Brachial Plexus Birth Injuries: Evaluation—Radiologic Evaluation

Imaging is critical in the evaluation of pediatric preganglionic brachial plexus injury. As in adults, the timely identification of nerve root avulsions and pseudomeningoceles is a vital component of prognostication and surgical decision-making. The primary modalities used to assess injuries proximal to the dorsal root ganglia in children are CT myelography and MRI, including myelography-type MRI sequences. This brief chapter is complementary to the chapter on adult preganglionic brachial plexus injury radiologic evaluation, addressing unique considerations for the pediatric patient, with a focus on the choice of CT myelography vs. MRI in preganglionic brachial plexus birth palsy. CT myelography is historically considered the imaging gold standard and remains the preferred modality at some centers. However, in pediatric patients, it is important to minimize exposure to ionizing radiation and avoid anesthesia and even minimally invasive procedures when possible. Thus, there is a growing trend toward MRI, which also offers excellent diagnostic performance for the evaluation of preganglionic brachial plexus birth palsy. A rational approach would be to start imaging in this clinical scenario with MRI and only move on to CT myelography if the MRI findings are less than definitive.