Abstract
Background The authors describe a new computerized tomography (CT) myelography technique with
coronal and oblique coronal view to demonstrate the status of the cervical nerve rootlets
involved in brachial plexus injury. They discuss the value of this technique for diagnosis
of nerve root avulsion compared with CT myelography with axial view.
Methods CT myelography was performed with penetration of the cervical subarachnoid space
by the contrast medium. Then the coronal and oblique coronal reconstructions were
created. The results of CT myelography were evaluated and classified with presence
of pseudomeningocele, intradural ventral nerve rootlets, and intradural dorsal nerve
rootlets. The diagnosis was by extraspinal surgical exploration with or without spinal
evoked potential measurements and choline acetyl transferase activity measurement
in 25 patients and recovery by a natural course in 3 patients. Its diagnostic accuracy
was compared with that of CT myelography with axial view, correlated with surgical
findings or a natural course in 57 cervical roots in 28 patients.
Results Coronal and oblique coronal views were superior to axial views in visualization of
the rootlets and orientation of the exact level of the root. Sensitivity and specificity
for coronal and oblique coronal views of unrecognition of intradural ventral and dorsal
nerve root shadow without pseudomeningocele in determining pre-ganglionic injury were
100% and 96%, respectively. There was no statistically significant difference between
coronal and oblique coronal views and axial views.
Conclusion The information by the coronal and oblique coronal slice CT myelography enabled the
authors to assess the rootlets of the brachial plexus and provided valuable data for
helping to decide whether to proceed with exploration, nerve repair, primary reconstruction.
