The most common causes of BP affections are traffic accidents and sports injuries ( 3), compressive syndromes, tumours, iatrogenic lesions, acute plexitis, post-radiation plexopathy and brachial plexopathy due to arterial aneurysms ( 7, 8). Brachial plexus injury is one of the most common injury in young people of working age, causing socio-economic problems and psychiatric disorders ( 2). Lesions of the BP are among the most serious disabilities ever, given its importance to the upper limb function. The BP is formed by the ventral rami of the lower four cervical roots (C5–C8) and comprises of roots, trunks, divisions, cords, and terminal branches (five nerves: axillary, musculocutaneous, radial, ulnar and median nerves) ( 1). The brachial plexus (BP) represents a complex neural structure that provides motor and sensitive innervation of the upper extremity. Keywords: Diffusion tensor imaging (DTI) brachial plexus magnetic resonance neurography (MRN) magnetic resonance tractography (MRT) generalized q-sampling imaging algorithm (GQI algorithm) The presented algorithm yields a high quality reconstruction of the BP bundles that may be helpful both in research and clinical practice. Other diffusion parameters were not significantly different.Ĭonclusions: Using NQA instead of FA in the proposed algorithm allowed for a better separation of muscle and root nerve bundles. In the central part of the BP, a significant difference between control subjects and patients at P=0.02 was found in the NQA values. Results: In control subjects, no significant effect of laterality in diffusion parameters was found (P>0.05) in the BP. The MRN was performed in MedINRIA and post-processed using the maximum intensity projection (MIP) method to demonstrate BP root bundles in multiple planes. Calculated diffusion parameters were statistically analysed using the two-sample t-test. The diffusion data were processed in individual C4-T1 root bundles using the generalized q-sampling imaging (GQI) algorithm. In our study, the NQA parameter has been used for fiber tracking instead of fractional anisotropy (FA). The fibre bundles reconstruction was optimized in terms of eliminating the skeletal muscle fibres contamination using the SSC and the tracking threshold of the normalized quantitative anisotropy (NQA) on reconstruction of the BP. Methods: Twenty-seven healthy volunteers and four patients with root avulsions underwent magnetic resonance imaging (MRI) examinations on a 3T MR scanner with optimized measurement protocols for diffusion-weighted images and coronal T2 weighted 3D short-term inversion recovery sampling perfection with application optimized contrast using varying flip angle evaluation sequences used for BP fibre reconstruction and MR neurography (MRN). We proposed an algorithm for robust visualization and assessment of BP root bundles using the segmentation of the spinal cord (SSC, C4-T1) as seed points for the initial starting area for the fibre tracking algorithm. Notably challenging is the separation of the peripheral nerve bundles and skeletal muscles as both structures have similar fractional anisotropy values. ^ORCID: Ibrahim Ibrahim, 0000-0003-3530-5165 Antonín Škoch, 0000-0002-1739-3256 Vít Herynek, 0000-0002-1775-2394 Ivan Humhej, 0000-0002-3971-2625 Jaroslav Tintěra, 0000-0002-0685-7174.īackground: Magnetic resonance (MR) tractography of the brachial plexus (BP) is challenging due to different factors such as motion artifacts, pulsation artifacts, signal-to-noise ratio, spatial resolution eddy currents induced geometric distortions, sequence parameters and choice of used coils. Purkyně University, Masaryk Hospital, Ústí nad Labem, Czech RepublicĬontributions: (I) Conception and design: I Ibrahim, J Tintěra (II) Administrative support: I Humhej, J Beran (III) Provision of study materials or patients: V Flusserová, M Juhaňáková, M Brzák (IV) Collection and assembly of data: I Ibrahim, E Rolencová, M Nagy, J Tintěra (V) Data analysis and interpretation: I Ibrahim, A Skoch, V Herynek (VI) Manuscript writing: All authors (VII) Final approval of manuscript: All authors. Ibrahim Ibrahim 1^, Antonín Škoch 1^, Vít Herynek 2^, Ivan Humhej 3^, Jan Beran 1, Vlasta Flusserová 1, Eva Rolencová 1, Martina Juhaňáková 1, Michal Brzák 1, Markéta Nagy 1, Jaroslav Tintěra 1^ġ Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic Ģ Center for Advanced Preclinical Imaging, First Faculty of Medicine, Charles University, Prague, Czech Republic ģ Department of Neurosurgery, J. Policy of Dealing with Allegations of Research Misconduct.Policy of Screening for Plagiarism Process.
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