DTI MRI of the Brain, Spinal Cord and Brachial Plexus: Pilot Study
Research type
Research Study
Full title
Magnetic Resonance Imaging of the Spinal Cord, Deep Motor Tracts of the Brain and Brachial Plexus with Diffusion Tensor Imaging Tractography Following Traumatic Brachial Plexus Injury in Adults: A Development (Phase 1) and Proof of Concept (Phase 2) Study
IRAS ID
178644
Contact name
Ryckie Wade
Contact email
Sponsor organisation
Leeds Teaching Hospitals
Duration of Study in the UK
0 years, 6 months, 1 days
Research summary
This brachial plexus is a network of nerves which originate in the spinal cord and travel to the arm to supply it with movement and feeling. Serious injury to these nerves in adults has devastating results. It results in permanent loss of movement and feeling in the arm and hand. Such injuries are commonplace in high speed road traffic accidents, which are increasingly common in the UK.
When a nerve is damaged at the junction with the spinal cord it is called a nerve root avulsion. When the nerve is severely damaged beyond the junction with the spinal cord, it may be irreversibly damaged (ruptured or crushed). When nerves are injured severely the part of the nerve furthest from the spinal cord dies away. If we repair the nerves early, then the nerve will regrow down the arm and reanimate the arm with feeling and movement.
As nerves regenerate (regrow) at approximately 1mm per day, there is often a long delay from the time we repair the nerves to the time the patients have any recovery of feeling or movement (months or years). At present, we don’t have any way of monitoring how well nerves are recovering inside the body and by the time we know if our surgery has truly worked or failed, we opportunity to reanimate the limb has passed.
Currently, we use Magnetic Resonance Imaging (MRI) to help us see the level of injury i.e. where the injury may be in the spinal cord, neck or arm along its anatomical pathway. MRI can help us to see the number of nerves avulsed (pulled away) from the spinal cord when the damage is at the junction with the spinal cord but current scanning protocols do not give clear images. More recently, MRI studies on animals have suggested that the spinal cord itself also undergoes changes after nerve injury i.e. an area of the spinal cord shrinks after its corresponding nerve in the limb is damaged. This year, researchers in Italy developed a new MRI scanning protocol which enables us to track nerves from the spinal cord into the limb and determine their integrity.
At present, our MRI images are not good enough to guide management in isolation so most patients undergo major exploratory surgery. Our study will use MRI in different modes to see if we can detect subtle changes in the brain, spinal cord and brachial plexus in patients with nerve injuries. We hypothesise that if we can translate our laboratory work in animals to humans and combine this with the recent advances in MRI imaging, then we could begin to see the brachial plexus with scans and potentially avoid the need for major exploratory surgery. Further, we could monitor the recovery (or lack) of nerves after injury and/or surgery and identify those destined to a poor outcome, so we can intervene sooner and reanimate the limb. If this MR scanning protocol could be made to work, it could revolutionise the management of brachial plexus injury worldwide.
REC name
Yorkshire & The Humber - Leeds East Research Ethics Committee
REC reference
16/YH/0162
Date of REC Opinion
15 Jun 2016
REC opinion
Further Information Favourable Opinion