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Published in: Clinical Neuroradiology 3/2014

01-09-2014 | Review Article

MR Imaging of the Brachial Plexus

Authors: I. Rehman, MBBS, F. H. Chokshi, MD, Assist. Prof. F. Khosa, MD, FFRRCSI, FRCPC, DABR

Published in: Clinical Neuroradiology | Issue 3/2014

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Abstract

The characterization of brachial plexus (BP) pathology can be perplexing for the radiologist, especially due to varying combination of sensory and motor symptoms depending on the extent of disease and the level of disease process. Localization can be difficult due to inherently complex anatomy of the BP complicated by a variety of benign and malignant disease processes. Infrequently requested imaging of the BP, can be a challenge to both the novice and experienced reader. Invasive methods of diagnosis, such as biopsy, yield variable results and carry the risk of causing permanent sensory and/or motor deficit and may also cause long-term neuralgic pain. The purpose of this article is to provide a straightforward review of BP pathology as seen by conventional magnetic resonance imaging and to illustrate the value of this noninvasive technique in guiding management.
Literature
1.
go back to reference 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(10):2666–72.PubMedCrossRef 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(10):2666–72.PubMedCrossRef
2.
go back to reference Wittenberg K, Adkins M. MR imaging of nontraumatic brachial plexopathies: frequency and spectrum of findings. Radiographics. 2000;20:1023–32.PubMedCrossRef Wittenberg K, Adkins M. MR imaging of nontraumatic brachial plexopathies: frequency and spectrum of findings. Radiographics. 2000;20:1023–32.PubMedCrossRef
3.
go back to reference Bowen BC, Pattany PM, Saraf-Lavi E, Maravilla KR. The brachial plexus: normal anatomy, pathology, and MR imaging. Neuroimag Clin N Am. 2004;14(1):59–85.CrossRef Bowen BC, Pattany PM, Saraf-Lavi E, Maravilla KR. The brachial plexus: normal anatomy, pathology, and MR imaging. Neuroimag Clin N Am. 2004;14(1):59–85.CrossRef
5.
go back to reference Todd M, Shah GV, Mukherji SK. MR Imaging of brachial plexus. Top Magn Reson Imaging. 2004;15(2):113–25.PubMedCrossRef Todd M, Shah GV, Mukherji SK. MR Imaging of brachial plexus. Top Magn Reson Imaging. 2004;15(2):113–25.PubMedCrossRef
6.
go back to reference Kim S, Choi J, Huh Y, Song H, Lee S, Kim SM, et al. 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. 2007;17(2):509–22.PubMedCrossRef Kim S, Choi J, Huh Y, Song H, Lee S, Kim SM, et al. 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. 2007;17(2):509–22.PubMedCrossRef
7.
go back to reference Tagliafico A, Succio G, Serafini G, Martinoli C. Diagnostic performance of ultrasound in patients with suspected brachial plexus lesions in adults: a multicenter retrospective study with MRI, surgical findings and clinical follow-up as reference standard. Skeletal Radiol. 2013;42:371–6.PubMedCrossRef Tagliafico A, Succio G, Serafini G, Martinoli C. Diagnostic performance of ultrasound in patients with suspected brachial plexus lesions in adults: a multicenter retrospective study with MRI, surgical findings and clinical follow-up as reference standard. Skeletal Radiol. 2013;42:371–6.PubMedCrossRef
8.
go back to reference Martinoli C, Gandolfo N, Perez MM, Klauser A, Palmieri F, Padua L, et al. Brachial plexus and nerves about the shoulder. Semin Musculoskeletal Radiol. 2010;14(5):523–46.CrossRef Martinoli C, Gandolfo N, Perez MM, Klauser A, Palmieri F, Padua L, et al. Brachial plexus and nerves about the shoulder. Semin Musculoskeletal Radiol. 2010;14(5):523–46.CrossRef
9.
go back to reference Yoshikawa T, Hayashi N, Yamamoto S, Tajiri Y, Yoshioka N, Masumoto T, et al. Brachial plexus injury: clinical manifestations, conventional imaging findings, and the latest imaging techniques. Radiographics. 2006;26(1 Suppl):S133–43.CrossRef Yoshikawa T, Hayashi N, Yamamoto S, Tajiri Y, Yoshioka N, Masumoto T, et al. Brachial plexus injury: clinical manifestations, conventional imaging findings, and the latest imaging techniques. Radiographics. 2006;26(1 Suppl):S133–43.CrossRef
10.
go back to reference Es HW, Bollen TL, Heesewijk HPM. MRI of the brachial plexus: a pictorial review. Eur J Radiol. 2010;74(2):391–402.PubMedCrossRef Es HW, Bollen TL, Heesewijk HPM. MRI of the brachial plexus: a pictorial review. Eur J Radiol. 2010;74(2):391–402.PubMedCrossRef
13.
go back to reference Demondion X, Herbinet P, Boutry N, Fontaine C, Francke J, Cotten A. Sonographic mapping of the normal brachial plexus. AJNR Am J Neuroradiol. 2003;24(7):1303–9.PubMed Demondion X, Herbinet P, Boutry N, Fontaine C, Francke J, Cotten A. Sonographic mapping of the normal brachial plexus. AJNR Am J Neuroradiol. 2003;24(7):1303–9.PubMed
14.
go back to reference Demondion X, Boutry N, Drizenko A, Paul C, Francke JP, Cotten A. Thoracic outlet: anatomic correlation with MR imaging. AJR Am J Roentgenol. 2000;175(2):417–22.PubMedCrossRef Demondion X, Boutry N, Drizenko A, Paul C, Francke JP, Cotten A. Thoracic outlet: anatomic correlation with MR imaging. AJR Am J Roentgenol. 2000;175(2):417–22.PubMedCrossRef
15.
go back to reference Demondion X, Herbinet P, Jan S, Boutry N. Imaging assessment of thoracic outlet syndrome. Radiographics. 2006;26:1735–50.PubMedCrossRef Demondion X, Herbinet P, Jan S, Boutry N. Imaging assessment of thoracic outlet syndrome. Radiographics. 2006;26:1735–50.PubMedCrossRef
16.
go back to reference Aralasmak A, Karaali K, Cevikol C, Uysal H, Senol U. MR imaging findings in brachial plexopathy with thoracic outlet syndrome. AJNR Am J Neuroradiol. 2010;31(3):410–7.PubMedCrossRef Aralasmak A, Karaali K, Cevikol C, Uysal H, Senol U. MR imaging findings in brachial plexopathy with thoracic outlet syndrome. AJNR Am J Neuroradiol. 2010;31(3):410–7.PubMedCrossRef
17.
go back to reference Sureka J, Cherian RA, Alexander M, Thomas BP. MRI of brachial plexopathies. Clinical Radiology. 2009;64(2):208–218.PubMedCrossRef Sureka J, Cherian RA, Alexander M, Thomas BP. MRI of brachial plexopathies. Clinical Radiology. 2009;64(2):208–218.PubMedCrossRef
18.
go back to reference Tagliafico A, Succio G, Neumaier CE, Serafini G, Ghidara M, Calabrese M, et al. MR imaging of the brachial plexus: comparison between 1.5-T and 3-T MR imaging: preliminary experience. Skeletal Radiol. 2011;40(6):717–24.PubMedCrossRef Tagliafico A, Succio G, Neumaier CE, Serafini G, Ghidara M, Calabrese M, et al. MR imaging of the brachial plexus: comparison between 1.5-T and 3-T MR imaging: preliminary experience. Skeletal Radiol. 2011;40(6):717–24.PubMedCrossRef
19.
go back to reference Tagliafico A, Succio G, Neumaier CE, Baio G, Serafini G, Ghidara M et al. Brachial plexus assessment with three-dimensional isotropic resolution fast spin echo MRI: comparison with conventional MRI at 3.0 T. Br J Radiol. 2012 Jun;85(1014):e110–6.PubMedCentralPubMedCrossRef Tagliafico A, Succio G, Neumaier CE, Baio G, Serafini G, Ghidara M et al. Brachial plexus assessment with three-dimensional isotropic resolution fast spin echo MRI: comparison with conventional MRI at 3.0 T. Br J Radiol. 2012 Jun;85(1014):e110–6.PubMedCentralPubMedCrossRef
20.
go back to reference Gerevini S, Mandelli C, Cadioli M, Scotti G. Diagnostic value and surgical implications of the magnetic resonance imaging in the management of adult patients with brachial plexus pathologies. Surg Radiol Anat. 2008;30(2):91–101.PubMedCrossRef Gerevini S, Mandelli C, Cadioli M, Scotti G. Diagnostic value and surgical implications of the magnetic resonance imaging in the management of adult patients with brachial plexus pathologies. Surg Radiol Anat. 2008;30(2):91–101.PubMedCrossRef
21.
go back to reference Gasparotti R, Ferraresi S, Pinelli L, Crispino M, Pavia M, Bonetti M, et al Three-Dimensional MR myelography of traumatic injuries of the brachial plexus. AJNR Am J Neuroradiol. 1997;18(9):1733–42.PubMed Gasparotti R, Ferraresi S, Pinelli L, Crispino M, Pavia M, Bonetti M, et al Three-Dimensional MR myelography of traumatic injuries of the brachial plexus. AJNR Am J Neuroradiol. 1997;18(9):1733–42.PubMed
22.
go back to reference Doi K, Otsuka K, Okamoto Y, Fujii H, Hattori Y, Baliarsing AS. Cervical nerve root avulsion in brachial plexus injuries: magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography. J Neurosurg. 2002 Apr;96(3 Suppl):277–84.PubMed Doi K, Otsuka K, Okamoto Y, Fujii H, Hattori Y, Baliarsing AS. Cervical nerve root avulsion in brachial plexus injuries: magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography. J Neurosurg. 2002 Apr;96(3 Suppl):277–84.PubMed
23.
go back to reference Abul-Kasim K, Backman C, Bjorkman A, Dahlin LB. Advanced radiological work-up as an adjunct to decision in early reconstructive surgery in brachial plexus injuries. J Brachial Plex Peripher Nerve Inj. 2010;5(14):1–7. Abul-Kasim K, Backman C, Bjorkman A, Dahlin LB. Advanced radiological work-up as an adjunct to decision in early reconstructive surgery in brachial plexus injuries. J Brachial Plex Peripher Nerve Inj. 2010;5(14):1–7.
24.
go back to reference Belzberg AJ, Dorsi MJ, Storm PB, Moriarity JL. Surgical repair of brachial plexus injury: a multinational survey of experienced peripheral nerve surgeons. Neurosurg Focus. 2004;16(5):1–11. Belzberg AJ, Dorsi MJ, Storm PB, Moriarity JL. Surgical repair of brachial plexus injury: a multinational survey of experienced peripheral nerve surgeons. Neurosurg Focus. 2004;16(5):1–11.
25.
go back to reference Vargas MI, Viallon M, Nguyen D, Delavelle J, Becker M. Diffusion tensor imaging (DTI) and tractography of the brachial plexus: feasibility and initial experience in neoplastic conditions. Neuroradiology. 2010;52(3):237–45.PubMedCrossRef Vargas MI, Viallon M, Nguyen D, Delavelle J, Becker M. Diffusion tensor imaging (DTI) and tractography of the brachial plexus: feasibility and initial experience in neoplastic conditions. Neuroradiology. 2010;52(3):237–45.PubMedCrossRef
26.
go back to reference Kobayashi S, Hayakawa K, Nakane T, Meir A, Mwaka ES, Yayama T, et al. Visualization of intraneural edema using gadolinium-enhanced magnetic resonance imaging of carpal tunnel syndrome. J Orthop Sci. 2009;14(1):24–34.PubMedCrossRef Kobayashi S, Hayakawa K, Nakane T, Meir A, Mwaka ES, Yayama T, et al. Visualization of intraneural edema using gadolinium-enhanced magnetic resonance imaging of carpal tunnel syndrome. J Orthop Sci. 2009;14(1):24–34.PubMedCrossRef
27.
go back to reference Hayashi N, Yamamato S, Okubo T, Yoshioka N, Shirouzu I, Abe O, et al. Avulsion injury of cervical nerve roots: enhanced intradural nerve roots at MR imaging. Radiology.1998;206(3):817–22.PubMedCrossRef Hayashi N, Yamamato S, Okubo T, Yoshioka N, Shirouzu I, Abe O, et al. Avulsion injury of cervical nerve roots: enhanced intradural nerve roots at MR imaging. Radiology.1998;206(3):817–22.PubMedCrossRef
28.
go back to reference Hayashi N, Masumoto T, Abe O, Aoki S, Ohtomo K, Tajiri Y. Accuracy of abnormal paraspinal muscle findings on contrast-enhanced MR images as indirect signs of unilateral cervical root-avulsion injury. Radiology. 2002;223(2):397–402.PubMedCrossRef Hayashi N, Masumoto T, Abe O, Aoki S, Ohtomo K, Tajiri Y. Accuracy of abnormal paraspinal muscle findings on contrast-enhanced MR images as indirect signs of unilateral cervical root-avulsion injury. Radiology. 2002;223(2):397–402.PubMedCrossRef
29.
go back to reference Uetani M, Hayashi K, Hashmi R, Nakahara N, Aso N, Ito N. Traction injuries of the brachial plexus: signal intensity changes of the posterior cervical paraspinal muscles on MRI. J Comput Assist Tomo. 1997;21(5):790–5.CrossRef Uetani M, Hayashi K, Hashmi R, Nakahara N, Aso N, Ito N. Traction injuries of the brachial plexus: signal intensity changes of the posterior cervical paraspinal muscles on MRI. J Comput Assist Tomo. 1997;21(5):790–5.CrossRef
30.
go back to reference Qayyum A, MacVicar AD, Padhani AR, Revell P, Husband JES. Symptomatic brachial plexopathy following treatment for breast cancer: utility of MR imaging with surface-coil techniques. Radiology. 2000;214(3):837–42.PubMedCrossRef Qayyum A, MacVicar AD, Padhani AR, Revell P, Husband JES. Symptomatic brachial plexopathy following treatment for breast cancer: utility of MR imaging with surface-coil techniques. Radiology. 2000;214(3):837–42.PubMedCrossRef
31.
go back to reference Mikityansky I, Zager EL, Yousem DM, Loevner LA. MR imaging of the brachial plexus. Magn Reson Imaging Clin N Am. 2012;20(4):791–826.PubMedCrossRef Mikityansky I, Zager EL, Yousem DM, Loevner LA. MR imaging of the brachial plexus. Magn Reson Imaging Clin N Am. 2012;20(4):791–826.PubMedCrossRef
32.
go back to reference Lingawi SS, Bilbey JH, Munk PL, Poon PY, Allan BM, Ollivoto IA, et al. MR imaging of brachial plexopathy in breast cancer patients without palpable recurrence. Skeletal Radiol. 1999 Jun;28(6):318–23.PubMedCrossRef Lingawi SS, Bilbey JH, Munk PL, Poon PY, Allan BM, Ollivoto IA, et al. MR imaging of brachial plexopathy in breast cancer patients without palpable recurrence. Skeletal Radiol. 1999 Jun;28(6):318–23.PubMedCrossRef
33.
go back to reference Ahmad A, Barrington S, Maisey M, Rubens RD. Use of positron emission tomography in evaluation of brachial plexopathy in breast cancer patients. Br J Cancer. 1999;79(3–4):478–82.PubMedCentralPubMedCrossRef Ahmad A, Barrington S, Maisey M, Rubens RD. Use of positron emission tomography in evaluation of brachial plexopathy in breast cancer patients. Br J Cancer. 1999;79(3–4):478–82.PubMedCentralPubMedCrossRef
34.
go back to reference Ayoub T, Raman V, Chouwdhry M. Brachial neuritis caused by Varicella-Zoster diagnosed by changes in brachial plexus on MRI. J Neurol. 2010;257(1):1–4.PubMedCrossRef Ayoub T, Raman V, Chouwdhry M. Brachial neuritis caused by Varicella-Zoster diagnosed by changes in brachial plexus on MRI. J Neurol. 2010;257(1):1–4.PubMedCrossRef
35.
go back to reference Linda DD, Harish S, Stewart BG, Finlay K, Parasu N, Rebello RP. Multimodality imaging of peripheral neuropathies of the upper limb and brachial plexus. Radiographics. 2010;30(5):1373–400.PubMedCrossRef Linda DD, Harish S, Stewart BG, Finlay K, Parasu N, Rebello RP. Multimodality imaging of peripheral neuropathies of the upper limb and brachial plexus. Radiographics. 2010;30(5):1373–400.PubMedCrossRef
36.
go back to reference Kim ST, Kim HJ, Park SW, Baek JH, Byun HS, Kim YM. Nodular fasciitis in the head and neck: CT and MR imaging findings. AJNR Am J Neuroradiol. 2005 Nov-Dec;26(10):2617–23.PubMed Kim ST, Kim HJ, Park SW, Baek JH, Byun HS, Kim YM. Nodular fasciitis in the head and neck: CT and MR imaging findings. AJNR Am J Neuroradiol. 2005 Nov-Dec;26(10):2617–23.PubMed
37.
go back to reference Kichari JR, Hussain SM, Den Hollander JC, Krestin GP. MR imaging of the brachial plexus: current imaging sequences, normal findings, and findings in a spectrum of focal lesions with MR-pathologic correlation. Curr Probl Diagn Radiol. 2003 Mar-Apr;32(2):88–101.PubMedCrossRef Kichari JR, Hussain SM, Den Hollander JC, Krestin GP. MR imaging of the brachial plexus: current imaging sequences, normal findings, and findings in a spectrum of focal lesions with MR-pathologic correlation. Curr Probl Diagn Radiol. 2003 Mar-Apr;32(2):88–101.PubMedCrossRef
38.
go back to reference Wasa J, Nishida Y, Tsukushi S, Shido Y, Sugiura H, Nakashima H, et al. MRI features in the differentiation of malignant peripheral nerve sheath tumors and neurofibromas. Am J Roentgenol. 2010;194(6):1568–74.CrossRef Wasa J, Nishida Y, Tsukushi S, Shido Y, Sugiura H, Nakashima H, et al. MRI features in the differentiation of malignant peripheral nerve sheath tumors and neurofibromas. Am J Roentgenol. 2010;194(6):1568–74.CrossRef
39.
go back to reference Lavi ES, Levi AD, Schallert EK, Brown AD, Norenberg MD. MRI of intraneural perineurioma of the brachial plexus. Radiology Case Reports. (Online) 2012. doi:10.2484/rcr.v7i1.649. Lavi ES, Levi AD, Schallert EK, Brown AD, Norenberg MD. MRI of intraneural perineurioma of the brachial plexus. Radiology Case Reports. (Online) 2012. doi:10.2484/rcr.v7i1.649.
40.
go back to reference Tagliafico A, Massimo C, Puntoni M, Pace D, Baio G, Neumaier CE et al. Brachial plexus MR imaging: accuracy and reproducibility of DTI-derived measurements and fibre tractography at 3.0T. Eur Radiol. 2011;21(8):1764–71.PubMedCrossRef Tagliafico A, Massimo C, Puntoni M, Pace D, Baio G, Neumaier CE et al. Brachial plexus MR imaging: accuracy and reproducibility of DTI-derived measurements and fibre tractography at 3.0T. Eur Radiol. 2011;21(8):1764–71.PubMedCrossRef
41.
go back to reference Mallouhi A, Marik W, Prayer D, Kainberger F, Bodner G, Kasprian G. 3T MR tomography of the brachial plexus: structural and microstructural evaluation. Eur J Radiol. 2012;81(9):2231–45.PubMedCrossRef Mallouhi A, Marik W, Prayer D, Kainberger F, Bodner G, Kasprian G. 3T MR tomography of the brachial plexus: structural and microstructural evaluation. Eur J Radiol. 2012;81(9):2231–45.PubMedCrossRef
42.
go back to reference Gasparotti R, Lodoli G, Meoded A, Carletti F, Garozzo D, Ferraresi S. Feasibility of diffusion tensor tractography of brachial plexus injuries at 1.5 T. Invest Radiol. 2013 Feb;48(2):104–12.PubMedCrossRef Gasparotti R, Lodoli G, Meoded A, Carletti F, Garozzo D, Ferraresi S. Feasibility of diffusion tensor tractography of brachial plexus injuries at 1.5 T. Invest Radiol. 2013 Feb;48(2):104–12.PubMedCrossRef
43.
go back to reference Chhabra A, Thawait GK, Soldatos T, Thakkar RS, del Grande F, Chalian M, et al. High-resolution 3T MR neurography of the brachial plexus and its branches, with emphasis on 3D imaging. AJNR Am J Neuroradiol. 2013;34(3):486–97.PubMedCrossRef Chhabra A, Thawait GK, Soldatos T, Thakkar RS, del Grande F, Chalian M, et al. High-resolution 3T MR neurography of the brachial plexus and its branches, with emphasis on 3D imaging. AJNR Am J Neuroradiol. 2013;34(3):486–97.PubMedCrossRef
Metadata
Title
MR Imaging of the Brachial Plexus
Authors
I. Rehman, MBBS
F. H. Chokshi, MD
Assist. Prof. F. Khosa, MD, FFRRCSI, FRCPC, DABR
Publication date
01-09-2014
Publisher
Springer Berlin Heidelberg
Published in
Clinical Neuroradiology / Issue 3/2014
Print ISSN: 1869-1439
Electronic ISSN: 1869-1447
DOI
https://doi.org/10.1007/s00062-014-0297-3

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