Science News: Diagnostic Performance of Preoperative Ultrasound for Traumatic Brachial Plexus Root Injury: A Comparison Study With an Electrophysiology Study

Submitted by: Nakul Katyal, MD
Edited by: Eman Tawfik, MD                

Liu A, Jia X, Zhang L, et al. Diagnostic performance of preoperative ultrasound for traumatic brachial plexus root injury: A comparison study with an electrophysiology study. Front Neurol. 2023;13:1077830. doi: 10.3389/fneur.2022.1077830.

Summary: This retrospective study aimed to investigate the diagnostic performance of preoperative ultrasound (US) compared with electrophysiology study (EPS) in the assessment of traumatic brachial plexus (BP) root injury. Patients with suspected traumatic BP root injury who underwent preoperative US and EPS examination were included in the analysis. Each BP root was assessed via US and EPS as either completely or incompletely injured. 

A total of 49 patients with traumatic BP injury who underwent surgical exploration were included. 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), whereas EPS correctly detected 75 completely injured BP roots (sensitivity, 0.843; specificity, 0.929; PPV, 0.872; NPV, 0.912; accuracy, 0.898). The US showed significantly higher accuracy than EPS. When combining US and EPS for completely injured BP root detection, the sensitivity of the inclusive combination (US or EPS) was significantly higher than EPS alone, and the specificity of the exclusive combination (US and EPS) was significantly higher than EPS alone.

Comments: Preoperative assessment for traumatic BP injury is vital for clinicians to establish a treatment strategy. The electrodiagnostic studies play a pivotal role in this assessment, but US has emerged as a valuable complementary tool. However, literature comparing the diagnostic performance of US and EPS in patients with BP injury is limited. This study highlights the diagnostic accuracy of the US in detection of complete BP root injury, both in isolation and in combination with EPS. The results add to the growing body of literature supporting the use of neuromuscular US in clinical practice The main study limitations included the retrospective nature of the analysis and the inclusion of only severe BPI cases requiring surgical intervention. The performances of US or the combined use of US and EPS needs to be further investigated in a medium or minor level of BP injury.