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Accuracy of Abnormal Paraspinal Muscle Findings on Contrast-enhanced MR Images as Indirect Signs of Unilateral Cervical Root-Avulsion Injury¹

¹ From the Departments of Radiology (N.H., T.M., O.A., S.A., K.O.) and Orthopedics (Y.T.), Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Received April 30, 2001; revision requested June 7; revision received September 24; accepted October 22. Address correspondence to N.H. (e-mail: naoto-tky@umin.ac.jp).

View larger version (149K): [in a new window]   Figure 1a. Left C5 and C6 root-avulsion injury in a 25-year-old man 46 days after injury. (a) Transverse fat-suppressed postcontrast SE (756/12) MR image at the C4 vertebral level shows multifidus muscles (upper straight arrows) and semispinalis cervicis muscle (lower straight arrows) as having increased enhancement. Also, the group of iliocostalis cervicis, longissimus capitis, and cervicis muscles shows increased enhancement and atrophy (curved arrows), as compared with the contralateral side (arrowheads). (b) Schematic figure of paraspinal muscles at same C4 vertebral level muscles. Black areas = abnormal enhancement.

View larger version (49K): [in a new window]   Figure 1b. Left C5 and C6 root-avulsion injury in a 25-year-old man 46 days after injury. (a) Transverse fat-suppressed postcontrast SE (756/12) MR image at the C4 vertebral level shows multifidus muscles (upper straight arrows) and semispinalis cervicis muscle (lower straight arrows) as having increased enhancement. Also, the group of iliocostalis cervicis, longissimus capitis, and cervicis muscles shows increased enhancement and atrophy (curved arrows), as compared with the contralateral side (arrowheads). (b) Schematic figure of paraspinal muscles at same C4 vertebral level muscles. Black areas = abnormal enhancement.

View larger version (114K): [in a new window]   Figure 2a. Right C5 through C8 root-avulsion injury in a 17-year-old male patient 81 days after injury. The multifidus, semispinalis cervicis, and longus colli muscles, the group of splenius cervicis and capitis muscles, and the group of iliocostalis cervicis, longissimus cervicis, and longissimus capitis muscles show high SI (arrowheads) on the (a) transverse precontrast SE (756/12) and (b) transverse fast SE (4,700/112 [effective]; echo train length, 15) MR images and show increased enhancement on (c) the transverse postcontrast SE (756/12) MR image. Note that the semispinalis capitis muscle is preserved between the semispinalis cervicis muscle and the group of splenius cervicis and capitis muscles. Only the lateral portion (short arrows) of the group of splenius cervicis and capitis muscles shows abnormalities, presumably attributed to denervation of the splenius cervicis muscle, while the splenius capitis muscle is intact. The area of abnormal SI and abnormal contrast enhancement between the scalenus anterior and medius muscles is the injured brachial plexus (long arrow).

View larger version (118K): [in a new window]   Figure 2b. Right C5 through C8 root-avulsion injury in a 17-year-old male patient 81 days after injury. The multifidus, semispinalis cervicis, and longus colli muscles, the group of splenius cervicis and capitis muscles, and the group of iliocostalis cervicis, longissimus cervicis, and longissimus capitis muscles show high SI (arrowheads) on the (a) transverse precontrast SE (756/12) and (b) transverse fast SE (4,700/112 [effective]; echo train length, 15) MR images and show increased enhancement on (c) the transverse postcontrast SE (756/12) MR image. Note that the semispinalis capitis muscle is preserved between the semispinalis cervicis muscle and the group of splenius cervicis and capitis muscles. Only the lateral portion (short arrows) of the group of splenius cervicis and capitis muscles shows abnormalities, presumably attributed to denervation of the splenius cervicis muscle, while the splenius capitis muscle is intact. The area of abnormal SI and abnormal contrast enhancement between the scalenus anterior and medius muscles is the injured brachial plexus (long arrow).

View larger version (114K): [in a new window]   Figure 2c. Right C5 through C8 root-avulsion injury in a 17-year-old male patient 81 days after injury. The multifidus, semispinalis cervicis, and longus colli muscles, the group of splenius cervicis and capitis muscles, and the group of iliocostalis cervicis, longissimus cervicis, and longissimus capitis muscles show high SI (arrowheads) on the (a) transverse precontrast SE (756/12) and (b) transverse fast SE (4,700/112 [effective]; echo train length, 15) MR images and show increased enhancement on (c) the transverse postcontrast SE (756/12) MR image. Note that the semispinalis capitis muscle is preserved between the semispinalis cervicis muscle and the group of splenius cervicis and capitis muscles. Only the lateral portion (short arrows) of the group of splenius cervicis and capitis muscles shows abnormalities, presumably attributed to denervation of the splenius cervicis muscle, while the splenius capitis muscle is intact. The area of abnormal SI and abnormal contrast enhancement between the scalenus anterior and medius muscles is the injured brachial plexus (long arrow).

View larger version (156K): [in a new window]   Figure 3. Right C5 through C8 root-avulsion injury in a 21-year-old man 50 days after injury. Coronal postcontrast three-dimensional gradient-echo (37/10; flip angle, 45°) MR image shows abnormal enhancement in the multifidus muscle (arrowheads) and a portion of the splenius cervicis muscle (arrows). Fibers of enhanced multifidus muscle are attached to the C4 spine and run downward laterally to insert at articular processes of vertebrae below.