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Brachial Plexus

Naoki Takahashi¹, Vamsidhar Narra¹

¹Mallinckrodt Institute of Radiology, Washington University Medical Center, St. Louis, Missouri

Publication Name:

Current Protocols in Magnetic Resonance Imaging

Unit Number:

Unit A14.1

DOI:

10.1002/0471142719.mia1401s00

Online Posting Date:

May, 2001

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Abstract

MRI is the primary imaging modality used to diagnose the cause of brachial plexopathy. This unit presents protocols to diagnose the cause of brachial plexus. The Basic Protocol provides the core component of this procedure and an alternate protocol is presented for the case of avulsion injury from trauma. A second alternate protocol is presented for the case where neoplastic involvement of the brachial plexus is suspected or any abnormalities are seen. A third alternate protocol is presented for the cases when the patient has symptoms of thoracic outlet syndrome and vascular compression is suspected.

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Unit Introduction
Basic Protocol: Imaging of Brachial Plexus
Alternate Protocol 1: Imaging of Brachial Plexus for Avulsion Injury
Alternate Protocol 2: Imaging of Brachial Plexus for Neoplastic Involvement
Alternate Protocol 3: Contrast-Enhanced MRA for Thoracic Outlet Syndrome
Commentary
Bibliography
Figures
Tables

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Materials

Alternate Protocol 2: Imaging of Brachial Plexus for Neoplastic Involvement

Materials

Normal saline (0.9% NaCl), sterile
Gadolinium-based MR contrast agent (e.g., Magnevist, Omniscan, or Prohance) 22-G intravenous catheter
Power injector (optional)

Alternate Protocol 3: Contrast-Enhanced MRA for Thoracic Outlet Syndrome

Materials

Normal saline (0.9% NaCl), sterile
Gadolinium-based MR contrast agent (e.g., Magnevist, Omniscan, or Prohance)
Power injector (for the MRA technique)

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Figures

Figure A14.1.1

Normal brachial plexus. (A) Coronal and (B) sagittal T₁-weighted images demonstrate normal brachial plexus (arrows), which is a thin linear structure surrounded by fat and running along the subclavian artery (arrow heads).

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Figure A14.1.2

Brachial plexus involved by metastatic breast carcinoma. (A) Sagittal T₁-weighted image shows an isointense soft tissue mass (arrow) encasing the brachial plexus and subclavian artery (arrow head). (B) On inversion recovery image, the mass is hyper-intense (arrow). The subclavian artery (arrow head) is encased by the mass. (C) After administration of gadolinium contrast, the mass shows enhancement (T₁-weighted image with fat saturation) (arrow). Note the encasement of the subclavian artery (arrow head) by the mass.

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Figure A14.1.3

Radiation fibrosis involving brachial plexus. (A) Coronal and (B) sagittal T₁-weighted images demonstrate soft tissue strands and loss of fat plane surrounding the right brachial plexus (arrows). Compare with the normal brachial plexus on the left in the coronal image.

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Literature Cited

Literature Cited
	Bowen, B.C., Verma, A., Brandon, A.H., and Fiedler, J.A. 1996. Radiation induced brachial plexopathy: MR imaging with clinical correlation. Am. J. Neuroradiol. 17:1932-1936.
	Glazer, H.S., Lee, J.K.T., Levitt, R.G., Heiken, J.P., Ling, D., Totty, W.G., Balfe, D.M., Emani, B., Wasserman, T.H., and Murphy, W.A. 1985. Radiation fibrosis: Differentiation from recurrent tumor by MR imaging—work in progress. Radiology 156:721-726.
	Posniak, H.V., Olson, M.C., Dudiak, C.M., Wisniewski, R., and O'Malley, C. 1993. MR imaging of the brachial plexus. Am. J. R Roentgenol. 161:373-379.
	Shellock, F.G. 1996. Pocket Guide to MR Procedures and Metallic Objects. Lippincott-Raven, Philadelphia.
	Thyagarajan, D., Cascino, T., and Harms, G. 1995. Magnetic resonance imaging in brachial plexopathy of cancer. Neurology 45:421-427.
	Wittenberg, K.H. and Adkins, M.C. 2000. MR imaging of nontraumatic brachial plexopathies: frequency and spectrum of findings. Radiographics 20:1023-1032.
Key References
	Posniak et al., 1993. See above.
Covers overview of MR appearances of various diseases involving brachial plexus.
	Shellock, 1996. See above.
Covers a number of important patient management issues related to MR imaging, including recommended safety procedures, a list of metallic implants that have been tested for MR compatibility, and a list of other sources on MR safety.
	Wittenberg and Adkins 2000. See above.
Covers overview of MR appearances of various diseases involving brachial plexus.