What imaging modalities are recommended for evaluating brachial plexus injuries in adults and children?

For evaluating brachial plexus injuries in both adults and children, MRI is the recommended imaging modality due to its superior ability to visualize soft tissue structures including nerves, spinal cord, and surrounding tissues.

In children under 16 years, MRI should be performed if there is a strong clinical suspicion of cervical spinal cord or column injury, which may include brachial plexus involvement, especially when neurological signs or symptoms are present ¹.

In adults, MRI is indicated after initial CT imaging if neurological abnormalities suggest spinal cord or nerve root injury, which can be associated with brachial plexus trauma ¹.

Plain X-rays may be considered initially in children if MRI criteria are not met but clinical suspicion remains, and further imaging should be guided by radiological consultation ¹. CT is primarily used in adults for bony injury assessment but is less sensitive for nerve injuries such as those affecting the brachial plexus ¹.

According to the literature, conventional imaging such as X-rays and CT can identify fractures or bony abnormalities that may impact the brachial plexus, but MRI remains the gold standard for detailed evaluation of brachial plexus injuries because it can demonstrate nerve root avulsions, neuromas, and post-ganglionic lesions with high resolution (Yoshikawa et al., 2006).

Advanced imaging techniques, including MR neurography, may provide additional detail in complex cases but are not yet standard in all clinical settings (Yoshikawa et al., 2006).