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Introduction: We assessed the diagnostic accuracy of 3T magnetic resonance imaging in comparison with surgical exploration for detecting root avulsion in brachial plexus birth injuries. Methods: This retrospective cohort study describes a consecutive series of 18 infants with brachial plexus birth injuries born between January 2019 and May 2024 who had a surgical exploration of the plexus preceded by magnetic resonance imaging under the same general anaesthetic.

Results: The overall diagnostic accuracy of magnetic resonance imaging for detecting root avulsion(s) of C5–T1 was 68%, with 67% sensitivity and 92% specificity. It has a ‘good’ diagnostic accuracy for detection of root avulsion, although only a ‘sufficient’ sensitivity.

Conclusion: Although useful, magnetic resonance imaging in its current form cannot be solely relied upon for clinical decision-making in brachial plexus birth injuries. Level of evidence: IV