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Bang MH, Song HL, Hahn S, Kim W, Do HK. Neuralgic amyotrophy with hourglass-like constrictions: A case report. World J Clin Cases 2024; 12:6728-6735. [PMID: 39650818 PMCID: PMC11514359 DOI: 10.12998/wjcc.v12.i34.6728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 09/11/2024] [Accepted: 09/25/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Neuralgic amyotrophy (NA) is a rare disease with sudden upper limb pain followed by affected muscle weakness. The most commonly affected area in NA is the upper part of the brachial plexus, and the paraspinal muscles are rarely affected (1.5%), making these cases difficult to distinguish from cervical radiculopathy. CASE SUMMARY A 76-year-old male presented to the emergency department with left hip pain post-fall. After undergoing left femoral neck fracture surgery, he experienced sudden left shoulder pain for 10 days with subsequent left arm weakness. Cervical spine computed tomography revealed mild right asymmetric intervertebral disc bulging with a decreased C5-6disc space. Three weeks later, an electrodiagnostic study confirmed brachial plexopathy findings involving the cervical root. Magnetic resonance neurography was performed for a differential diagnosis. Contrast enhancement was identified at the upper trunk of the brachial plexus, including the C5 nerve root. A suprascapular nerve hourglass-like focal constriction (HLFC) was also identified, confirming NA. After being diagnosed with NA, the patient received 15 mg prednisolone, twice daily, for 3 weeks. Physical therapy was initiated, including left arm strengthening exercises and electrical stimulation therapy. Left shoulder muscle strength significantly improved one month after comprehensive rehabilitation. CONCLUSION NA's unique features like HLFC and paraspinal involvement are crucial for accurate diagnosis, avoiding confusion with cervical radiculopathy.
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Affiliation(s)
- Mi-Hyeon Bang
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, South Korea
| | - Ha-Lim Song
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, South Korea
| | - Seok Hahn
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, South Korea
| | - Wanil Kim
- Division of Biochemistry, Department of Convergence Medical Science, Institute of Medical Science, Gyeongsang National University College of Medicine, Jinju 52727, South Korea
| | - Hwan-Kwon Do
- Department of Physical Medicine and Rehabilitation, Dongnam Institute of Radiological and Medical Sciences, Busan 46033, South Korea
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Cheng T, Li F, Jiang X, Yu D, Wei J, Yuan Y, Xu H. Comparison of different acceleration factors of artificial intelligence-compressed sensing for brachial plexus MRI imaging: scanning time and image quality. BMC Med Imaging 2024; 24:309. [PMID: 39543482 PMCID: PMC11566112 DOI: 10.1186/s12880-024-01493-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 11/06/2024] [Indexed: 11/17/2024] Open
Abstract
BACKGROUND 3D brachial plexus MRI scanning is prone to examination failure due to the lengthy scan times, which can lead to patient discomfort and motion artifacts. Our purpose is to investigate the efficacy of artificial intelligence-assisted compressed sensing (ACS) in improving the acceleration efficiency and maintaining or enhancing the image quality of brachial plexus MR imaging. METHODS A total of 30 volunteers underwent 3D sampling perfection with application-optimized contrast using different flip angle evolution short time inversion recovery using a 3.0T MR scanner. The imaging protocol included parallel imaging (PI) and ACS employing acceleration factors of 4.37, 6.22, and 9.03. Radiologists evaluated the neural detail display, fat suppression effectiveness, presence of image artifacts, and overall image quality. Signal intensity and standard deviation of specific anatomical sites within the brachial plexus and background tissues were measured, with signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) subsequently calculated. Cohen's weighted kappa (κ), One-way ANOVA, Kruskal-Wallis and pairwise comparisons with Bonferroni-adjusted significance level. P < 0.05 was considered statistically significant. RESULTS ACS significantly reduced scanning times compared to PI. Evaluations revealed differences in subjective scores and SNR across the sequences (P < 0.05), with no marked differences in CNR (P > 0.05). For subjective scores, ACS 9.03 were lower than the other three sequences in neural details display, image artifacts and overall image quality. There was no significant difference in fat suppression. For objective quantitative evaluation, SNR of right C6 root in ACS 6.22 and ACS 9.03 was higher than that in PI; SNR of left C6 root in ACS 4.37, ACS 6.22 and ACS 9.03 was higher than that in PI; SNR of medial cord in ACS 6.22, ACS 9.03 was higher than that in PI. CONCLUSION Compared with PI, ACS can shorten scanning time while ensuring good image quality.
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Affiliation(s)
- Tianxin Cheng
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Beijing, 100050, China
| | - Feifei Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Beijing, 100050, China
- Department of Radiology, BaoShan Hospital of Traditional Chinese Medicine, Baoshan, Yunnan, China
| | - Xuetao Jiang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Beijing, 100050, China
- Department of Radiology, Zunyi First People's Hospital, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Dan Yu
- United Imaging Research Institute of Intelligent Imaging, Beijing, China
| | - Jie Wei
- Shanghai United Imaging Healthcare Co., Ltd., Shanghai, China
| | - Ying Yuan
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Beijing, 100050, China.
| | - Hui Xu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Beijing, 100050, China.
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Hu SX, Xiao Y, Peng WL, Zeng W, Zhang Y, Zhang XY, Ling CT, Li HX, Xia CC, Li ZL. Accelerated 3D MR neurography of the brachial plexus using deep learning-constrained compressed sensing. Eur Radiol 2024; 34:842-851. [PMID: 37606664 DOI: 10.1007/s00330-023-09996-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/20/2023] [Accepted: 06/02/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES To explore the use of deep learning-constrained compressed sensing (DLCS) in improving image quality and acquisition time for 3D MRI of the brachial plexus. METHODS Fifty-four participants who underwent contrast-enhanced imaging and forty-one participants who underwent unenhanced imaging were included. Sensitivity encoding with an acceleration of 2 × 2 (SENSE4x), CS with an acceleration of 4 (CS4x), and DLCS with acceleration of 4 (DLCS4x) and 8 (DLCS8x) were used for MRI of the brachial plexus. Apparent signal-to-noise ratios (aSNRs), apparent contrast-to-noise ratios (aCNRs), and qualitative scores on a 4-point scale were evaluated and compared by ANOVA and the Friedman test. Interobserver agreement was evaluated by calculating the intraclass correlation coefficients. RESULTS DLCS4x achieved higher aSNR and aCNR than SENSE4x, CS4x, and DLCS8x (all p < 0.05). For the root segment of the brachial plexus, no statistically significant differences in the qualitative scores were found among the four sequences. For the trunk segment, DLCS4x had higher scores than SENSE4x (p = 0.04) in the contrast-enhanced group and had higher scores than SENSE4x and DLCS8x in the unenhanced group (all p < 0.05). For the divisions, cords, and branches, DLCS4x had higher scores than SENSE4x, CS4x, and DLCS8x (all p ≤ 0.01). No overt difference was found among SENSE4x, CS4x, and DLCS8x in any segment of the brachial plexus (all p > 0.05). CONCLUSIONS In three-dimensional MRI for the brachial plexus, DLCS4x can improve image quality compared with SENSE4x and CS4x, and DLCS8x can maintain the image quality compared to SENSE4x and CS4x. CLINICAL RELEVANCE STATEMENT Deep learning-constrained compressed sensing can improve the image quality or accelerate acquisition of 3D MRI of the brachial plexus, which should be benefit in evaluating the brachial plexus and its branches in clinical practice. KEY POINTS •Deep learning-constrained compressed sensing showed higher aSNR, aCNR, and qualitative scores for the brachial plexus than SENSE and CS at the same acceleration factor with similar scanning time. •Deep learning-constrained compressed sensing at acceleration factor of 8 had comparable aSNR, aCNR, and qualitative scores to SENSE4x and CS4x with approximately half the examination time. •Deep learning-constrained compressed sensing may be helpful in clinical practice for improving image quality and acquisition time in three-dimensional MRI of the brachial plexus.
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Affiliation(s)
- Si-Xian Hu
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yi Xiao
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Wan-Lin Peng
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Wen Zeng
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yu Zhang
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xiao-Yong Zhang
- Clinical Science, Philips Healthcare, Chengdu, Sichuan, China
| | - Chun-Tang Ling
- Clinical Science, Philips Healthcare, Chengdu, Sichuan, China
| | - Hai-Xia Li
- C&TS, Philips Healthcare, Guangzhou, Guangdong, China
| | - Chun-Chao Xia
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
| | - Zhen-Lin Li
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Pan L, Ren Z, Zhu K, Li J. Eliciting tactile sensations in the hand through non-invasive proximal nerve stimulation: a feasibility study. Med Biol Eng Comput 2023; 61:3225-3232. [PMID: 37721698 DOI: 10.1007/s11517-023-02923-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 08/29/2023] [Indexed: 09/19/2023]
Abstract
Recently, non-invasive proximal nerve stimulation has been widely investigated to restore tactile sensations. It has been demonstrated that tactile sensations in the hand could be elicited by nerve stimulation on the upper arm. However, it is still unknown whether tactile sensations could be elicited by stimulation at a proximal location close to the neck. In this study, non-invasive proximal nerve stimulation tests were performed to elicit tactile sensations in the hand of subjects. Six Ag/AgCl gel electrodes (2 × 3) were placed on the supraclavicular fossa where the proximal parts of the brachial plexus nerves were located. Then, fifteen potential electrode pairs were tested to explore whether tactile sensations could be elicited by non-invasive proximal nerve stimulation. Eight able-bodied subjects (male) were recruited to participate in the test. The stimulated sensation regions in the hand and the sensory intensity were reported and recorded during the experiment. The results demonstrated that the tactile sensations in various regions in the hand could be elicited through non-invasive nerve stimulation at the proximal location close to the neck.
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Affiliation(s)
- Lizhi Pan
- The Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering, Tianjin University, 135 Yaguan Road, Jinnan District, Tianjin, 300350, China
| | - Zhihao Ren
- The Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering, Tianjin University, 135 Yaguan Road, Jinnan District, Tianjin, 300350, China
| | - Kun Zhu
- The Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering, Tianjin University, 135 Yaguan Road, Jinnan District, Tianjin, 300350, China
| | - Jianmin Li
- The Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering, Tianjin University, 135 Yaguan Road, Jinnan District, Tianjin, 300350, China.
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Koneru S, Nguyen VT, Hacquebord JH, Adler RS. Brachial Plexus Nerve Injuries and Disorders. Magn Reson Imaging Clin N Am 2023; 31:255-267. [PMID: 37019549 DOI: 10.1016/j.mric.2023.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Multimodality imaging of the brachial plexus is essential to accurately localize the lesion and characterize the pathology and site of injury. A combination of computed tomography (CT), ultrasound, and MR imaging is useful along with clinical and nerve conduction studies. Ultrasound and MR imaging in combination are effective to accurately localize the pathology in most of the cases. Accurate reporting of the pathology with dedicated MR imaging protocols in conjunction with Doppler ultrasound and dynamic imaging provides practical and useful information to help the referring physicians and surgeons to optimize medical or surgical treatment regimens.
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Mabrouk SMM, Zaytoon HAEH, Farid AM, Khadrah RSA. Additive value of magnetic resonance neurography in diagnosis of brachial plexopathy: a cross-section descriptive study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00555-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Management of brachial plexopathy requires proper localization of the site and nature of nerve injury. Nerve conduction studies and electrophysiological studies (ED) are crucial when diagnosing brachial neuropathy but these do not determine the actual site of the lesion. Conventional MRI has been used to evaluate the brachial plexus. Still, it carried the disadvantage of the inability to provide multi-planar images that depict the entire length of the neural plexus .It might be difficult to differentiate the brachial plexus nerves from adjacent vascular structures. Magnetic resonance neurography (MRN) is an innovative imaging technique for direct imaging of the spinal nerves. Our study aims to detect the additive role of MRN in the diagnosis of brachial plexopathy over ED. Forty cases of clinically suspected and proved by clinical examination and ED—traumatic (N = 30) and non-traumatic (N = 10)—were included in our study. We compared MRN finding with results of clinical examination and ED.
Results
MRN findings showed that the root was involved in 80% of cases, trunks in 70% of cases affecting the middle trunk in 40% of cases, the middle and posterior cord in 25%, lateral cord in 50%, and terminal branches on 10% of cases. Ten percent of cases were normal according to MRN, and 90% had abnormal findings in the form of preganglionic nerve root avulsion in 30% of cases, mild perineural edema surrounding C6/7 nerve roots in 20%, lower brachial trunk high signal in 10%, complicated with pseudo meningocele in 20%, and with increased shoulder muscle T2 signal intensity with muscle atrophy in 10%. There were minimal differences between clinical examination finding and MRN findings, with very good agreement between electromyography and nerve conduction (p value < 0.05, with sensitivity and specificity values of 94.44% and 100%, respectively).
Conclusion
MRN is important in differentiating different types of nerve injuries, nerve root avulsion, and nerve edema, playing an important role in differentiating the site of nerve injury, both preganglionic or postganglionic and planning for treatment of the cause of nerve injury, either medical or surgical.
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Kwee RM, Borghans RAP, Bruls RJM, Fasen BACM, Kuburic D. Diagnostic performance of diffusion-weighted MR neurography as an adjunct to conventional MRI for the assessment of brachial plexus pathology. Eur Radiol 2021; 32:2791-2797. [PMID: 34750661 DOI: 10.1007/s00330-021-08324-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/30/2021] [Accepted: 09/04/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To investigate the diagnostic performance of diffusion-weighted (DW) MR neurography as an adjunct to conventional MRI for the assessment of brachial plexus pathology. METHODS DW MR neurography scans (short tau inversion recovery fat suppression and b-value of 800 s/mm2) of 15 consecutive patients with and 45 randomly selected patients without brachial plexus abnormalities were independently and blindly reviewed by a 5th year radiology resident, a junior neuroradiologist, and a senior neuroradiologist. RESULTS Median interpretation times ranged between 20 and 30 s. Interobserver agreement was substantial (κ coefficients of 0.715-0.739). For the 5th year radiology resident, sensitivity was 53.3% (95% CI, 30.1-75.2%) and specificity was 100% (95% CI, 92.1-100%). For the junior neuroradiologist, sensitivity was 66.7% (95% CI, 41.7-84.8%) and specificity was 100% (95% CI, 92.1-100%). For the senior neuroradiologist, sensitivity was 73.3% (95% CI, 48.1-89.1%) and specificity was 95.6% (95% CI, 85.2-98.8%). Traumatic injury, metastases, radiation-induced plexopathy, schwannoma, and inflammatory process of unknown cause could be detected by the majority of readers (100% detection rate for each disease entity by at least two readers). Neuralgic amyotrophy, iatrogenic injury after first rib resection, and cervical disc herniation causing root compression were not detected by the majority of readers (0% detection rate for each disease entity by at least two readers). CONCLUSION DW MR neurography may be a useful adjunct when assessing for brachial plexus abnormalities, because interpretation time is relatively short and the majority of abnormalities can be detected. KEY POINTS • DW MR neurography interpretation time of the brachial plexus is relatively short (median interpretation times of 20 to 30 s). • Interobserver agreement between three readers with different levels of experience is substantial (κ coefficients of 0.715 to 0.739). • DW MR neurography can detect brachial plexus abnormalities with moderate sensitivity (53.3 to 73.3%) and high specificity (95.6 to 100%).
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Affiliation(s)
- Robert M Kwee
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands.
| | - Rob A P Borghans
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands
| | - Rik J M Bruls
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands
| | - Bram A C M Fasen
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands
| | - Damir Kuburic
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands
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Nair PP, Mariappan YK, Paruthikunnan SM, Kamath A, Rolla NK, Saha I, Kadavigere R. Magnetic Resonance Neurography of the Brachial Plexus Using 3D SHINKEI: Comparative Evaluation with Conventional Magnetic Resonance Sequences for the Visualization of Anatomy and Detection of Nerve Injury at 1.5T. J Med Phys 2021; 46:140-147. [PMID: 34703097 PMCID: PMC8491319 DOI: 10.4103/jmp.jmp_13_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 11/04/2022] Open
Abstract
Background and Purpose This work aims at optimizing and studying the feasibility of imaging the brachial plexus at 1.5T using 3D nerve-SHeath signal increased with INKed rest-tissue RARE imaging (3D SHINKEI) neurography sequence by comparing with routine sequences. Materials and Methods The study was performed on a 1.5T Achieva scanner. It was designed in two parts: (a) Optimization of SHINKEI sequence at 1.5T; and (b) Feasibility study of the optimized SHINKEI sequence for generating clinical quality magnetic resonance neurography images at 1.5T. Simulations and volunteer experiments were conducted to optimize the T2 preparation duration for optimum nerve-muscle contrast at 1.5T. Images from the sequence under study and other routine sequences from 24 patients clinically referred for brachial plexus imaging were scored by a panel of radiologists for diagnostic quality. Injury detection efficacy of these sequences were evaluated against the surgical information available from seven patients. Results T2 preparation duration of 50 ms gives the best contrast to noise between nerve and muscle. The images of 3D SHINKEI and short-term inversion recovery turbo spin-echo sequences are of similar diagnostic quality but significantly better than diffusion weighted imaging with background signal suppression. In comparison with the surgical findings, 3D SHINKEI has the lowest specificity; however, it had the highest sensitivity and predictive efficacy compared to other routine sequences. Conclusion 3D SHINKEI sequence provides a good nerve-muscle contrast and has high predictive efficacy of nerve injury, indicating that it is a potential screening sequence candidate for brachial plexus scans at 1.5T also.
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Affiliation(s)
- Prashant Prabhakaran Nair
- Department of Radiodiagnosis and Imaging, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Bengaluru, Karnataka, India
| | | | - Samir M Paruthikunnan
- Department of Radiodiagnosis and Imaging, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Bengaluru, Karnataka, India
| | - Asha Kamath
- Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Gurgaon, Haryana, India
| | | | | | - Rajagopal Kadavigere
- Department of Radiodiagnosis and Imaging, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Bengaluru, Karnataka, India
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Gilcrease-Garcia BM, Deshmukh SD, Parsons MS. Anatomy, Imaging, and Pathologic Conditions of the Brachial Plexus. Radiographics 2021; 40:1686-1714. [PMID: 33001787 DOI: 10.1148/rg.2020200012] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The brachial plexus is an intricate anatomic structure with an important function: providing innervation to the upper extremity, shoulder, and upper chest. Owing to its complex form and longitudinal course, the brachial plexus can be challenging to conceptualize in three dimensions, which complicates evaluations in standard orthogonal imaging planes. The components of the brachial plexus can be determined by using key anatomic landmarks. Applying this anatomic knowledge, a radiologist should then be able to identify pathologic appearances of the brachial plexus by using imaging modalities such as MRI, CT, and US. Brachial plexopathies can be divided into two broad categories that are based on disease origin: traumatic and nontraumatic. In the traumatic plexopathy group, there are distinct imaging findings and management methods for pre- versus postganglionic injuries. For nontraumatic plexopathies, having access to an accurate patient history is often crucial. Knowledge of the timing of radiation therapy is critical to diagnosing post-radiation therapy brachial plexopathy. In acute brachial neuritis, antecedent stressors occur within a specific time frame. Primary and secondary tumors of the brachial plexus are not uncommon, with the most common primary tumors being peripheral nerve sheath tumors. Direct extension and metastasis from primary malignancies such as breast and lung cancer can occur. Although diagnosing a brachial plexus anomaly is potentially perplexing, it can be straightforward if it is based on foundational knowledge of anatomy, imaging findings, and pathologic features. ©RSNA, 2020.
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Affiliation(s)
- Brian M Gilcrease-Garcia
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill (B.M.G., S.D.D.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Box 8131, St Louis, MO 63110 (M.S.P.)
| | - Swati D Deshmukh
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill (B.M.G., S.D.D.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Box 8131, St Louis, MO 63110 (M.S.P.)
| | - Matthew S Parsons
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill (B.M.G., S.D.D.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Box 8131, St Louis, MO 63110 (M.S.P.)
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10
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Bai Y, Wang Y, Ma C, Wu L, Zhou Q, Zhang C, Xia C. Application value of enhanced 3D STIR SPACE sequence in brachial plexus. Minerva Surg 2021; 77:73-76. [PMID: 33944522 DOI: 10.23736/s2724-5691.21.08905-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Yupeng Bai
- Medical Image Center, The Third Affiliated Hospital of Anhui Medical University/Hefei No1. People's Hospital, Hefei, China
| | - Yueyue Wang
- Medical Image Center, Hefei Binhu Hospital, Hefei, China
| | - Changyue Ma
- Medical Image Center, The Third Affiliated Hospital of Anhui Medical University/Hefei No1. People's Hospital, Hefei, China
| | - Lingqiao Wu
- Medical Image Center, Hefei Binhu Hospital, Hefei, China
| | - Qian Zhou
- Medical Image Center, Hefei Binhu Hospital, Hefei, China
| | - Chunyan Zhang
- Medical Image Center, Hefei Binhu Hospital, Hefei, China
| | - Chunhua Xia
- Medical Image Center, The Third Affiliated Hospital of Anhui Medical University/Hefei No1. People's Hospital, Hefei, China -
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Bordalo-Rodrigues M, Siqueira MG, Kurimori CO, Carneiro ACR, Martins RS, Foroni L, Oliveira AJM, Solla DJF. Diagnostic accuracy of imaging studies for diagnosing root avulsions in post-traumatic upper brachial plexus traction injuries in adults. Acta Neurochir (Wien) 2020; 162:3189-3196. [PMID: 32591949 DOI: 10.1007/s00701-020-04465-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is no consensus about which type of imaging study, computed tomography myelography (CTM) or magnetic resonance imaging (MRI), provides better information concerning root avulsion in adult brachial plexus injuries. METHODS Patients with upper brachial plexus traumatic injuries underwent both CTM and MRI and surgical exploration. The imaging studies were analyzed by two independent radiologists and the data were compared with the intraoperative findings. The statistical analysis was based on dichotomous classification of the nerve roots (normal or altered). The interobserver agreement was assessed using Cohen's Kappa. The accuracy of CTM and MRI in comparison with the intraoperative findings was evaluated using the same methodology. RESULTS Fifty-two adult patients were included. CTM tended to yield slightly higher percentages of alterations than MRI The interobserver agreement was better on CTM than on MRI for all nerve roots: C5, 0.9960 (strong) vs. 0.145 (poor); C6, 0.970 (strong) vs. 0.788 (substantial); C7, 0.969 (strong) vs. 0.848 (strong). The accuracy regarding the intraoperative findings was also higher on CTM (moderate, kappa 0.40-0.59) than on MRI (minimal, kappa 0.20-0.39) for all nerve roots. Accordingly, the overall percentage concordance (both normal or both altered) was superior in the CTM evaluation (approx. 70-75% vs. 60-65%). CTM was superior for both sensitivity and specificity at all nerve roots. CONCLUSION CTM had greater interobserver agreement and higher diagnostic accuracy than MRI in adult patients with root avulsions due to brachial plexus injury.
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Combine contrast-enhanced 3D T2-weighted short inversion time inversion recovery MR neurography with MR angiography at 1.5 T in the assessment of brachial plexopathy. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2020; 34:229-239. [DOI: 10.1007/s10334-020-00867-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 06/20/2020] [Accepted: 07/08/2020] [Indexed: 12/21/2022]
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Upadhyaya V, Upadhyaya DN, Bansal R, Pandey T, Pandey AK. MR neurography in Parsonage-Turner syndrome. Indian J Radiol Imaging 2019; 29:264-270. [PMID: 31741594 PMCID: PMC6857269 DOI: 10.4103/ijri.ijri_269_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/01/2019] [Accepted: 09/04/2019] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: Parsonage Turner Syndrome is a well known clinical entity. Several excellent articles have succinctly described Magnetic Resonance Imaging (MRI) findings in PTS. However, these articles have inferred neural involvement in PTS based on the patterns of denervation of muscles in the shoulder region. The aim of this study is to directly visualize the distribution and extent of abnormality in MR Neurography (MRN) of the brachial plexus in known cases of brachial plexus neuritis or Parsonage-Turner Syndrome (PTS). Methods: 15 patients who were diagnosed with PTS based on clinical and electrophysiological findings participated in the study. MRN of the brachial plexus was done in a 1.5T system using a combination of T1W (T1-weighted), T2W (T2-weighted) fat-saturated, STIR (Short Tau Inversion Recovery), 3D STIR SPACE (Sampling Perfection with Application Optimized Contrasts) and 3D T2W SPACE sequences. Findings were recorded and assessed. Results: The age range of our patients was 7-65 years (mean 37.87 years). Most of the patients had unilateral symptoms. All patients had weakness in shoulder abduction. Other common associated complaints included pain in the shoulder/neck/arm and preceding fever. MRN revealed the percentage of involvement of roots, trunks, cords and terminal branches was 53.3%, 46.7%, 40% and 13.3% respectively. Evidence of muscle denervation in the form of edema, fatty infiltration and atrophy was noted in 8 (53.3%) patients. Conclusion: Most of the patients in this study had unilateral involvement on MRN. The roots were the commonest site of involvement followed by the trunks, cords and terminal branches. C5 was the most commonly involved root.
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Affiliation(s)
- Vaishali Upadhyaya
- Department of Radiology, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Nirala Nagar, Uttar Pradesh, India
| | - Divya Narain Upadhyaya
- Department of Plastic Surgery, King George's Medical University, Shah Meena Road, Chowk, Lucknow, Uttar Pradesh, India
| | - Richa Bansal
- Department of Radiology, Max Superspecialty Hospital, Saket, New Delhi, India
| | - Tarun Pandey
- Department of Neurosurgery, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Nirala Nagar, Uttar Pradesh, India
| | - Ashok Kumar Pandey
- Department of Neurology, Vivekananda Polyclinic and Institute of Medical Sciences, Vivekanandapuri, Nirala Nagar, Uttar Pradesh, India
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Caldana WCI, Kodaira SK, Cavalcanti CFDA, Rodrigues MB, Saito ODC, Buchpiguel CA. Value of ultrasound in the anatomical evaluation of the brachial plexus: correlation with magnetic resonance imaging. Radiol Bras 2018; 51:358-365. [PMID: 30559552 PMCID: PMC6290743 DOI: 10.1590/0100-3984.2017.0083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Objective To assess the accuracy of ultrasound in the visualization of the brachial
plexus and to determine the value of the method in comparison with that of
magnetic resonance imaging (MRI). Materials and Methods This was an anatomical study of the brachial plexuses of 20 asymptomatic
adults (40 plexuses), comparing ultrasound and MRI in terms of their
accuracy. In the ultrasound study, a high-frequency linear transducer was
used, and a neurovascular coil was used in the MRI study. To estimate the
frequency of visualization, the brachial plexus was divided into
segments. Results The cervical nerve roots, the upper trunk, and the middle trunk were the
segments that were best visualized on ultrasound. On MRI, the degree of
visualization was excellent for most of the segments. In the comparison
between ultrasound and MRI, the C6, C7, upper trunk, and middle trunk
segments showed equivalent degrees of visualization, with a high level of
agreement between the two methods. Conclusion In the brachial plexus, ultrasound can be used in the assessment of the
cervical nerve roots, as well as of the upper and middle trunks, although it
provides limited visualization of the remaining segments. Ultrasound and MRI
showed a high level of agreement for the visualization of the C6, C7, and
middle trunk segments.
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Affiliation(s)
- Wanda Chiyoko Iwakami Caldana
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Sergio Keidi Kodaira
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | | | - Marcelo Bordalo Rodrigues
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Osmar de Cassio Saito
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Carlos Alberto Buchpiguel
- Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil
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Brachial plexus traumatic root injury in adults: Role of different non contrast MRI sequences in pre-operative assessment. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Lee JH, Cheng KL, Choi YJ, Baek JH. High-resolution Imaging of Neural Anatomy and Pathology of the Neck. Korean J Radiol 2017; 18:180-193. [PMID: 28096728 PMCID: PMC5240499 DOI: 10.3348/kjr.2017.18.1.180] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 07/10/2016] [Indexed: 11/15/2022] Open
Abstract
The neck has intricately connected neural structures, including cervical and brachial plexi, the sympathetic system, lower cranial nerves, and their branches. Except for brachial plexus, there has been little research regarding the normal imaging appearance or corresponding pathologies of neural structures in the neck. The development in imaging techniques with better spatial resolution and signal-to-noise ratio has made it possible to see many tiny nerves to predict complications related to image-guided procedures and to better assess treatment response, especially in the management of oncology patients. The purposes of this review is to present imaging-based anatomy of major nerves in the neck and explain their relevant clinical significance according to representative pathologies of regarded nerves in the neck.
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Affiliation(s)
- Jeong Hyun Lee
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Kai-Lung Cheng
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung 402, Taiwan.; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung 402, Taiwan.; Department of Veterinary Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Young Jun Choi
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jung Hwan Baek
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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High resolution neurography of the brachial plexus by 3Tesla magnetic resonance imaging. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.rxeng.2016.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Cejas C, Rollán C, Michelin G, Nogués M. High resolution neurography of the brachial plexus by 3 Tesla magnetic resonance imaging. RADIOLOGIA 2016; 58:88-100. [PMID: 26860655 DOI: 10.1016/j.rx.2015.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 09/23/2015] [Accepted: 12/16/2015] [Indexed: 12/23/2022]
Abstract
The study of the structures that make up the brachial plexus has benefited particularly from the high resolution images provided by 3T magnetic resonance scanners. The brachial plexus can have mononeuropathies or polyneuropathies. The mononeuropathies include traumatic injuries and trapping, such as occurs in thoracic outlet syndrome due to cervical ribs, prominent transverse apophyses, or tumors. The polyneuropathies include inflammatory processes, in particular chronic inflammatory demyelinating polyneuropathy, Parsonage-Turner syndrome, granulomatous diseases, and radiation neuropathy. Vascular processes affecting the brachial plexus include diabetic polyneuropathy and the vasculitides. This article reviews the anatomy of the brachial plexus and describes the technique for magnetic resonance neurography and the most common pathologic conditions that can affect the brachial plexus.
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Affiliation(s)
- C Cejas
- Departamento de Imágenes, Fundación para la lucha de las enfermedades neurológicas de la infancia Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina.
| | - C Rollán
- Departamento de Imágenes, Fundación para la lucha de las enfermedades neurológicas de la infancia Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
| | - G Michelin
- Departamento de Imágenes, Fundación para la lucha de las enfermedades neurológicas de la infancia Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
| | - M Nogués
- Departamento de Neurología, Fundación para la lucha de las enfermedades neurológicas de la infancia Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
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A case study from a nursing and occupational therapy perspective – Providing care for a patient with a traumatic brachial plexus injury. Int J Orthop Trauma Nurs 2015; 19:15-23. [DOI: 10.1016/j.ijotn.2014.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 01/10/2014] [Accepted: 01/13/2014] [Indexed: 11/21/2022]
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Zheng M, Zhu Y, Zhou X, Chen S, Cong R, Chen D. Diagnosis of closed injury and neoplasm of the brachial plexus by ultrasonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:417-422. [PMID: 24677066 DOI: 10.1002/jcu.22155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 08/12/2013] [Accepted: 03/06/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE To evaluate the feasibility and accuracy of high-frequency sonography (US) in diagnosing traumatic brachial plexus (BP) lesions and neoplasms in the adult. METHODS Eleven patients with suspected BP closed trauma, 6 patients with BP neoplasm, and 12 healthy volunteers were scanned. The US findings were compared with surgical findings. RESULTS The interscalene space and intervertebral foramina were useful anatomic markers in identifying the BP. In the 24 sites examined in the normal group (12 subjects examined on both sides), the fifth to seventh cervical nerve roots (C5-7, including upper and middle trunk) were seen, whereas the eighth cervical and first thoracic nerve roots (C8, T1, including the lower trunk) were seen in 91.7% (22/24) of the subjects. The BP appeared as three or four discrete rounded hypoechoic nodules between the anterior scalene and middle scalene muscle in transverse views at the C5-7 level, representing the trunks in the sagittal oblique section. In the BP trauma group (n = 11), the normal nerve trunk was interrupted, and lesions were shown as thickening and swelling with indistinct inner structures. In the neoplasm group (n = 6), masses were shown as hypoechoic masses. CONCLUSIONS High-frequency US is valuable in diagnosing BP closed injuries and neoplasms.
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Affiliation(s)
- Minjuan Zheng
- Ultrasound Department, Xijing Hospital, Fourth Military Medical University, Xi'an, China, 710032
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21
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Ultrasonography of the brachial plexus, normal appearance and practical applications. Diagn Interv Imaging 2014; 95:259-75. [DOI: 10.1016/j.diii.2014.01.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rehman I, Chokshi FH, Khosa F. MR Imaging of the Brachial Plexus. Clin Neuroradiol 2014; 24:207-16. [DOI: 10.1007/s00062-014-0297-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 02/06/2014] [Indexed: 12/26/2022]
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Caranci F, Briganti F, La Porta M, Antinolfi G, Cesarano E, Fonio P, Brunese L, Coppolino F. Magnetic resonance imaging in brachial plexus injury. Musculoskelet Surg 2013; 97 Suppl 2:S181-90. [PMID: 23949940 DOI: 10.1007/s12306-013-0281-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/13/2013] [Indexed: 12/20/2022]
Abstract
Brachial plexus injury represents the most severe nerve injury of the extremities. While obstetric brachial plexus injury has showed a reduction in the number of cases due to the improvements in obstetric care, brachial plexus injury in the adult is an increasingly common clinical problem. The therapeutic measures depend on the pathologic condition and the location of the injury: Preganglionic avulsions are usually not amenable to surgical repair; function of some denervated muscles can be restored with nerve transfers from intercostals or accessory nerves and contralateral C7 transfer. Postganglionic avulsions are repaired with excision of the damaged segment and nerve autograft between nerve ends or followed up conservatively. Magnetic resonance imaging is the modality of choice for depicting the anatomy and pathology of the brachial plexus: It demonstrates the location of the nerve damage (crucial for optimal treatment planning), depicts the nerve continuity (with or without neuroma formation), or may show a completely disrupted/avulsed nerve, thereby aiding in nerve-injury grading for preoperative planning. Computed tomography myelography has the advantage of a higher spatial resolution in demonstration of nerve roots compared with MR myelography; however, it is invasive and shows some difficulties in the depiction of some pseudomeningoceles with little or no communication with the dural sac.
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Affiliation(s)
- F Caranci
- Department of Advanced Biomedical Sciences, Unit of Neuroradiology, Federico II University of Naples, Via S. Pansini 5, 80131, Naples, Italy.
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Lawande M, Patkar DP, Pungavkar S. Pictorial essay: Role of magnetic resonance imaging in evaluation of brachial plexus pathologies. Indian J Radiol Imaging 2013; 22:344-9. [PMID: 23833427 PMCID: PMC3698898 DOI: 10.4103/0971-3026.111489] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Brachial plexopathies, traumatic and nontraumatic, often present with vague symptoms. Clinical examination and electrophysiological studies are useful but may not localize the lesion accurately. Magnetic resonance imaging (MRI) with its multiplanar imaging capability and soft tissue contrast resolution plays an important role in evaluation of the abnormal brachial plexus.
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Affiliation(s)
- Malini Lawande
- Department of MRI, Dr. Balabhai Nanavati Hospital, Mumbai, India
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27
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Tagliafico A, Succio G, Serafini G, Martinoli C. Diagnostic accuracy of MRI in adults with suspect brachial plexus lesions: a multicentre retrospective study with surgical findings and clinical follow-up as reference standard. Eur J Radiol 2012; 81:2666-2672. [PMID: 22071340 DOI: 10.1016/j.ejrad.2011.10.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 10/12/2011] [Accepted: 10/14/2011] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To evaluate brachial plexus MRI accuracy with surgical findings and clinical follow-up as reference standard in a large multicentre study. MATERIALS AND METHODS The research was approved by the Institutional Review Boards, and all patients provided their written informed consent. A multicentre retrospective trial that included three centres was performed between March 2006 and April 2011. A total of 157 patients (men/women: 81/76; age range, 18-84 years) were evaluated: surgical findings and clinical follow-up of at least 12 months were used as the reference standard. MR imaging was performed with different equipment at 1.5 T and 3.0 T. The patient group was divided in five subgroups: mass lesion, traumatic injury, entrapment syndromes, post-treatment evaluation, and other. Sensitivity, specificity with 95% confidence intervals (CIs), positive predictive value (PPV), pre-test-probability (the prevalence), negative predictive value (NPV), pre- and post-test odds (OR), likelihood ratio for positive results (LH+), likelihood ratio for negative results (LH-), accuracy and post-test probability (post-P) were reported on a per-patient basis. RESULTS The overall sensitivity and specificity with 95% CIs were: 0.810/0.914; (0.697-0.904). Overall PPV, pre-test probability, NPV, LH+, LH-, and accuracy: 0.823, 0.331, 0.905, 9.432, 0.210, 0.878. CONCLUSIONS The overall diagnostic accuracy of brachial plexus MRI calculated on a per-patient base is relatively high. The specificity of brachial plexus MRI in patients suspected of having a space-occupying mass is very high. The sensitivity is also high, but there are false-positive interpretations as well.
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Affiliation(s)
- Alberto Tagliafico
- Institute of Anatomy, Department of Experimental Medicine, University of Genoa, Largo Rosanna Benzi 8, 16132 Genoa, Italy.
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Tagliafico A, Succio G, Emanuele Neumaier C, Serafini G, Ghidara M, Calabrese M, Martinoli C. MR imaging of the brachial plexus: comparison between 1.5-T and 3-T MR imaging: preliminary experience. Skeletal Radiol 2011; 40:717-724. [PMID: 20972564 DOI: 10.1007/s00256-010-1050-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 09/30/2010] [Accepted: 10/04/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare 1.5-T and 3-T magnetic resonance (MR) imaging of the brachial plexus. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained from 30 healthy volunteers and 30 consecutive patients with brachial plexus disturbances. MR was prospectively performed with comparable sequence parameters and coils with a 1.5-T and a 3-T system. Imaging protocols at both field strengths included T1-weighted turbo spin-echo (tSE) sequences and T2-weighed turbo spin-echo (tSE) sequences with fat saturation. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) between muscle and nerve were calculated for both field strengths. The visibility of brachial plexus nerve at various anatomic levels (roots, interscalene area, costoclavicular space, and axillary level) was analyzed with a four-point grading scale by two radiologists. MR imaging diagnoses and pathological findings were also compared qualitatively. RESULTS SNR and CNRs were significantly higher on 3-T MR images than on 1.5-T MR images (Friedman test) for all sequences. Nerve visibility was significantly better on 3-T MR images than on 1.5-T MR images (paired sign test). Pathological findings (n = 30/30) were seen equally well with both field strengths. MR imaging diagnoses did not differ for the 1.5- and 3-T protocols. CONCLUSIONS High-quality MR images of the brachial plexus can be obtained with 3-T MR imaging by using sequences similar to those used at 1.5-T MR imaging. In patients and healthy volunteers, the visibility of nerve trunks and cords at 3-T MR imaging appears to be superior to that at 1.5-T MR imaging.
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Affiliation(s)
- Alberto Tagliafico
- Department of Radiology, National Institute for Cancer Research, Genova, Italy.
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Steens SCA, Pondaag W, Malessy MJA, Verbist BM. Obstetric brachial plexus lesions: CT myelography. Radiology 2011; 259:508-15. [PMID: 21330567 DOI: 10.1148/radiol.10101417] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the value of computed tomographic (CT) myelography in the detection of root damage and differentiation of root avulsions from neurotmesis in a large cohort of patients with an obstetric brachial plexus lesion (OBPL). MATERIALS AND METHODS Institutional review board approval was obtained. Informed consent was waived by the medical ethics committee. One hundred eighteen patients with OBPL born in the cephalic position and six patients born in the breech position were selected for surgery by two neurosurgeons in a multidisciplinary team. Functional loss of the C5 through T1 innervated muscles was noted. All patients underwent preoperative CT myelography at an average age of 19 weeks. CT myelographic examination results were reviewed by two radiologists, who were blinded to the clinical findings, for the presence of root avulsions and pseudocysts. Interobserver agreement was assessed by calculating κ values. RESULTS CT myelographic results showed root avulsions in at least one level in 66 (56%) of 118 patients born in the cephalic position and in six (100%) of six patients born in the breech position. Levels C7 and C8 showed the most root avulsions, even if not expected from clinical examination results. A large number of root avulsions showed pseudocysts (73 [68%] of 107 levels in patients born in the cephalic position and 11 [73%] of 15 levels in patients born in the breech position). CONCLUSION CT myelographic results showed root avulsions in more than half of patients with OBPL. Root avulsions were even detected at levels that were not expected at clinical examination. Because root avulsions require specific reconstructive techniques, CT myelography is recommended for every preoperative patient with OBPL.
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Affiliation(s)
- Stefan C A Steens
- Department of Radiology, Leiden University Medical Center, C2S, PO Box 9600, 2300 RC Leiden, The Netherlands.
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Offiah C, Hall E. Post-treatment imaging appearances in head and neck cancer patients. Clin Radiol 2010; 66:13-24. [PMID: 21147294 DOI: 10.1016/j.crad.2010.09.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 08/22/2010] [Accepted: 09/03/2010] [Indexed: 11/18/2022]
Abstract
Surgery and radiotherapy (with or without chemotherapy) for head and neck cancer can create a daunting array of radiological appearances post-treatment. The role of the radiologist lies not only in detecting recurrent neoplastic disease, but also identifying non-neoplastic changes that may account for clinical presentation and symptoms in this patient group. There are a number of non-neoplastic as well as neoplastic changes and disease entities that can present on surveillance imaging, such as primary resection and reconstructive surgical change, surgical neck dissection changes, radionecrosis, post-treatment denervation change, and radiotherapy-related secondary tumours. Some of these require conservative management, while others require more active treatment. Awareness and recognition of the imaging appearances of these post-treatment changes is therefore critical for the radiologist involved in the multidisciplinary care of the head and neck cancer patient.
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Affiliation(s)
- C Offiah
- Department of Neuroradiology, St Bartholomew's Hospital, Barts and The London NHS Trust, London, UK.
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31
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The postradiation neck: evaluating response to treatment and recognizing complications. AJR Am J Roentgenol 2010; 195:W164-71. [PMID: 20651177 DOI: 10.2214/ajr.09.4122] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We summarize the rationale for and physiology of radiation therapy for the treatment of head and neck cancer and review the imaging findings of expected changes and complications after radiation to the neck. It is important to be able to recognize these features at all stages during management of patients with squamous cell carcinoma and other head and neck malignancies and to be able to distinguish these changes from residual or recurrent disease. CONCLUSION Radiation therapy results in imaging findings of tissue edema followed by fibrosis, scarring, and atrophy. Complications from radiation therapy can occur months to years after treatment. Findings of a new mass, lymphadenopathy, or bone or cartilage destruction must be viewed as concerning for recurrent disease.
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32
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van Es HW, Bollen TL, van Heesewijk HPM. MRI of the brachial plexus: a pictorial review. Eur J Radiol 2010; 74:391-402. [PMID: 20226609 DOI: 10.1016/j.ejrad.2009.05.067] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 05/13/2009] [Indexed: 11/26/2022]
Abstract
Magnetic resonance imaging (MRI) of the brachial plexus is the imaging modality of first choice for depicting anatomy and pathology of the brachial plexus. The anatomy of the roots, trunks, divisions and cords is very well depicted due to the inherent contrast differences between the nerves and the surrounding fat. In this pictorial review the technique and the anatomy will be discussed. The following pathology will be addressed: neurogenic tumors of the brachial plexus and sympathetic chain, superior sulcus tumors, other tumors in the vicinity of the brachial plexus, the differentiation between radiation and metastatic plexopathy, trauma, neurogenic thoracic outlet syndrome and immune-mediated neuropathies.
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Affiliation(s)
- Hendrik W van Es
- Department of Radiology, St. Antonius Hospital, Nieuwegein, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands.
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Lieske B, Ravichandran D. Late brachial plexus injury due to physiotherapy following axillary clearance for breast carcinoma. Int J Clin Pract 2010; 64:122-4. [PMID: 20089031 DOI: 10.1111/j.1742-1241.2006.00860.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Filler A. Magnetic resonance neurography and diffusion tensor imaging: origins, history, and clinical impact of the first 50,000 cases with an assessment of efficacy and utility in a prospective 5000-patient study group. Neurosurgery 2009; 65:A29-43. [PMID: 19927075 PMCID: PMC2924821 DOI: 10.1227/01.neu.0000351279.78110.00] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Methods were invented that made it possible to image peripheral nerves in the body and to image neural tracts in the brain. The history, physical basis, and dyadic tensor concept underlying the methods are reviewed. Over a 15-year period, these techniques-magnetic resonance neurography (MRN) and diffusion tensor imaging-were deployed in the clinical and research community in more than 2500 published research reports and applied to approximately 50,000 patients. Within this group, approximately 5000 patients having MRN were carefully tracked on a prospective basis. METHODS A uniform Neurography imaging methodology was applied in the study group, and all images were reviewed and registered by referral source, clinical indication, efficacy of imaging, and quality. Various classes of image findings were identified and subjected to a variety of small targeted prospective outcome studies. Those findings demonstrated to be clinically significant were then tracked in the larger clinical volume data set. RESULTS MRN demonstrates mechanical distortion of nerves, hyperintensity consistent with nerve irritation, nerve swelling, discontinuity, relations of nerves to masses, and image features revealing distortion of nerves at entrapment points. These findings are often clinically relevant and warrant full consideration in the diagnostic process. They result in specific pathological diagnoses that are comparable to electrodiagnostic testing in clinical efficacy. A review of clinical outcome studies with diffusion tensor imaging also shows convincing utility. CONCLUSION MRN and diffusion tensor imaging neural tract imaging have been validated as indispensable clinical diagnostic methods that provide reliable anatomic pathological information. There is no alternative diagnostic method in many situations. With the elapsing of 15 years, tens of thousands of imaging studies, and thousands of publications, these methods should no longer be considered experimental.
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Affiliation(s)
- Aaron Filler
- Institute for Nerve Medicine, Santa Monica, California 90405, USA.
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Correlation Between Skin Biopsy With Quantification of Intraepidermal Nerve Fiber and the Severity of Sciatic Nerve Traction Injury in Rats. ACTA ACUST UNITED AC 2009; 66:737-42. [DOI: 10.1097/ta.0b013e3181623332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sureka J, Cherian RA, Alexander M, Thomas BP. MRI of brachial plexopathies. Clin Radiol 2008; 64:208-18. [PMID: 19103352 DOI: 10.1016/j.crad.2008.08.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 08/14/2008] [Accepted: 08/20/2008] [Indexed: 11/28/2022]
Abstract
Magnetic resonance imaging (MRI) has become the primary imaging technique in the evaluation of brachial plexus pathology, and plays an important role in the identification, localization, and characterization of the cause. Improvements in MRI technique have helped in detecting changes in the signal intensity of nerves, subtle enhancement, and in detecting perineural pathology, thereby refining the differential diagnosis. The present review of the visualization of brachial plexus abnormalities using MRI is based on a review of 26 cases. The causes include trauma and a spectrum of non-traumatic causes, such as acute idiopathic/viral plexitis, metastases, immune-mediated plexitis, and mass lesions compressing the brachial plexus.
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Affiliation(s)
- J Sureka
- Department of Radiology, Christian Medical College, Vellore, India.
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Zhang Z, Song L, Meng Q, Li Z, Luo B, Pei Z, Zeng J. Segmented echo planar MR imaging of the brachial plexus with inversion recovery magnetization preparation at 3.0T. J Magn Reson Imaging 2008; 28:440-4. [PMID: 18666178 DOI: 10.1002/jmri.21304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate the image quality of segmented echo planar MRI with inversion recovery magnetization preparation (seg-IR-EPI) to depict the anatomy and pathologic changes involving the brachial plexus. MATERIALS AND METHODS The coronal seg-IR-EPI sequence was performed on 30 healthy volunteers and 20 patients. Postprocessing techniques were used to generate images of brachial plexus and the images acquired were qualitatively evaluated by two experienced radiologists based on grading of the morphological images. Signal-to-noise ratios (SNRs) and nerve soft tissue contrast-to-noise-ratios (CNRs) were calculated and the normalized SNR (SNRn) and the normalized CNR (CNRn) were compared with the STIR TSE sequence. RESULTS Although seg-IR-EPI had more ghosting artifacts than STIR TSE, excellent general image appearance with minor blurring can be achieved with seg-IR-EPI. In all healthy volunteers the means of CNRn were significantly greater for seg-IR-EPI than for STIR-TSE, while the means of SNRn were significantly lower for seg-IR-EPI than for STIR-TSE. CONCLUSION In the present study the seg-IR-EPI sequence obtained uniform fat suppression and high-contrast T2-weighted images of brachial plexus. Our data suggest that the seg-IR-EPI sequence may provide high fidelity in evaluating brachial plexus.
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Affiliation(s)
- Zhongwei Zhang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
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Diagnostic value and surgical implications of the magnetic resonance imaging in the management of adult patients with brachial plexus pathologies. Surg Radiol Anat 2007; 30:91-101. [PMID: 18094920 DOI: 10.1007/s00276-007-0292-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Accepted: 12/06/2007] [Indexed: 10/22/2022]
Abstract
The imaging of the brachial plexus (BP) cannot easily be achieved because of the extension of the region to be studied, the different tissue compositions of the adjacent anatomic structures and the necessity to work with thin tissue slices. Here is a description of the brachial plexus MRI (bpMRI) protocol that we use for the pre-operative evaluation of patients affected by the following brachial plexus (BP) pathologies: neoplastic, post-traumatic, inflammatory. The surgical implications are discussed. A survey was done on 115 patients (66 males; 49 females; mean age 46.4 years old), which underwent a bpMRI over a 32-month period (32 post-traumatic, 26 neoplastic, 25 affected by inflammatory diseases). Our bpMRI protocol is evaluated according to each mechanism of disease. The bpMRI provides a topographic localization of the tumour showing the nerve dislocations or infiltration by the neoplasm. In traumatic patients we suggest that the bpMRI could be useful to detect the degree of axonal damage when the nerve lesion is in continuity. We also consider the diagnosis and the possible surgical implications for the inflammatory plexopathies. In conclusion, a standardized bpMRI protocol has an invaluable diagnostic value for the surgeons and neurologists. It is only limited by its duration (at least 45 min).
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Reeder SB, Yu H, Johnson JW, Shimakawa A, Brittain JH, Pelc NJ, Beaulieu CF, Gold GE. T1- and T2-weighted fast spin-echo imaging of the brachial plexus and cervical spine with IDEAL water–fat separation. J Magn Reson Imaging 2006; 24:825-32. [PMID: 16969792 DOI: 10.1002/jmri.20721] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To compare the iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) method with fat-saturated T1-weighted (T1W) and T2W fast spin-echo (FSE) and short-TI inversion recovery (STIR) imaging of the brachial plexus and cervical spine. MATERIALS AND METHODS Images acquired at 1.5T in five volunteers using fat-saturated T1W and T2W FSE imaging and STIR were compared with T1W and T2W IDEAL-FSE images. Examples of T1W and T2W IDEAL-FSE images acquired in patients are also shown. RESULTS T1W and T2W IDEAL-FSE demonstrated superior fat suppression (P<0.05) and image quality (P<0.05), compared to T1W and T2W fat-saturated FSE, respectively. SNR performance of T1W-IDEAL-FSE was similar to T1W FSE in the spinal cord (P=0.250) and paraspinous muscles (P=0.78), while T2W IDEAL-FSE had superior SNR in muscle (P=0.02) and CSF (P=0.02), and marginally higher cord SNR (P=0.09). Compared to STIR, T2W IDEAL-FSE demonstrated superior image quality (P<0.05), comparable fat suppression (excellent, P=1.0), and higher SNR performance (P<0.001). CONCLUSION IDEAL-FSE is a promising method for T1W and T2W imaging of the brachial plexus and cervical spine.
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Affiliation(s)
- Scott B Reeder
- Department of Radiology, University of Wisconsin, Madison, Wisconsin 53792-3252, USA.
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Kim S, Choi JY, Huh YM, Song HT, Lee SA, Kim SM, Suh JS. Role of magnetic resonance imaging in entrapment and compressive neuropathy--what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 2. Upper extremity. Eur Radiol 2006; 17:509-22. [PMID: 16572333 DOI: 10.1007/s00330-006-0180-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Revised: 01/10/2006] [Accepted: 01/26/2006] [Indexed: 10/24/2022]
Abstract
The diagnosis of nerve entrapment and compressive neuropathy has been traditionally based on the clinical and electrodiagnostic examinations. As a result of improvements in the magnetic resonance (MR) imaging modality, it plays not only a fundamental role in the detection of space-occupying lesions, but also a compensatory role in clinically and electrodiagnostically inconclusive cases. Although ultrasound has undergone further development in the past decades and shows high resolution capabilities, it has inherent limitations due to its operator dependency. We review the course of normal peripheral nerves, as well as various clinical demonstrations and pathological features of compressed and entrapped nerves in the upper extremities on MR imaging, according to the nerves involved. The common sites of nerve entrapment of the upper extremity are as follows: the brachial plexus of the thoracic outlet; axillary nerve of the quadrilateral space; radial nerve of the radial tunnel; ulnar nerve of the cubital tunnel and Guyon's canal; median nerve of the pronator syndrome, anterior interosseous nerve syndrome, and carpal tunnel syndrome. Although MR imaging can depict the peripheral nerves in the extremities effectively, radiologists should be familiar with nerve pathways, common sites of nerve compression, and common space-occupying lesions resulting in nerve compression in MR imaging.
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Affiliation(s)
- Sungjun Kim
- Department of Diagnostic Radiology, College of Medicine, Yonsei University, 134, Shinchondong, Seodaemun-ku, 120-752 Seoul, South Korea
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Castillo M. Imaging the anatomy of the brachial plexus: review and self-assessment module. AJR Am J Roentgenol 2006; 185:S196-204. [PMID: 16304040 DOI: 10.2214/ajr.05.1014] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The educational objectives of this continuing medical education activity are to describe the normal anatomy of the brachial plexus, to name the most common symptoms associated with a brachial plexopathy, to describe the most common imaging findings resulting from trauma to the brachial plexus, to describe the imaging manifestations of common neoplasias affecting the brachial plexus, and to also describe the imaging findings and symptoms related to irradiation-induced brachial plexopathies. CONCLUSION In this article, I have illustrated and described the normal anatomy of the brachial plexus; the most common symptoms related to brachial plexopathy; and imaging findings related to trauma, tumors, and irradiation affecting the brachial plexus.
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Affiliation(s)
- Mauricio Castillo
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7510, USA.
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Garosi L, de Lahunta A, Summers B, Dennis R, Scase T. Bilateral, hypertrophic neuritis of the brachial plexus in a cat: magnetic resonance imaging and pathological findings. J Feline Med Surg 2006; 8:63-8. [PMID: 16213764 PMCID: PMC10832937 DOI: 10.1016/j.jfms.2005.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2005] [Indexed: 10/25/2022]
Abstract
A 9-year-old Burmese cat was presented for investigation of a subacute onset of bilateral forelimb paresis. Magnetic resonance imaging of the cervico-thoracic vertebral column and brachial plexus revealed a bilaterally symmetrical, severe and diffuse swelling of the spinal nerves forming the caudal part of the brachial plexus. Histopathology of the abnormal nerve roots, spinal nerves and brachial plexi showed inflammatory and marked proliferative changes with similar features to that of hypertrophic neuritis of man. Hypertrophic neuritis in man is a rare, tumor-like, chronic inflammatory peripheral nerve disorder of unknown origin most frequently involving the brachial plexus.
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Affiliation(s)
- Laurent Garosi
- Animal Health Trust, Centre for Small Animal Studies, Lanwades Park, Kentford, Newmarket CB8 7UU, England.
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