MRI for detecting root avulsions in traumatic adult brachial plexus injuries: a systematic review and meta-analysis of diagnostic accuracy

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MRI for detecting root avulsions in traumatic adult brachial plexus injuries : a systematic review and meta-analysis of diagnostic accuracy . / Wade, Ryckie G ; Takwoingi, Yemisi; Wormald, Justin CR ; Ridgway, John P ; Tanner, Steven ; Rankine, James J ; Bourke, Grainne .

In: Radiology, Vol. 293, No. 1, 01.10.2019, p. 125–133.

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Wade, Ryckie G ; Takwoingi, Yemisi ; Wormald, Justin CR ; Ridgway, John P ; Tanner, Steven ; Rankine, James J ; Bourke, Grainne . / MRI for detecting root avulsions in traumatic adult brachial plexus injuries : a systematic review and meta-analysis of diagnostic accuracy . In: Radiology. 2019 ; Vol. 293, No. 1. pp. 125–133.

Bibtex

@article{fb8edcf4bf59446d838ea62c4410e8cf,
title = "MRI for detecting root avulsions in traumatic adult brachial plexus injuries: a systematic review and meta-analysis of diagnostic accuracy ",
abstract = "Background: Traumatic brachial plexus injuries affect 1% of patients involved in major trauma. MRI is the best test for traumatic brachial plexus injuries, although its ability to differentiate root avulsions (which require urgent reconstructive surgery) from other types of nerve injury remains unknown.Purpose: To evaluate the accuracy of MRI for diagnosing root avulsions in adults with traumatic brachial plexus injuries.Materials and Methods: For this systematic review, MEDLINE and Embase were searched from inception to August 20, 2018. Studies of adults with traumatic nonpenetrating unilateral brachial plexus injuries were included. The target condition was root avulsion. The index test was preoperative MRI, and the reference standard was surgical exploration. A bivariate meta-analysis was used to estimate summary sensitivities and specificities of MRI for avulsion.Results: Eleven studies of 275 adults (mean age, 27 years; 229 men) performed between 1992 and 2016 were included. Most participants had been injured in motorcycle collisions (84%). All studies were at risk of bias, and there were high applicability concerns for the index test (ie, MRI) in four studies given the lack of diagnostic criteria, inadequate descriptions of pulse sequences, and multiplicity of reporting radiologists. Overall, 72% of patients with brachial plexus injuries had at least one root avulsion (interquartile range [IQR]: 53%–86%); meta-analysis of patient-level data was not performed because of sparse and heterogeneous data. With the nerve root as the unit of analysis, 583 of 918 roots were avulsed (median, 55%; IQR: 38%–71%); the mean sensitivity of MRI for root avulsion was 93% (95% confidence interval [CI]: 77%, 98%) with a mean specificity of 72% (95% CI: 42%, 90%).Conclusion: On the basis of limited data, MRI offers modest diagnostic accuracy for traumatic brachial plexus root avulsion(s), and early surgical exploration should remain as the preferred method of diagnosis.",
author = "Wade, {Ryckie G} and Yemisi Takwoingi and Wormald, {Justin CR} and Ridgway, {John P} and Steven Tanner and Rankine, {James J} and Grainne Bourke",
year = "2019",
month = oct,
day = "1",
doi = "10.1148/radiol.2019190218",
language = "English",
volume = "293",
pages = "125–133",
journal = "Radiology",
issn = "0033-8419",
publisher = "Radiological Society of North America",
number = "1",

}

RIS

TY - JOUR

T1 - MRI for detecting root avulsions in traumatic adult brachial plexus injuries

T2 - a systematic review and meta-analysis of diagnostic accuracy

AU - Wade, Ryckie G

AU - Takwoingi, Yemisi

AU - Wormald, Justin CR

AU - Ridgway, John P

AU - Tanner, Steven

AU - Rankine, James J

AU - Bourke, Grainne

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Background: Traumatic brachial plexus injuries affect 1% of patients involved in major trauma. MRI is the best test for traumatic brachial plexus injuries, although its ability to differentiate root avulsions (which require urgent reconstructive surgery) from other types of nerve injury remains unknown.Purpose: To evaluate the accuracy of MRI for diagnosing root avulsions in adults with traumatic brachial plexus injuries.Materials and Methods: For this systematic review, MEDLINE and Embase were searched from inception to August 20, 2018. Studies of adults with traumatic nonpenetrating unilateral brachial plexus injuries were included. The target condition was root avulsion. The index test was preoperative MRI, and the reference standard was surgical exploration. A bivariate meta-analysis was used to estimate summary sensitivities and specificities of MRI for avulsion.Results: Eleven studies of 275 adults (mean age, 27 years; 229 men) performed between 1992 and 2016 were included. Most participants had been injured in motorcycle collisions (84%). All studies were at risk of bias, and there were high applicability concerns for the index test (ie, MRI) in four studies given the lack of diagnostic criteria, inadequate descriptions of pulse sequences, and multiplicity of reporting radiologists. Overall, 72% of patients with brachial plexus injuries had at least one root avulsion (interquartile range [IQR]: 53%–86%); meta-analysis of patient-level data was not performed because of sparse and heterogeneous data. With the nerve root as the unit of analysis, 583 of 918 roots were avulsed (median, 55%; IQR: 38%–71%); the mean sensitivity of MRI for root avulsion was 93% (95% confidence interval [CI]: 77%, 98%) with a mean specificity of 72% (95% CI: 42%, 90%).Conclusion: On the basis of limited data, MRI offers modest diagnostic accuracy for traumatic brachial plexus root avulsion(s), and early surgical exploration should remain as the preferred method of diagnosis.

AB - Background: Traumatic brachial plexus injuries affect 1% of patients involved in major trauma. MRI is the best test for traumatic brachial plexus injuries, although its ability to differentiate root avulsions (which require urgent reconstructive surgery) from other types of nerve injury remains unknown.Purpose: To evaluate the accuracy of MRI for diagnosing root avulsions in adults with traumatic brachial plexus injuries.Materials and Methods: For this systematic review, MEDLINE and Embase were searched from inception to August 20, 2018. Studies of adults with traumatic nonpenetrating unilateral brachial plexus injuries were included. The target condition was root avulsion. The index test was preoperative MRI, and the reference standard was surgical exploration. A bivariate meta-analysis was used to estimate summary sensitivities and specificities of MRI for avulsion.Results: Eleven studies of 275 adults (mean age, 27 years; 229 men) performed between 1992 and 2016 were included. Most participants had been injured in motorcycle collisions (84%). All studies were at risk of bias, and there were high applicability concerns for the index test (ie, MRI) in four studies given the lack of diagnostic criteria, inadequate descriptions of pulse sequences, and multiplicity of reporting radiologists. Overall, 72% of patients with brachial plexus injuries had at least one root avulsion (interquartile range [IQR]: 53%–86%); meta-analysis of patient-level data was not performed because of sparse and heterogeneous data. With the nerve root as the unit of analysis, 583 of 918 roots were avulsed (median, 55%; IQR: 38%–71%); the mean sensitivity of MRI for root avulsion was 93% (95% confidence interval [CI]: 77%, 98%) with a mean specificity of 72% (95% CI: 42%, 90%).Conclusion: On the basis of limited data, MRI offers modest diagnostic accuracy for traumatic brachial plexus root avulsion(s), and early surgical exploration should remain as the preferred method of diagnosis.

UR - http://www.scopus.com/inward/record.url?scp=85072509157&partnerID=8YFLogxK

U2 - 10.1148/radiol.2019190218

DO - 10.1148/radiol.2019190218

M3 - Review article

VL - 293

SP - 125

EP - 133

JO - Radiology

JF - Radiology

SN - 0033-8419

IS - 1

ER -