Early MRI Can Predict the Indication for Surgery in Brachial Plexus Birth Injury

• DOI: 10.2106/jbjs.24.00561
• Publication Date: 2025-01-29T19:09:54Z
• Authors: Andrea S. Bauer; Ann E. Van Heest; M. Claire Manske; Peter Y. Shen; Martin J. Asis; Jennifer Chang; Sandra Taylor; Michelle A. James
• Keywords: Brachial plexus injury

Background: Magnetic resonance imaging (MRI) has not been routinely used for infants with brachial plexus birth injury (BPBI); instead, the decision to operate is based on trajectory of clinical recovery by 6 months age. The aim this study was develop an MRI protocol that can be performed without sedation or contrast in order identify who would benefit from surgery at earlier age than which could made clinically. Methods: This prospective multicenter NAPTIME (Non-Anesthetized Plexus Technique Infant Evaluation) included aged 28 120 days BPBI 3 tertiary care centers. Subjects had nonsedated non-contrast rapid volumetric proton density 3-T scanners. Neuroradiologists each site calculated nerve root score subjects their site. Interrater reliability a subset subjects. All were evaluated routine examinations up age, time treating surgeon determined whether offer surgery. Surgeons blinded results. ability discriminate indication using receiver operating characteristic (ROC) curve, estimating area under curve (AUC) across range scores. Results: Sixty-five successfully completed MRI; 18 (28%) ultimately met criteria interrater moderate 0.703 (95% confidence interval [CI], 0.582 0.818). median 16.2 (interquartile [IQR], 9.9 18.9), while those did 7.0 (IQR, 5.0 to10.5). predicted meeting AUC 0.812 CI, 0.688 0.936). A >13 offered specificity 0.94 and sensitivity 0.61 surgical indication. Conclusions: Non-contrast useful tool determining severity BPBI. might distinguish will meet reconstructive when Level Evidence: Prognostic II . See Instructions Authors complete description levels evidence.