Magnetic Resonance Imaging (MRI) Features and Diagnostic Accuracy in Pediatric Brachial Plexus Neuropathy: A Retrospective Analysis

Abstract

Background: Brachial plexus neuropathy is a common and frequently occurring disease that may present with upper limb numbness and dysfunction, leading to a high disability rate. Objectives: To analyze the magnetic resonance imaging (MRI) features of brachial plexus neuropathy in children. Methods: This study included 60 children who underwent MRI of the brachial plexus at our hospital from July 2019 to May 2024. The MRI scans included axial T1WI and T2WI sequences, axial and coronal T2-STIR sequences, and coronal 3D-FIESTA sequences. The imaging results were analyzed to identify features of brachial plexus neuropathy. Results: In this study, all 60 children underwent MRI of the brachial plexus. It was found that 34 (56.67%) cases were diagnosed as brachial plexus nerve injury via imaging, including 12 (20.00%) cases on the left side, 18 (30.00%) cases on the right side, and 4 (6.67%) cases on both sides. The imaging diagnoses were consistent with the clinical diagnoses in 32 cases and inconsistent in 2 cases. Meanwhile, 4 (6.67%) cases were diagnosed as other types of brachial plexus neuropathy, including 1 (1.67%) case of neurofibroma, 2 (3.33%) cases of neurosheathoma on the left side, and 1 (1.67%) case of right radicular sleeve cyst. The results were consistent with the clinical diagnoses in 3 cases and inconsistent in 1 case. Additionally, 7 (11.67%) cases were diagnosed as non-brachial plexus neuropathy, while 15 (25.00%) cases showed no obvious abnormality of the brachial plexus nerve. The sensitivity, specificity, and positive/negative predictive values were 100.00% (14/14), 78.95% (15/19), 91.11% (41/45), and 100.00% (15/15), respectively. The imaging features of brachial plexus nerve injury included thickening and thinning of nerve roots, high signals on T2 fat-suppression sequences, small cystic low signals at the level of the intervertebral foramen, cystic dilatation of nerve roots, formation of spinal cysts, and irregularly shaped long T1 and T2 signals at the C6 intervertebral foramen. The imaging features of neurofibroma included spike-shaped isometric T1 and T2 signals in the cervical soft tissues and high signals on T2 fat-suppression sequences, with relatively homogeneous signals, a clear boundary, and an irregular morphology of the lesion wrapping around the brachial plexus nerve. Additionally, the imaging features of neurosheathoma included space-occupying lesions, predominantly oval-shaped isometric T1 and slightly longer T2 signals, located at the lateral upper edge of the thorax, the lower part of the posterior clavicle, and the left side of the brachial plexus. Conclusions: The MRI can effectively show the location, range, and type of lesions, providing a valuable imaging reference for the early diagnosis and treatment of brachial plexus neuropathy in children.