Diffusion-tensor magnetic resonance imaging in patients with consequences of obstetric brachial plexus palsy

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Abstract

BACKGROUND: Diffusion-tensor magnetic resonance imaging allows visualizing the conductive pathways of the brain and spinal cord and assessing their structure and integrity and has found wide application in practical medicine. Currently, brachial plexus diffusion-tensor magnetic resonance imaging is not a routine research technique, and very few studies have described its use in children and adolescents.

AIM: This study aimed to evaluate the possibility of brachial plexus diffusion-tensor magnetic resonance imaging application in pediatric patients with obstetric brachial plexus palsy sequelae and identify correlations between the diffusion-tensor magnetic resonance imaging parameters of brachial plexus and parameters of electrophysiological study of the upper extremities in these patients.

MATERIALS AND METHODS: A complex examination of 50 patients was performed. The main group included 30 patients aged 6–17 years, with contractures and secondary deformities of the bones of the shoulder girdle and upper limbs caused by unilateral obstetric brachial plexus palsy. The control group included 20 patients aged 7–17 (10.1 ± 2.1) years without clinical signs, and anamnestic data indicated the presence of damage to the brachial plexus and peripheral nerves of the upper limbs.

RESULTS: No significant differences in diffusion-tensor magnetic resonance imaging parameters of the right and left brachial plexus were found in the control group. Significant differences in fractional anisotropy of the C5–C8 tracts on the side of the damaged brachial plexus were detected compared with those on the side of the undamaged brachial plexus. On the side of the injured brachial plexus, nonlinear correlations were found between the fractional anisotropy of the tracts of the spinal nerve and its branches and the amplitude of sensory responses from the sensory nerve, which originated from the anterior branches of this spinal nerve, and between the volume of the branches of the tracts of the spinal nerve and the amplitude of соmpound motor responses from the muscles, which were innervated by the anterior branches of this spinal nerve.

CONCLUSIONS: Diffusion-tensor magnetic resonance imaging allows for the evaluation of the structural changes in the SNs that participate in the formation of the brachial plexus. The results can be used for further studies of diffusion-tensor magnetic resonance imaging of brachial plexuses in various pathologies in pediatric patients.

About the authors

Alina M. Khodorovskaya

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: alinamyh@gmail.com
ORCID iD: 0000-0002-2772-6747
SPIN-code: 3348-8038
Russian Federation, Saint Petersburg

Aleksandr Yu. Efimtsev

Almazov National Medical Research Centre

Email: atralf@mail.ru
ORCID iD: 0000-0003-2249-1405
SPIN-code: 3459-2168

MD, PhD, Dr. Sci. (Med.)

Russian Federation, Saint Petersburg

Olga E. Agronovich

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: olga_agranovich@yahoo.com
ORCID iD: 0000-0002-6655-4108
SPIN-code: 4393-3694

MD, PhD, Dr. Sci. (Med.)

Russian Federation, Saint Petersburg

Margarita V. Savina

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: drevma@yandex.ru
ORCID iD: 0000-0001-8225-3885
SPIN-code: 5710-4790

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Vyacheslav I. Zorin

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: zoringlu@yandex.ru
ORCID iD: 0000-0002-9712-5509
SPIN-code: 4651-8232

MD, PhD, Cand. Sci. (Med.), Assistant Professor

Russian Federation, Saint Petersburg

Sergey A. Braylov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: sergeybraylov@mail.ru
ORCID iD: 0000-0003-2372-9817
SPIN-code: 9369-6073

MD

Russian Federation, Saint Petersburg

Anastasiia I. Arakelian

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: a_bryanskaya@mail.ru
ORCID iD: 0000-0002-3998-4954
SPIN-code: 9224-5488

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Sergey A. Lukyanov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: Sergey.lukyanov95@yandex.ru
ORCID iD: 0000-0002-8278-7032
SPIN-code: 3684-5167

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Aleksandr S. Grishchenkov

Almazov National Medical Research Centre; Sokolov’ North-Western Regional Scientific and Clinical Center

Email: gasradiology@gmail.ru
ORCID iD: 0000-0003-0910-6904
SPIN-code: 5654-0112

MD

Russian Federation, Saint Petersburg; Saint Petersburg

Yana A. Filin

Almazov National Medical Research Centre

Email: filin_yana@mail.ru
ORCID iD: 0009-0009-0778-6396

MD, resident

Russian Federation, Saint Petersburg

Daniil B. Vcherashniy

Ioffe Physical Technical Institute

Email: dan-v@yandex.ru
ORCID iD: 0000-0003-1658-789X
SPIN-code: 6139-7842

PhD, Cand. Sci. (Phys.-Math.)

Russian Federation, Saint Petersburg

Viktoria V. Morozova

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: frostigersieg@gmail.com
ORCID iD: 0009-0007-5961-2641

MD

Russian Federation, Saint Petersburg

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Supplementary files

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2. Fig. 1. Patient K., 11 years old. Three-dimensional reconstruction of spinal nerve tracts. Erb’s paresis on the left. The absence of SN C7 is indicated by an arrow

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3. Fig. 2. Fractional anisotropy of the С5–Th1 spinal nerve tracts. C — control group; M — main group (on the side of the damaged brachial plexus); * statistically significant differences (p < 0.05)

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4. Fig. 3. The volume of branches of the spinal nerve tracts on the sides of the damaged (M) and intact brachial plexus (C). * Presence of statistically significant differences between the volume of branches of the SN tracts of the damaged and intact brachial plexus

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5. Fig. 4. Patient V., 15 years old. Three-dimensional reconstruction of SN tracts C5–C8. Damage to the left brachial plexus. Decreased volume of C5–C8 tract branches and trunks. SN Th1 is not constructed

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6. Fig. 5. Patient M., 7 years old. Three-dimensional reconstruction of brachial plexus tracts. Erb’s paresis on the left. Increased volume of branches of the SN tracts C5–C7

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