Exploratory study of MR 3D-FIESTA sequence in diagnosing brachial plexus injury in children

Brachial plexus injury in children, particularly from birth trauma, can lead to significant upper limb dysfunction if not diagnosed accurately and early. Conventional magnetic resonance imaging (MRI) sequences provide excellent anatomical detail but often fail to clearly visualize the fine neural structures critical for surgical planning, especially in distinguishing pre- from post-ganglionic injuries. The three-dimensional fast imaging employing steady-state acquisition sequence offers high spatial resolution and rapid acquisition, which may be particularly advantageous for pediatric patients. This study aims to evaluate the clinical utility of this MRI sequence in diagnosing brachial plexus injuries in children, using intraoperative findings as the reference standard. This retrospective study employed a combined MRI protocol integrating conventional sequences (axial T1/T2-weighted imaging, coronal T2-STIR) with 3D-FIESTA in 23 pediatric brachial plexus injury cases. The complementary diagnostic value of conventional anatomical imaging and 3D-FIESTA’s high-resolution nerve visualization was systematically evaluated against intraoperative exploration findings. MRI with 3D-FIESTA clearly displayed normal brachial plexus structures (roots, trunks, ganglia) and injury features in all 23 children, with findings corroborated by intraoperative exploration. MRI of the brachial plexus using 3D-FIESTA sequence exhibits multiple advantages of clearly displaying the brachial plexus, effectively distinguishing pre- and post-ganglionic injuries, and locating post-ganglionic injuries of the brachial plexus preferably. It can be considered as one of the preferred methods for the diagnosis of brachial plexus injury.