AUTHOR=Liu Ailin , Jia Xiaotian , Zhang Li , Huang Xiaoyun , Chen Weimin , Chen Lin 

TITLE=Diagnostic performance of preoperative ultrasound for traumatic brachial plexus root injury: A comparison study with an electrophysiology study

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.1077830

DOI=10.3389/fneur.2022.1077830

ISSN=1664-2295

ABSTRACT=Purpose
Accurate preoperative assessment for traumatic brachial plexus injury (BPI) is critical for clinicians to establish a treatment plan. The objective of this study was to investigate the diagnostic performance of preoperative ultrasound (US) through comparison with electrophysiology study (EPS) in the assessment of traumatic brachial plexus (BP) root injury.
Materials and methods
We performed a retrospective study in patients with traumatic BPI who had preoperative US and EPS, excluding obstetric palsy and other non-traumatic neuropathies. US examination was performed on an EPIQ 5 color Doppler equipment. EPS was performed on a Keypoint 9033A07 Electromyograph / Evoked Potentials Equipment, testing electromyography (EMG), nerve conduction studies (NCS), and somatosensory evoked potentials (SEP). Each BP root of all patients was respectively assessed by US and EPS as completely-injured or incompletely-injured. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated on the basis of correlation with intraoperative findings. Accuracy of US and EPS were compared by McNemar test. The added benefit of US was evaluated through comparing sensitivity and specificity between the combined tests with EPS by McNemar test.
Results
During the time period from October, 2018 to September, 2022, 49 patients were included in this study. Surgical exploration confirmed 89 completely-injured BP roots in 28 patients. US correctly detected 80 completely-injured BP roots (sensitivity, 0.899; specificity, 0.981; PPV, 0.964; NPV, 0.944; accuracy, 0.951). EPS correctly detected 75 completely-injured BP roots (sensitivity, 0.843; specificity, 0.929; PPV, 0.872; NPV, 0.912; accuracy, 0.898). US showed significantly higher accuracy than EPS (p=0.03). When combining US and EPS for completely-injured BP roots detection, the sensitivity of the inclusive combination (0.966) was significantly higher than EPS alone (p=0.000977), and the specificity of the exclusive combination (1.000) was significantly higher than EPS alone (p=0.000977).
Conclusions
Preoperative US is an effective diagnostic tool in the assessment of traumatic BP root injury. US had higher accuracy than EPS in this study. Sensitivity and specificity were significantly higher than EPS when US was combined with EPS.