الفهرس 
introduction
GROSS ANATOMY OF BRACHIAL PLEXUSOnly 14 pages are availabe for public view
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Abstract
Brachial plexus injury (either obstetric or traumatic) represents an imaging challenge either due to complex anatomical design of the brachial plexus with large field to be examined and surrounding heterogeneous soft tissue structures or due to the complex nature of the trauma and its sequela where the brachial plexus become affected at multiple levels with different type of lesions. Incidence of traumatic brachial plexus injury is increasing in our society due to increased incidence of motor bike accidents. MRI represents the most accepted, accurate, safe and non-invasive diagnostic imaging modality in traumatic brachial plexus injury for identification, localization and classification of the lesion. In this study 37 patients were enrolled from Assiut university hospitals from 2016 to 2019, 22 cases of adult traumatic injury and 15 cases of obstetric BP injury. MRI was done preoperatively then its results were compared to operative data. MRI protocol involve conventional sequences involving T1WI, T2WI, STIR sequences in addition to advanced sequences involving BWIBS, 3D T2 STIR SPACE sequences and MR Myelography. The current study data revealed that MRI is sensitive for preganglionic lesions with sensitivity 86% and specificity 92%. While its results in postganglionic injury were 73% sensitivity and 99% specificity, classified as 73% sensitivity and 99% specificity for nerve rupture and 73% sensitivity and 100% specificity for traumatic neuroma formation. Also MRI findings show different results between obstetric and adult cases, as it gave better results in the adult patients. This difference was obvious for the preganglionic and postganglionic lesions as well. For preganglionic lesions MRI sensitivity was 63% and specificity was 96% for obstetric cases, while in adult traumatic cases sensitivity was 96% and specificity was 95%. As regard the postganglionic injury, for nerve rupture MRI sensitivity and specificity were 60% and 99% respectively in obstetric cases and were 88% and 100% respectively in adult cases. In detection of traumatic neuroma MRI sensitivity and specificity were 80% and 100% respectively in obstetric cases while in adult patients the results were 60% sensitivity and 100% specificity. This study not only revealed the role of MRI in diagnosis of brachial plexus injury but also revealed the new advanced MRN technique involving BWIBS, 3D T2 STIR SPACE sequences with MR Myelography provides fast and accurate technique for evaluation of traumatic brachial plexus injury. These sequences gave better results when compared with multiple time-consuming other conventional sequences. 3D T2 STIR SPACE sequence is valuable in preganglionic injury with 90% sensitivity and 90% specificity compared to 66% sensitivity and 82% specificity of the conventional sequences. DWI is sensitive for the postganglionic lesions with 73% sensitivity and 99% specificity in case of nerve rupture compared to conventional sequence results with 65% sensitivity and 99% specificity. But in detection of neuroma DWI showed 73% sensitivity and 100% specificity compared to other conventional sequences results with 60% sensitivity and 100 % specificity. Therefore, STIR sequence and DWIBS sequence have complementary advantages in imaging the brachial plexus. MRI with its advanced new technique provide a fast, accurate and safe imaging modality for the diagnosis of traumatic brachial plexus injury and should be done preoperatively for each case with clinically suspected traumatic or obstetric brachial plexus injury. Pateint with clinical suspicion of traumatic or obestetric brachial plexus injury should be evaluated preoperatively with MRI examination to detect the level and characterize the type of injury. MRI examination should be performed with the fast new advanced sequences instead of time consumping conventional sequences.