BỘ GIÁO DỤC VÀ ĐÀO TẠO BỘ QUỐC PHÒNG SCIENTIFIC RESEARCH INSTITUTE OF CLINICAL MEDICINE 108 NGUYEN NGOC TRUNG RESEARCH ON VISUAL CHARACTERISTICS AND VALUE OF MRI IN THE DIAGNOSIS OF TRAUMATIC BRACHIAL PLEXUS INJURY Specialisation: Image Diagnostics Code: 62.72.01.66 SUMMARY OF THE DISSERTATION OF MEDICINE HA NOI - 2019 THE DISSERTATION WAS ACCOMPLISHER SCIENTIFIC RESEARCH INSTITUTE OF CLINICAL MEDICINE 108 Supervisors: Lam Khanh, Associate Professor, Doctor Tran Van Riep, Associate Professor, Doctor Reviewer 1: Reviewe 2: Reviewe 3: The dissertation defence before the Institutional Board takes place at Scienifically archived at: National library Scientific Research Institute of Clinical Medicine 108 INTRODUCTION Brachial plexus occurs when one or more nerve roots are removed from the spinal cord at the base, or the nerves are stretched, cut, collapsed, inserted squeezing out of the hole Brachial plexus injuries due to traumatic injury tend to increase, mainly due to traffic accidents Worldwide studies such as Oliveira CM (2015), Jain DK (2012) all confirmed the main cause of traffic accidents (78.7 and 94%) In Vietnam, according to NC of Ho Huu Luong (1992), the incidence of neck spine injuries was high (60-70%) According to Le Van Doan (2013), Brachial plexus injuries due to traumatic injuries are not rare and the main cause is traffic accidents In the world and in Vietnam, there have been some researches of MRI of brachial plexus injuries due to traumatic injury However, these studies not have a multifaceted assessment of injury due to disease limitation Based on the above situation, we conducted a study entitled "Research on visual characteristics and value of MRI in the diagnostic of traumatic brachial plexus injury" with two objectives: Characterization of imaging of brachial plexus injuries due to traumatic injury on Tesla MRI Determine the value of the Tesla MRI in Diagnosis of brachial plexus injuries versus surgery Dessertation novelty: The study is the first one in Vietnam to apply Telsa MRI in the evaluation of traumatic brachial plexus injury Contribution to Image Diagnostics: A new diagnostic technique is developed Contribution to Treatment: The study assesses systematic brachial plexus injury and simultaneously indicates the correlation between clinic and image diagnostics, thus assisting clinical practitioners in the determination of an appropriate treatment policy to recover effectively the patients’ functions Thesis structure The dissertation consists of 124 pages: Question pages, overview 36 pages; Subject and methodology 15 pages; Results 31 pages; Comment 37 pages; Conclusion pages; Recommendation: page The thesis consists of 41 tables, 45 figures, graphs, 119 references (Vietnamese: 18; 101) Chapter OVERVIEW DOCUMENT 1.1 The role of MRI in the diagnosis of brachial plexus injuries MRI is a visualization method based on the principle of putting the body into a strong magnetic field to synchronize the direction of motion of the hydrogen atoms in the water molecules and then use a radio frequency antenna Low to activate the tissues in the body, hydrogen atoms will resonate and emit signals In the magnetically stable magnetic field, the radio frequency will vary according to the purpose of the survey, the target group of the various organs (parenchyma, muscle, fat, water, blood vessels, etc.) The emitted signal is picked up by the antenna and transmitted to the signal processing computer and the control computer, whereby the image of the body structure is displayed With the new high-powered MRI camera, the Gyroscan Achieva Tesla from Phillips (The Netherlands), uses T2W of Vista Sense with the help of 3D rendering and rendering software, the root, stem, bundle, and part of the branches are separated, while separating the rotifer with other complex structures in the neck 1.2 Situation of MRI in diagnosis of traumatic brachial plexus injury Early in the world, there were some researches related MRI traumatic brachial plexus injury, namely Blair DN et al (1987), Bilbey JH et al (1994) Authors Cejas DC (2015) and Fan YL (2016) conclude that MRI is a useful supplement to clinical diagnosis, helping to select the best course of treatment for patients In Vietnam, as we know, only a few published results of the group of authors of 108 Military Central Hospital, namely Dinh Hoang Long (2012) concluded that MRI and surgical outcome were highly relevant (80.6%) after comparisons Chapter OBJECTIVES AND RESEARCH METHODS 2.1 Research subjects and methods The study was conducted on 60 patients who were examined and treated at the 108 Military Central Hospital from January 2012 to December 2014 2.1.1 Standard selection - Patients with a history of trauma, traumatic events with paralysis or paralysis and clinical examination and determination of lesions and symptoms of MRI Tesla - Being treated for traumatic brachial plexus injury at the Military Orthopedic Trauma Institute, 108 Military Central Hospital and a surgery document describing the lesions of traumatic brachial plexus injury according to the medical records of this study 2.1.2 Exclusion criteria Patients who is suffering from traumatic brain injury, but not due to traumatic injury, but due to medical disease, multiple injuries Patients who not agree to participate in this study Patients who are not recorded in the medical records 2.1.3 Sample size p(1  p) n  Z2(1 / 2) 2 Instead of the formula we have n = 48 patients 2.2 Research Methods A prospective, cross-sectional descriptive study comparing the diagnosis of brachial plexus injuries on MRI Tesla befor surgery with postoperative diagnosis 2.2.2 Research content 2.2.2.1 General characteristics of brachial plexus injuries: Age, gender, causes of injury, combined injury, place of injury, time from illness to imaging, duration from illness to surgery 2.2.2.2 Image of brachial plexus injuries on MRI In combination with the diagnostic criteria of some authors, we propose to investigate 10 signs of brachial plexus injuries on MRI Tesla as follows: spinal cord stenosis, oedema from preganglionic, root avulsion, pseudomeningocele, diarrhea (root, trunk, cords), swelling (root, trunk, cords), Rupture in the sheath (root, trunk, cords), Incomplete rupture, rupture (root, trunk, cords), atrophy - The above-mentioned brachial plexus injuries are described in the following positions: divided by anatomy and T1W vertical, T2W longitudinal, T2W horizontal, T2-weighted, T2-weighted, T2-weighted, myelography ), MIP and 3D - Location of marrow and root, trunk, cords on all MRI 2.2.2.3 Results diagnosis of surgeon - Results of root, trunk and cords according to the surgeon: root avulsion (including pseudomeningocele), rupture (root, trunk, cords) 2.2.2.4 Comparing the diagnosis of MRI with surgery based on two signs: root avulsion (including pseudomeningocele), rupture (root, trunk, cords) 2.2.3 Tools MRI Gyroscan Achieva Tesla camera from Phillips (Netherlands) located in the Department of Diagnostic Imaging, 108 Hospital with coil NeuroVascular NV-16 2.2.5 Image and data processing - Patients' MRI images are stored as DICOM 3.0 and PNG images The images are based on the Vista sense software from Phillips (The Netherlands) MRI readings are saved as Word files Statistical data is stored in a computer in Excel format and then processed using SPSS 16.0 - The algorithms used in the study: Statistics describing the frequency of occurrence of signs of brachial plexus injuries (10 signs) by absolute number and percentage on each type of pulse and section to find out Rules related to position, number, level of injury, injury mechanism and the advantages of each type of image Compare the results of the diagnosis of MRI brachial plexus injuries with results in surgery Calculate the suitability, sensitivity, specificity of CHT in the diagnosis of localization, the number of lesions compared with the diagnosis of surgeon Study map Chapter RESEARCH RESULTS 3.1 General characteristics of patients with brachial plexus injuries - Brachial plexus injuries is mainly in young and in men: mean age 28.8 ± 11.8 years, male / female = 29 - Causes of brachial plexus injuries are mainly caused by traffic accidents, accounting for 76.7% the left brachial plexus injuries > right Most are without combined lessions (88.3%) - The majority of patients (43.3%) were given MRI for a period of 30