0 0 0 1
sheath 0,3 0 0 0 0 0,3
Incomplete 0 1 1 1 0 3
rupture 0 0,3 0,3 0,3 0 1,0
27 31 31 26 19 134
Rupture
8,7 10,3 10,3 8,7 6,3 44,7
14 10 11 19 30 84
No damage
4,7 3,3 3,7 6,3 10,0 28,0
18
Table 3.27. Trunk injury of brachial plexus on MRI
Total
Upper Middle
Lower (180
trunk trunk
Location trunk trunks of
Số lượng
Damage (%) 60
(%) (%)
patients)
1 0 0 1
Diarrhea
0,6 0 0 0,6
11 9 7 27
Swelling
6,1 5,0 3,9 15,0
Rupture in the 1 0 0 1
sheath 0,6 0 0 0,6
15 5 4 24
Rupture
8,3 2,8 2,2 13,3
No damage 34 47 50 131
18,9 26,1 27,8 72,8
Table 3.28. Cord injury of brachial plexus on MRI
Total
Location Outside Inside Behind (180
cord cord cord cords of
Damage (%) (%) (%) 60
patients)
21 20 22 63
Swelling
11,7 11,1 12,2 35,0
4 2 3 9
Rupture
2,2 1,1 1,7 5,0
1 0 0 1
Atrophy
0,6 0 0 0,6
34 38 35 107
No damage
18,9 21,1 19,4 59,4
3.3. The value of MRI on the diagnosis of traumatic brachial plexus
injury
3.3.1. Diagnosis of traumatic brachial plexus injury by surgeon
SCIENTIFIC RESEARCH INSTITUTE OF CLINICAL
MEDICINE 108
NGUYEN NGOC TRUNG
RESEARCH ON VISUAL CHARACTERISTICS AND
VALUE OF MRI IN THE DIAGNOSIS OF
TRAUMATIC BRACHIAL PLEXUS INJURY
Specialisation: Image Diagnostics
Code: 62.72.01.66
SUMMARY OF THE DISSERTATION OF MEDICINE
HA NOI - 2019
THE DISSERTATION WAS ACCOMPLISHER
SCIENTIFIC RESEARCH INSTITUTE OF CLINICAL MEDICINE 108
Supervisors:
1. Lam Khanh, Associate Professor, Doctor
2. Tran Van Riep, Associate Professor, Doctor
Reviewer 1:
Reviewe 2:
Reviewe 3:
The dissertation defence before the Institutional Board takes
place at....
Scienifically archived at:
1. National library
2. Scientific Research Institute of Clinical Medicine 108
1
INTRODUCTION
Brachial plexus occurs when one or more nerve roots are removed
from the spinal cord at the base, or the nerves are stretched, cut, collapsed,
inserted. squeezing ... out of the hole. Brachial plexus injuries due to
traumatic injury tend to increase, mainly due to traffic accidents.
Worldwide studies such as Oliveira CM (2015), Jain DK (2012) all
confirmed the main cause of traffic accidents (78.7 and 94%). In Vietnam,
according to NC of Ho Huu Luong (1992), the incidence of neck spine
injuries was high (60-70%). According to Le Van Doan (2013), Brachial
plexus injuries due to traumatic injuries are not rare and the main cause
is traffic accidents.
In the world and in Vietnam, there have been some researches of
MRI of brachial plexus injuries due to traumatic injury. However, these
studies do not have a multifaceted assessment of injury due to disease
limitation. Based on the above situation, we conducted a study entitled
"Research on visual characteristics and value of MRI in the diagnostic of
traumatic brachial plexus injury" with two objectives:
1. Characterization of imaging of brachial plexus injuries due to
traumatic injury on 3 Tesla MRI.
2. Determine the value of the 3 Tesla MRI in Diagnosis of brachial
plexus injuries versus surgery.
Dessertation novelty: The study is the first one in Vietnam to
apply 3 Telsa MRI in the evaluation of traumatic brachial plexus injury.
Contribution to Image Diagnostics: A new diagnostic technique
is developed.
Contribution to Treatment: The study assesses systematic
brachial plexus injury and simultaneously indicates the correlation
between clinic and image diagnostics, thus assisting clinical practitioners
in the determination of an appropriate treatment policy to recover
effectively the patients’ functions.
Thesis structure
The dissertation consists of 124 pages: Question 2 pages, overview
36 pages; Subject and methodology 15 pages; Results 31 pages;
Comment 37 pages; Conclusion 2 pages; Recommendation: 1 page. The
thesis consists of 41 tables, 45 figures, 7 graphs, 119 references
(Vietnamese: 18; 101)
2
Chapter 1
OVERVIEW DOCUMENT
1.1. The role of MRI in the diagnosis of brachial plexus injuries
MRI is a visualization method based on the principle of putting
the body into a strong magnetic field to synchronize the direction of
motion of the hydrogen atoms in the water molecules and then use a radio
frequency antenna Low to activate the tissues in the body, hydrogen
atoms will resonate and emit signals. In the magnetically stable magnetic
field, the radio frequency will vary according to the purpose of the survey,
the target group of the various organs (parenchyma, muscle, fat, water,
blood vessels, etc.). The emitted signal is picked up by the antenna and
transmitted to the signal processing computer and the control computer,
whereby the image of the body structure is displayed.
With the new high-powered MRI camera, the Gyroscan Achieva 3 Tesla
from Phillips (The Netherlands), uses T2W of Vista Sense with the help
of 3D rendering and rendering software, the root, stem, bundle, and part
of the branches are separated, while separating the rotifer with other
complex structures in the neck.
1.2. Situation of MRI in diagnosis of traumatic brachial plexus injury
Early in the world, there were some researches related MRI
traumatic brachial plexus injury, namely Blair DN et al (1987), Bilbey JH
et al (1994). Authors Cejas DC (2015) and Fan YL (2016) conclude that
MRI is a useful supplement to clinical diagnosis, helping to select the best
course of treatment for patients.
In Vietnam, as we know, only a few published results of the
group of authors of 108 Military Central Hospital, namely Dinh Hoang
Long (2012) concluded that MRI and surgical outcome were highly
relevant (80.6%) after comparisons.
Chapter 2
OBJECTIVES AND RESEARCH METHODS
2.1. Research subjects and methods
The study was conducted on 60 patients who were examined
and treated at the 108 Military Central Hospital from January 2012 to
December 2014.
3
2.1.1. Standard selection
- Patients with a history of trauma, traumatic events with paralysis or
paralysis and clinical examination and determination of lesions and
symptoms of MRI Tesla 3.
- Being treated for traumatic brachial plexus injury at the Military
Orthopedic Trauma Institute, 108 Military Central Hospital and a surgery
document describing the lesions of traumatic brachial plexus injury
according to the medical records of this study.
2.1.2. Exclusion criteria
Patients who is suffering from traumatic brain injury, but not
due to traumatic injury, but due to medical disease, multiple injuries.
Patients who do not agree to participate in this study. Patients who are not
recorded in the medical records.
2.1.3. Sample size
p(1 p)
n Z2(1 / 2)
2
Instead of the formula we have n = 48 patients.
2.2. Research Methods
A prospective, cross-sectional descriptive study comparing the
diagnosis of brachial plexus injuries on MRI 3 Tesla befor surgery with
postoperative diagnosis.
2.2.2. Research content
2.2.2.1. General characteristics of brachial plexus injuries: Age,
gender, causes of injury, combined injury, place of injury, time from
illness to imaging, duration from illness to surgery.
2.2.2.2. Image of brachial plexus injuries on MRI
In combination with the diagnostic criteria of some authors, we
propose to investigate 10 signs of brachial plexus injuries on MRI 3 Tesla
as follows: spinal cord stenosis, oedema from preganglionic, root
avulsion, pseudomeningocele, diarrhea (root, trunk, cords), swelling
(root, trunk, cords), Rupture in the sheath (root, trunk, cords),
Incomplete rupture, rupture (root, trunk, cords), atrophy
- The above-mentioned brachial plexus injuries are described
in the following positions: divided by anatomy and T1W vertical, T2W
longitudinal, T2W horizontal, T2-weighted, T2-weighted, T2-weighted,
myelography ), MIP and 3D
- Location of marrow and root, trunk, cords on all MRI
4
2.2.2.3. Results diagnosis of surgeon
- Results of root, trunk and cords according to the surgeon: root avulsion
(including pseudomeningocele), rupture (root, trunk, cords)
2.2.2.4. Comparing the diagnosis of MRI with surgery based on two
signs: root avulsion (including pseudomeningocele), rupture (root, trunk,
cords)
2.2.3. Tools
MRI Gyroscan Achieva 3 Tesla camera from Phillips
(Netherlands) located in the Department of Diagnostic Imaging, 108
Hospital with coil NeuroVascular NV-16.
2.2.5. Image and data processing
- Patients' MRI images are stored as DICOM 3.0 and PNG images. The
images are based on the Vista sense software from Phillips (The
Netherlands).
MRI readings are saved as Word files. Statistical data is stored in a
computer in Excel format and then processed using SPSS 16.0.
- The algorithms used in the study: Statistics describing the frequency of
occurrence of signs of brachial plexus injuries (10 signs) by absolute
number and percentage on each type of pulse and section to find out Rules
related to position, number, level of injury, injury mechanism and the
advantages of each type of image. Compare the results of the diagnosis
of MRI brachial plexus injuries with results in surgery. Calculate the
suitability, sensitivity, specificity of CHT in the diagnosis of localization,
the number of lesions compared with the diagnosis of surgeon.
5
Study map
6
Chapter 3
RESEARCH RESULTS
3.1. General characteristics of patients with brachial plexus injuries
- Brachial plexus injuries is mainly in young and in men: mean age 28.8
± 11.8 years, male / female = 29.
- Causes of brachial plexus injuries are mainly caused by traffic accidents,
accounting for 76.7%. the left brachial plexus injuries > right. Most are
without combined lessions (88.3%).
- The majority of patients (43.3%) were given MRI for a period of 30 -
<90 days after injury. 43.4% of patients underwent surgery during 90 -
<180 days (3-6 months) after injury.
3.2. Picture of resonance from traumatic Brachial plexus injuries
3.2.1. Damage on T1W images
Table 3.2. Change the spinal curve
Patient Percentage
Number
symptom (%)
Loss natural spinal curve 3 5,0
No change 57 95,0
Vertebral body injury 0 0,0
Total 60 100
3.2.2. Damage on T2W vertical image
Table 3.3. Myelo and root injuries on T2W images
C5 C6 C7 C8 T1
Location
(%) (%) (%) (%) (%)
Damage
1 2 1 0 0
Spinal cord stenosis
1,7 3,3 1,7 0 0
Oedema from 4 4 2 1 0
preganglionic 6,6 6,6 3,3 1,7 0
2 10 26 19 9
Pseudomeningocele
3,3 16,7 43,3 31,7 15,0
54 44 31 40 51
No damage
90,0 73,3 51,7 66,7 85,0
7
3.2.3. Damage on T2W intraocular image
Table 3.4. Myelo and root injuries of brachial plexus on the
horizontal T2W image
Total
C5 C6 C7 C8 T1 (300
Location
root of
Damage
(%) (%) (%) (%) (%) 60
patients)
0 0 1 0 0 1
Spinal cord stenosis
0 0 0,3 0 0 0,3
Oedema from 4 0 2 1 0 7
preganglionic 1,3 0 0,7 0,3 0 2,3
7 10 14 11 6 48
Root avulsion
2,3 3,3 4,7 3,7 2,0 16,0
3 9 27 20 9 68
Pseudomeningocele
1,0 3,0 9,0 6,7 3,0 22,7
2 2 1 0 1 6
Diarrhea
0,7 0,7 0,3 0 0,3 2,0
12 10 8 7 5 42
Swelling
4,0 3,4 2,7 2,4 1,7 14,2
Rupture in the 1 0 0 0 0 1
sheath 0,3 0 0 0 0 0,3
Incomplete 0 0 1 1 0 2
rupture 0 0 0,3 0,3 0 0,7
27 31 31 26 19 134
Rupture
9,0 10,3 10,3 8,7 6,3 44,7
14 11 10 19 30 84
No damage
4,7 3,7 3,3 6,3 10 28,0
Table 3.5. Trunk injury on T2W horizontal
Total
Upper Middle
Lower (180
Location trunk trunk
trunk trunks of
Số lượng
(%) 60
Damage (%) (%)
patients)
1 0 0 1
Diarrhea
0,6 0 0 0,6
8
11 9 7 27
Swelling
6,1 5 3,9 15,0
Rupture in the 1 0 0 1
sheath 0,6 0 0 0,6
14 5 4 23
Rupture
7,8 2,8 2,2 12,8
35 47 50 132
No damage
19,4 26,1 27,8 73,3
Table 3.6. Cord Injuries of brachial plexus on T2W images
Total
Location Outside Inside Behind (180
cord cord cord cords of
(%) (%) (%) 60
Damage patients)
Spinal cord 21 20 22 63
stenosis 11,7 11,1 12,2 35,0
4 2 3 9
Rupture
2,2 1,1 1,7 5,0
1 0 0 1
Atrophy
0,6 0 0 0,6
34 38 35 107
No damage 18,9 21,1 19,4 59,4
3.2.4. Damage on T2W horizontal line image
Table 3.7. Myelo and root injuries on T2W horizontal line image
Total
Location
(300
C5 C6 C7 C8 T1
roots of
(%) (%) (%) (%) (%)
60
Damage
patients)
1 1 0 0 0 2
Spinal cord stenosis
0,3 0,3 0 0 0 0,7
7 10 14 11 6 48
Root avulsion
2,3 3,3 4,7 3,7 2 16,0
2 9 27 20 9 67
Pseudomeningocele
0,7 3,0 9,0 6,7 3,0 22,3
2 2 1 0 1 6
Diarrhea
0,7 0,7 0,3 0 0,3 2,0
9
12 9 8 7 5 41
Swelling
4,0 3,0 2,7 2,3 1,7 13,7
Incomplete 0 1 1 1 0 3
rupture 0 0,3 0,3 0,3 0 1,0
27 30 31 26 19 133
Rupture
9,0 10,0 10,3 8,7 6,3 44,3
15 12 10 19 30 86
No damage
5,0 4,0 3,3 6,3 10,0 28,7
Table 3.8. Trunk injuries on the T2W images cut horizontal
Total
Upper Middle
Lower (180
Location trunk trunk
trunk trunks of
Số lượng
(%) 60
Damage (%) (%)
patients)
1 0 0 1
Diarrhea
0,6 0 0 0,6
11 9 7 27
Swelling
6,1 5,0 3,9 15,0
Rupture in the 1 0 0 1
sheath 0,6 0 0 0,6
14 6 4 24
Rupture
4,7 3,3 2,2 13,3
35 46 50 131
No damage
19,4 25,6 27,8 72,8
Table 3.9. Cords injuries on the T2W image of horizontal cut
Total
Location Outside Inside Behind
(180 cords
cord cord cord
of 60
Damage (%) (%) (%)
patients)
21 20 22 63
Diarrhea
11,7 11,1 12,2 35,0
4 2 3 9
Rupture
2,2 1,1 1,7 5,0
1 0 0 1
Atrophy
0,6 0 0 0,6
34 38 35 107
No damage
18,9 21,1 19,4 59,4
10
3.2.5. Damage on T2W Vista Sense Photo Intersection
Table 3.10. Mycelo and root injuries on T2W Vista-Sense image
Total
Location (300
C5 C6 C7 C8 T1
roots of
(%) (%) (%) (%) (%)
Damage 60
patients)
1 2 1 0 0 4
spinal cord stenosis
0,3 0,7 0,3 0 0 1,3
Oedema from 4 4 2 1 0 11
preganglionic 1,3 1,3 0,7 0,3 0 3,7
7 10 14 11 6 48
Root avulsion
2,3 3,3 4,7 3,7 2,0 16,0
2 4 27 20 9 62
Pseudomeningocele
0,7 1,3 9,0 6,7 3,0 20,7
12 10 8 7 5 42
Swelling
4 3,4 1,6 2,4 1,7 14,0
Rupture in the 4 0 0 0 0 4
sheath 1,3 0 0 0 0 1,3
Incomplete 0 1 1 1 0 3
rupture 0 0,3 0,3 0,3 0 1,7
24 31 31 26 19 131
Rupture
8,0 10,3 10,3 8,7 6,3 43,7
14 10 10 19 30 83
No damage
4,7 3,3 3,3 6,3 10 27,7
Table 3.11. Trunk injuries on photos T2W Vista- Sense cut off
Total
Upper Middle
Lower (180
trunk trunk
Location trunk trunks of
Số lượng
Damage (%) 60
(%) (%)
patients)
1 0 0 1
Diarrhea
0,6 0 0 0,6
11 9 7 27
Swelling
6,1 5,0 3,9 15,0
Rupture in the 1 0 0 1
sheath 0,6 0 0 0,6
11
15 5 4 24
Rupture
8,3 2,8 2,2 13,3
34 47 50 131
No damage
18,9 26,1 27,8 72,8
Table 3.12. Cords injuries on the T2W Vista-Sense cut
Total
Location Outside Inside Behind (180
cord cord cord cords of
Damage (%) (%) (%) 60
patients)
21 20 22 63
Swelling
11,7 11,1 12,2 35,0
4 2 3 9
Rupture
2,2 1,1 1,7 5,0
1 0 0 1
Atrophy
0,6 0 0 0,6
34 38 35 107
No damage
18,9 21,1 19,4 59,4
3.2.6. Damage of Mycelo and root on mycelography
Table 3.13. Mycelo and root injuries on mycelography
Damage No damage Total
Locati
Amou percenta Amou percenta Amou percenta
on
nt ge nt ge nt ge
C5 2 3,3 58 96,7 60 100
C6 9 15,0 51 85,0 60 100
C7 27 45,0 33 55,0 60 100
C8 20 33,3 40 66,7 60 100
T1 9 15,0 51 85,0 60 100
Total 67 22,3 233 77,7 300 100
12
3.2.7. Damaged on image MIP
Table 3.14. Mycelo and root injury of brachial plexus on MIP
Total
Location (300
C5 C6 C7 C8 T1
roots of
(%) (%) (%) (%) (%)
Damage 60
patients)
7 10 14 10 5 46
Root avulsion
2,3 3,3 4,7 3,3 1,7 15,3
2 10 27 13 8 60
Pseudomeningocele
0,7 3,3 9,0 4,3 2,7 20,0
2 2 1 0 1 6
Diarrhea
0,7 0,7 0,3 0 0,3 2,3
6 4 3 3 2 18
Swelling
2,0 1,3 1,0 1,0 0,7 6,0
27 29 30 25 19 130
Rupture
9,0 9,7 10,0 8,3 6,3 43,3
18 15 12 22 32 99
No damage
6,0 5,0 4,0 7,3 10,7 33,0
Table 3.15. Trunk injuries on MIP image
Total
Upper Middle
Location Lower (180
trunk trunk
trunk trunks of
Số lượng
Damage (%) 60
(%) (%)
patients)
1 0 0 1
Diarrhea
0,6 0 0 0,6
6 4 3 13
Swelling
3,3 2,2 1,7 7,2
13 4 3 20
Rupture
7,2 2,2 1,7 11,1
41 53 55 149
No damage
22,8 29,4 30,6 82,8
13
Table 3.16. Cord injuries on MIP image
Total
Location Outside Inside Behind (180
cord cord cord cords of
Damage (%) (%) (%) 60
patients)
13 12 13 38
Swelling
7,2 6,7 7,2 21,1
4 2 3 9
Rupture
2,2 1,1 1,7 5,0
1 0 0 1
Atrophy
0,6 0 0 0,6
42 46 44 132
No damage
23,3 25,6 24,4 73,3
3.2.8. Damaged on MPR image
Table 3.17. Mycelo and root injuries of brachial plexus on MPR
image
Total
Location (300
C5 C6 C7 C8 T1
roots of
(%) (%) (%) (%) (%)
Damage 60
patients)
7 10 14 10 5 46
Root avulsion
2,3 3,3 4,7 3,3 1,7 15,3
2 9 27 19 8 65
Pseudomeningocele
0,7 3,0 9,0 6,3 2,7 21,7
2 2 1 0 1 6
Diarrhea
0,7 0,7 0,3 0 0,3 2,0
12 9 8 7 5 41
Swelling
4,0 3,0 2,7 2,3 1,7 13,7
Incomplete 0 1 1 1 0 3
rupture 0 0,3 0,3 0,3 0 1,0
26 29 30 26 19 130
Rupture
8,7 9,7 10,0 8,7 6,3 43,3
16 12 10 19 30 87
No damage
5,3 4,0 3,3 6,3 10,0 29,0
14
Table 3.18. Trunk injuries on MPR image
Total
Upper Middle
Lower (180
Location trunk trunk
trunk trunks of
Damage Số lượng
(%) 60
(%) (%)
patients)
1 0 0 1
Diarrhea
0,6 0 0 0,6
11 9 7 27
Swelling
6,1 5,0 3,9 15,0
15 5 4 24
Rupture
8,3 2,8 2,2 13,3
35 47 50 132
No damage
19,4 26,1 27,8 73,3
Table 3.19. Cord injury on MPR image
Total
Location Outside Inside Behind (180
cord cord cord cords of
Damage (%) (%) (%) 60
patients)
21 20 22 63
Swelling
11,7 11,1 12,2 35,0
4 2 3 9
Rupture
2,2 1,1 1,7 5,0
1 0 0 1
Atrophy
0,6 0 0 0,6
34 38 35 107
No damage
18,9 21,1 19,4 59,4
15
3.2.9. Damaged on 3D image
Table 3.20. Mycelo and root injuries of brachial plexus on 3D images
Total
Location (300
C5 C6 C7 C8 T1
roots of
(%) (%) (%) (%) (%)
Damage 60
patients)
7 10 13 9 5 44
Root avulsion
2,3 3,3 4,3 3,0 1,7 14,7
2 9 26 20 10 67
Pseudomeningocele
0,7 3,0 8,7 6,7 3,3 22,3
1 1 1 0 1 4
Diarrhea
0,3 0,3 0,3 0 0,3 1,3
11 8 7 7 5 38
Swelling
3,7 2,7 2,3 2,3 1,7 12,7
Rupture in the 1 0 0 0 0 1
sheath 0,3 0 0 0 0 0,3
Incomplete 0 0 1 1 0 2
rupture 0 0 0,3 0,3 0 0,7
26 31 30 26 19 132
Rupture
8,7 10,3 10,0 8,7 6,3 44,0
17 13 12 19 30 91
No damage
5,7 4,3 4,0 6,3 10,0 30,3
Table 3.21. Trunk injuries on 3D images
Total
Upper Middle
Lower (180
Location trunk trunk
trunk trunks of
Damage Số lượng
(%) 60
(%) (%)
patients)
9 7 6 22
Swelling
5,0 3,9 3,3 12,2
15 5 4 24
Rupture
8,3 2,8 2,2 13,3
38 49 51 138
No damage
21,1 27,2 28,3 76,7
16
Table 3.22. Cord injuries on 3D image
Total
Location Outside Inside Behind (180
cord cord cord cords of
Damage (%) (%) (%) 60
patients)
21 20 22 63
Swelling
11,7 11,1 12,2 35,0
4 1 2 7
Rupture
2,2 0,6 1,1 3,9
1 0 0 1
Atrophy
0,6 0 0 0,6
34 39 36 109
No damage
18,9 21,7 20,0 60,6
3.2.10. Brachial plexus injury on the root, trunk and cord on MRI
Table 3.23. Position of myocardial and Root injury of brachial plexus
on MRI
Damage No damage Total
Locati
Amou percenta Amou percenta Amou percenta
on
nt ge nt ge nt ge
C5 46 76,6 14 23,4 60 100
C6 49 81,6 11 18,4 60 100
C7 51 85,0 9 15,0 60 100
C8 43 76,2 17 28,3 60 100
T1 31 51,7 29 48,3 60 100
Total 220 73,33 80 26,67 300 100
Table 3.24. Position of trunk injury of brachial plexus on MRI
Damage No damage Total
Locati
Amou percenta Amou percenta Amou percenta
on
nt ge nt ge nt ge
Upper 18 30,0 42 70,0 60 100
Middle 12 20,0 48 80,0 60 100
Lower 13 21,7 47 78,3 60 100
Total 43 23,9 137 76,1 180 100
17
Table 3.25. Position of bord injury of brachial plexus on MRI
Damage No damage Total
Locati
Amou percenta Amou percenta Amou percenta
on
nt ge nt ge nt ge
Outside 26 43,3 34 56,7 60 100
Inside 21 35,0 39 65,0 60 100
Behind 25 41,7 35 58,3 60 100
Total 72 40,0 108 60,0 180 100
3.2.11. Image of brachial plexus injury on MRI
Table 3.26. Mycelo and root injury of brachial plexus on MRI
Total
Location (300
C5 C6 C7 C8 T1
roots of
(%) (%) (%) (%) (%)
Damage 60
patients)
1 2 1 0 0 4
Spinal cord stenosis
0,3 0,7 0,3 0 0 1,3
Oedema from 4 4 2 1 0 11
preganglionic 1,3 1,3 0,7 0,3 0 3,7
7 10 14 11 6 48
Root avulsion
2,3 3,3 4,7 3,7 10 16,0
2 10 26 20 9 67
Pseudomeningocele
0,7 3,3 8,7 6,7 3,0 22,3
2 2 1 0 1 6
Diarrhea
0,7 0,7 0,3 0 0,3 2,0
12 10 8 7 5 42
Swelling
4,0 3,3 2,7 2,3 1,7 14,0
Rupture in the 1 0 0 0 0 1
sheath 0,3 0 0 0 0 0,3
Incomplete 0 1 1 1 0 3
rupture 0 0,3 0,3 0,3 0 1,0
27 31 31 26 19 134
Rupture
8,7 10,3 10,3 8,7 6,3 44,7
14 10 11 19 30 84
No damage
4,7 3,3 3,7 6,3 10,0 28,0
18
Table 3.27. Trunk injury of brachial plexus on MRI
Total
Upper Middle
Lower (180
trunk trunk
Location trunk trunks of
Số lượng
Damage (%) 60
(%) (%)
patients)
1 0 0 1
Diarrhea
0,6 0 0 0,6
11 9 7 27
Swelling
6,1 5,0 3,9 15,0
Rupture in the 1 0 0 1
sheath 0,6 0 0 0,6
15 5 4 24
Rupture
8,3 2,8 2,2 13,3
No damage 34 47 50 131
18,9 26,1 27,8 72,8
Table 3.28. Cord injury of brachial plexus on MRI
Total
Location Outside Inside Behind (180
cord cord cord cords of
Damage (%) (%) (%) 60
patients)
21 20 22 63
Swelling
11,7 11,1 12,2 35,0
4 2 3 9
Rupture
2,2 1,1 1,7 5,0
1 0 0 1
Atrophy
0,6 0 0 0,6
34 38 35 107
No damage
18,9 21,1 19,4 59,4
3.3. The value of MRI on the diagnosis of traumatic brachial plexus
injury
3.3.1. Diagnosis of traumatic brachial plexus injury by surgeon