Nghiên cứu đặc điểm hình ảnh và giá trị của cộng hưởng từ trong chẩn đoán tổn thương đám rối thần kinh cánh tay do chấn thương tt tiếng anh

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

Number

Percentage

(%)

Loss natural spinal curve
No change

3
57

5,0
95,0

Vertebral body injury

0

0,0

symptom

Total
60
3.2.2. Damage on T2W vertical image
Table 3.3. Myelo and root injuries on T2W images
Location
Damage
Spinal cord stenosis
Oedema from
preganglionic
Pseudomeningocele
No damage

100

C5
(%)

C6
(%)

C7
(%)

C8
(%)

T1
(%)

1
1,7
4
6,6
2
3,3
54
90,0

2
3,3
4

6,6
10
16,7
44
73,3

1
1,7
2
3,3
26
43,3
31
51,7

0
0
1
1,7
19
31,7
40
66,7

0
0
0
0
9
15,0

51
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
0
0
0,3
0,3
0
0,7
rupture
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
6,1
5
3,9
Rupture in the
1
0
0
sheath
0,6
0
0
14
5
4
Rupture
7,8
2,8
2,2

35
47
50
No damage
19,4
26,1
27,8
Table 3.6. Cord Injuries of brachial plexus on T2W images
Swelling

Location
Damage
Spinal
stenosis
Rupture
Atrophy
No damage

cord

Outside
cord
(%)

Inside
cord
(%)

Behind
cord

(%)

21
11,7
4
2,2
1
0,6
34
18,9

20
11,1
2
1,1
0
0
38
21,1

22
12,2
3
1,7
0
0
35
19,4

27

15,0
1
0,6
23
12,8
132
73,3

Total
(180
cords of
60
patients)
63
35,0
9
5,0
1
0,6
107
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
4,0
3,0
2,7
2,3
1,7
0
1
1
1
0
Incomplete
0
0,3
0,3
0,3
0
rupture
27

30
31
26
19
Rupture
9,0
10,0 10,3
8,7
6,3
15
12
10
19
30
No damage
5,0
4,0
3,3
6,3
10,0
Table 3.8. Trunk injuries on the T2W images cut horizontal
Swelling

41
13,7
3
1,0
133
44,3
86

28,7

Total
(180
Location
trunks of
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
Upper
trunk

Middle
trunk
Số lượng
(%)

Lower
trunk
(%)

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
0
1
1
1
0
Incomplete
3
0
0,3
0,3
0,3
0
1,7
rupture
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

Rupture
No damage

15
8,3
34
18,9

5
2,8
47
26,1

4
2,2
50
27,8

24

13,3
131
72,8

Table 3.12. Cords injuries on the T2W Vista-Sense cut
Location
Damage
Swelling
Rupture
Atrophy
No damage

Outside
cord
(%)

Inside
cord
(%)

Behind
cord
(%)

21
11,7
4
2,2
1
0,6

34
18,9

20
11,1
2
1,1
0
0
38
21,1

22
12,2
3
1,7
0
0
35
19,4

Total
(180
cords of
60
patients)
63
35,0
9
5,0

1
0,6
107
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
Location
Damage
Diarrhea
Swelling
Rupture
No damage

Upper
trunk
(%)

Middle
trunk
Số lượng
(%)

Lower

trunk
(%)

1
0,6
6
3,3
13
7,2
41
22,8

0
0
4
2,2
4
2,2
53
29,4

0
0
3
1,7
3
1,7
55
30,6

Total
(180
trunks of
60
patients)
1
0,6
13
7,2
20
11,1
149
82,8


13

Table 3.16. Cord injuries on MIP image
Location
Damage
Swelling
Rupture
Atrophy
No damage

Outside
cord
(%)

Inside

cord
(%)

Behind
cord
(%)

13
7,2
4
2,2
1
0,6
42
23,3

12
6,7
2
1,1
0
0
46
25,6

13
7,2
3
1,7
0

0
44
24,4

Total
(180
cords of
60
patients)
38
21,1
9
5,0
1
0,6
132
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

0
1
1
1
0
Incomplete
3
0
0,3
0,3
0,3
0
1,0
rupture
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
Location
Damage

Diarrhea
Swelling
Rupture
No damage

Upper
trunk
(%)

Middle
trunk
Số lượng

(%)

Lower
trunk
(%)

1
0,6
11
6,1
15
8,3
35
19,4

0
0
9
5,0
5
2,8
47
26,1

0
0
7
3,9
4
2,2

50
27,8

Total
(180
trunks of
60
patients)
1
0,6
27
15,0
24
13,3
132
73,3

Table 3.19. Cord injury on MPR image
Location
Damage
Swelling
Rupture
Atrophy
No damage

Outside
cord
(%)

Inside

cord
(%)

Behind
cord
(%)

21
11,7
4
2,2
1
0,6
34
18,9

20
11,1
2
1,1
0
0
38
21,1

22
12,2
3
1,7
0

0
35
19,4

Total
(180
cords of
60
patients)
63
35,0
9
5,0
1
0,6
107
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
0
0
1
1
0
Incomplete
2
0
0
0,3
0,3
0
0,7
rupture

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
Location

Upper

trunk
(%)

Middle
trunk
Số lượng
(%)

Lower
trunk
(%)

9
5,0
15
8,3
38
21,1

7
3,9
5
2,8
49
27,2

6
3,3
4
2,2

51
28,3

Damage

Swelling
Rupture
No damage

Total
(180
trunks of
60
patients)
22
12,2
24
13,3
138
76,7


16

Table 3.22. Cord injuries on 3D image
Location
Damage
Swelling
Rupture
Atrophy

No damage

Outside
cord
(%)

Inside
cord
(%)

Behind
cord
(%)

21
11,7
4
2,2
1
0,6
34
18,9

20
11,1
1
0,6
0
0
39

21,7

22
12,2
2
1,1
0
0
36
20,0

Total
(180
cords of
60
patients)
63
35,0
7
3,9
1
0,6
109
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
0
1
1
1
0
Incomplete
3
0
0,3
0,3
0,3
0
1,0
rupture
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

Location
Damage
Diarrhea
Swelling

Rupture
sheath

in

the

Rupture
No damage

Upper
trunk
(%)

Middle
trunk
Số lượng
(%)

Lower
trunk
(%)

1
0,6
11
6,1
1
0,6
15

8,3
34
18,9

0
0
9
5,0
0
0
5
2,8
47
26,1

0
0
7
3,9
0
0
4
2,2
50
27,8

Total
(180
trunks of
60

patients)
1
0,6
27
15,0
1
0,6
24
13,3
131
72,8

Table 3.28. Cord injury of brachial plexus on MRI
Location
Damage
Swelling
Rupture
Atrophy
No damage

Outside
cord
(%)

Inside
cord
(%)

Behind
cord

(%)

21
11,7
4
2,2
1
0,6
34
18,9

20
11,1
2
1,1
0
0
38
21,1

22
12,2
3
1,7
0
0
35
19,4

Total

(180
cords of
60
patients)
63
35,0
9
5,0
1
0,6
107
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


19

Table 3.29. Diagnosis of root injury of brachial plexus by surgeon
Total
Location
(300
C5
C6
C7
C8
T1
roots of

(%)
(%)
(%)
(%)
(%)
Damage
60
patients)
23
30
32
21
14
120
Root avulsion
7,7
10,0
10,7
7,0
4,7
40,0
23
15
11
8
6
63
Rupture
7,7
5,0

3,7
2,7
2,0
21,0
10
9
13
25
37
94
No damage
3,3
3,0
4,3
8,3
12,3
31,3
Table 3.30. Diagnosis of trunk injury of brachial plexus by surgeon
Upper
Middle
Total
Location
Lower
trunk
trunk
(180 trun
trunk
Số lượng
ks of 60
Damage

(%)
(%)
(%)
patients)
15
5
4
24
Rupture
8,3
2,8
2,2
13,3
45
55
56
156
No damage
25,0
30,6
31,1
86,7
Table 3.31. Diagnosis of cord injury of brachial plexus by surgeon
Tổng
Bó ngoài
Bó trong
Bó sau
Vị trí
(180 bó
Số lượng

Số lượng Số lượng
Tổn thương
của 60
(%)
(%)
(%)
BN)
4
2
3
9
Rupture
2,2
1,1
1,7
5,0
56
58
57
171
No damage
93,3
96,7
95,0
95,0


20

3.3.2. The value of MRI on the diagnosis of traumatic brachial plexus

injury
The results of the diagnosis of traumatic brachial plexus injury
on MRI and the results of the diagnosis of the surgeon will be compared
with two signs: (1) root avulsion (including pseudomening), (2) rupture.
Table 3.32. The value of CHT in the outbreak diagnosis (including
pseudomening)
Root
Locati
on

C5
C6
C7
C8
T1

MRI

Surgery

Suitability
between MRI
and surgery

Amou percenta Amou percenta Amou percenta
nt
ge
nt
ge
nt

ge

Yes

9

15,0

23

38,3

No
Yes
No
Yes
No
Yes
No
Yes
No

51
20
40
40
20
31
29
15

45

85,0
33,3
66,7
66,7
33,3
51,7
48,3
25
75

37
30
30
32
28
21
39
14
46

61,7
50,0
50,0
53,3
46,7
35,0
65,0
23,3

76,7

Value of MRI
Sensitivi Specifici
ty
ty
%
%

46

76,6

39,1

100

41

68,3

46,7

100

50

83,3

81,3

100

47

78,3

76,2

89,7

53

88,3

64,3

97,8

Table 3.33. The value of MRI on the diagnosis of root, trunk and cord
rupture
Root
Locati
on

Yes
No
Yes
C6
No

C5

MRI

Surgery

Suitability
between MRI
and surgery

Amou percenta Amou percenta Amou percenta
nt
ge
nt
ge
nt
ge
27
33
31
29

45,0
55,0
51,7
48,3

23
37
15

45

38,3
61,7
25,0
75,0

Value of MRI
Sensitivi Specifici
ty
ty
%
%

36

60,0

56,5

62,2

36

60,0

73,3

55,5

21

Yes
No
Yes
C8
No
Yes
T1
No
C7

31
29
26
34
19
41

51,7
48,3
43,3
56,7
31,7
68,3

11
49
8

52
6
54

18,3
81,7
13,3
86,7
10,0
90

38

63,3

90,9

57,1

39

65,0

75,0

63,5

43

71,7

72,2

66,7

Table 3.34. The value of MRI on the diagnosis of trunk rupture
MRI

Surgery

Location

Suitability
between MRI
and surgery

Amou percenta Amou percenta Amou percenta
nt
ge
nt
ge
nt
ge
Ye
15
Uppe s
r
No 45
Ye
5

Midd s
le
No 55
Ye
4
Lowe s
r
No 56

25,0

2

3,3

75,0

58

96,7

8,3

0

0,0

91,7

60

100

6,6

0

0,0

93,4

60

Value of MRI
Sensitiv Specific
ity
ity
%
%

45

75,0

50,0

75,9

55

100

-

-

56

100

-

-

100

Table 3.35. The value of MRI on the diagnosis of cord rupture
MRI

Surgery

Suitability
between MRI
and surgery

Value of MRI

Location
Amou percenta Amou percenta Amou percenta
nt

ge
nt
ge
nt
ge
Ye
Outsi s
de
No
Ye
Inside s
No
Ye
Behin s
d
No

4

6,6

2

3,3

56

73,4

58

96,7

2

3,3

0

0,0

58

96,7

60

100

3

5,0

1

1,7

57

95,0

59

98,3

Sensitiv Specific
ity
ity
%
%

58

96,7

100,0

96,6

58

96,7

-

-

56

100

0

94,9


22

Table 3.36. The value of MRI in the outbreak diagnosis (including
pseudomeningocele) and the root rupture
Suitability
between
MRI
Surgery
MRI and
MRI
surgery
Locat
ion
Sensiti Specifi
Amo percent Amo percent Amo percent
vity
city
unt
age
unt
age
unt
age
%

%
C5
34
56,7
46
76,7
42
70,0
67,4
78,6
C6
42
68,3
45
75,0
43
71,7
77,8
53,3
C7
45
75,0
43
71,7
54
90,0
95,3
76,5
C8
37

61,7
29
48,3
52
86,7
100,0 74,1
T1
25
41,7
20
33,3
53
88,3
95,0
85,0
Chapter 4
DISCUSS
4.1. General features of arm neuropathy
- Traumatic brachial plexus injuries is mainly in young and in men: mean
age 28.8 ± 11.8 years, male / female = 29.
- Traumatic brain injury are mainly caused by traffic accidents (76.7%).
Traumatic brachial plexus injuries on the left> 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.
The authors of our same views as: Dinh Hoang Long (2012), Jain DK
(2012), Faglioni W (2014) ...
4.2. Characteristics of Traumatic brachial plexus injuries on MRI
4.2.1. Damage on T1W vertical image
In (Table 3.2), the vertical T1W vertical image shows that
95.0%

(57/60)
of
patients
had
no
loss
of
natural spine curves or spinal cord injury and had no signs of 10 signs of
branchial plexus injury.
4.2.2. Damage on the T2W vertical image
Compared with the study by Dinh Hoang Long et al (2012), the
image of continuous loss in nerve roots accounted for 76.1%, the


23

pseudomeningocele found in 75.6% of the surveyed roots. In our
research, only the pseudomeningocele accounted for 22.0% of roots
(66/300 roots). Explaining the differences, we think that this is a random
difference in the number of samples, conducted by Hoang Hoang Long
(2012) in 36 patients; We studied on a larger number of 60 patients.
4.2.3. Damage on tranverse T2W image
The values of Tables 3.4, 3.5, 3.6 are compared to those of
Dinh Hoang Long et al (2012). All patients in our research had root
avulsion on a transverse T2W image, accounting for 81.1% of roots and
myelo were lost, and indirect imaging of pseudomeningocele accounted
for 77.2%. This is due to the choice of the patients in Hoang Long’s
research who have root lesions and to detect only focal and marginal
lesions. We can observe the lesions of trunk and cord.
4.2.4. Damage on horizontal T2W image

Comparing the values of the tables: 3.7, 3.8, 3.9 with Ochi M
et al (1994) the results: C5 root avulsion accounted for 84.2%; C6 94.7%.
The proportion of transport is similar, with C5 being 84.2% and C6 being
94.7%. However, the author does not evaluate the trunk and cords as our
research.
4.2.5. Damage on T2W Vista
Damage to roots and myelo: 8/10 signs of injury, in which the
most prominent is the complete rupture with the rate of 43.7% (position
C6, C7 most common and the same is 10.3%). (Table 3.10). Traumatic
trunk injury of brachial plexus: 8/10 signs of injury, most are swelling
(15.0%), then rupture (13.3%) and more concentrated on the upper trunk
(Table 3.11) . Cords injury: 3/10 signs of injury, in which swelling is
predominant (35.0%) and relatively uniform in all 3 cords (Table 3.12).
The results also indicated that the C7 root was most affected
because it involved both injury mechanisms (high root damage and low
root damage).
4.2.6. Damage on myelo MRI
In our study, the root and myelo injury rate was 22.3%, with
C7 roots accounting for the highest proportion (45.0%) (Table 3.13). The
author Dinh Hoang Long (2012) has the similarity between our study that
C7 root lesions account for the highest proportion.
4.2.7. Damage on Maximum intensity projection (MIP)