Detection of the Stellate and Thoracic Sympathetic Chain Ganglia with High-Resolution 3D-CISS MR Imaging

Chaudhry, Ammar; Kamali, Arash; Herzka, Daniel A.; Wang, K.C.; Carrino, John A.; Blitz, Ari M.

doi:10.3174/ajnr.a5698

Cited by 8 publications

(8 citation statements)

References 27 publications

(8 reference statements)

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“…Shin et al [ 13 ] found that the mCSG occasionally lies medially to the common carotid artery, distant from the tubercle. Previous studies have suggested that the mCSG may be adjacent to the posterior wall of the carotid sheath [ 12 , 13 ]. All these variations in the mCSG position potentially contribute to the SGB variable efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…Lee et al [ 11 ] visualized 73 % of the superior CSG using 3T magnetic resonance imaging (MRI). Chaudhry et al [ 12 ] demonstrated that the stellate ganglia could be precisely characterized on pre-contrast three-dimensional constructive interference in steady state MRI. These two ganglia are difficult to detect using HRUS owing to the limited acoustic window, restricted by the bones and lungs.…”

Section: Introductionmentioning

confidence: 99%

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Sono-anatomy of the middle cervical sympathetic ganglion verified with pathology

Lei,

Hao,

Yang

et al. 2024

Heliyon

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sono-anatomy of the middle cervical sympathetic ganglion verified with pathology

Lei,

Hao,

Yang

et al. 2024

Heliyon

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“…The CTG/SG can be identified along the sympathetic chain on the border between the neck and thorax, anteriorly and slightly caudad to the head of the first rib11,12, inferior and anterior to the transverse process of C712,19, lateral and posterior to the lateral edge of the longus colli muscle (at the level of T1)11, inferior to the subclavian artery12, medial, posterior, medial and anterior or medial and posterior to the vertebral artery3,11. Which was confirmed also in the current study.…”

Section: Discussionmentioning

confidence: 99%

“…In our study we have tracked down a configuration of the cervico-thoracic ganglia complex not categorized in previous MR study exploring CTG/SG 11,19. The majority of CG-C in our work resembled a question-mark in various configurations: thinner or thicker, mirror, reversed or mirror and upside-down, more or less straight including bludgeon-like shape and an exclamation-mark, or a part of a question-mark: without a dot, resembling kidney or comma.…”

Section: Discussionmentioning

confidence: 99%

The “question-mark” MR anatomy of the cervico-thoracic ganglia complex: can it help to avoid mistaking it for a malignant lesion on ⁶⁸Ga-PSMA-11 PET/MR?

Białek

Małkowski

2019

Radiology and Oncology

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BackgroundDetectable uptake of 68Ga-PSMA-ligands in sympathetic ganglia may potentially lead to mistaking them for malignant lesions. Our aim was to investigate the anatomy of cervico-thoracic-ganglia-complex (CTG-C) in the MR part of multimodal 68Ga-PSMA-11 PET/MR imaging, in view of PET factors hindering its proper identification.Patients and methodsIn 106 patients, 212 sites of the CTG-C were retrospectively reviewed to assess the radiotracer uptake (SUVmax), size, shape, position, symmetry of location and visual uptake intensity. Asymmetry of PSMA-ligand uptake and increased uptake were regarded as risk factors of malignancy.ResultsIn 66.0% left (L) and 53.8% right (R) CTG-C we noticed configurations, resembling the shape of an exclamation-mark, a question-mark, or its part (called “typical”). Tumor-like CTG-C shapes (oval, binodular or longitudinal) were detected in 28.3% L-CTG-C and in 40.6% R-CTG-C. When visual assessment of PET suggested malignancy, the recognition of “typical” shape of underlying CTG-C on MR generated a rise in the accuracy of their proper identification (from 34.4% to 75%, χ2(1) = 70.4; p < 0.001). Recognizing the shape of the CTG-C as “typical” in MR allowed us to classify as “not-suspicious” 61.9% of all CTG-C which were treated as “suspicious” after sole PET assessment.ConclusionsThe characteristic shape of cervico-thoracic-ganglia-complex (resembling a question-mark, or its part) helps in proper recognition of CTG-C on multimodal whole-body 68Ga-PSMA-ligand PET/MR imaging, when detectable uptake might lead to considering pathology.

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“…The sympathetic trunk, extending from the base of the skull to the coccyx, presents bilaterally. It divides into the cervical, thoracic, lumbar and sacral segments [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Incidence of inadvertent intercostal or epidural spread during thoracic sympathetic ganglion block

Hong

Kim

2020

Anesth Pain Med

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Background: Sympathetic blocks (SBs) have been used widely to relieve the symptoms of sympathetically maintained pain (SMP). The thoracic sympathetic ganglion is not separated from somatic nerves by muscles and connective tissue. The upper thoracic ganglion runs along the posterior surface of the vertebral column in close proximity to the adjacent epidural region. This anatomical difference leads to frequent epidural and intercostal spread in cases of thoracic SBs. The purpose of this study was to investigate the incidence of inadvertent intercostal and epidural injections during thoracic SBs.Methods: Twenty-two patients who were suffering from complex regional pain syndrome or lymphedema after breast cancer surgery were managed with two or three times of thoracic SBs. Therefore, injections of 63 thoracic SBs from 22 patients were enrolled in this study. An investigator who did not attend the procedure evaluated the occurrence of intercostal or epidural spread using anteroposterior fluoroscopic images.Results: The overall incidence of inadvertent intercostal or epidural spread of contrast was 47.5%. Among the inadvertent injections, intercostal spread (34.9%) was more frequent than epidural spread (12.6%). Only 52.5% of the thoracic SBs demonstrated successful contrast spread without any inadvertent spread. The mean difference in skin temperature between the blocked and unblocked sides was 2.5 ± 1.8ºC. Fifty-nine (93.6%) injections demonstrated more than 1.5ºC difference.Conclusions: Thoracic SBs showed a high incidence (47.5%) of inadvertent epidural or intercostal injection. Thus, special attention is required for the diagnosis of SMP or the injection of any neurolytic agent around sympathetic ganglion.

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Detection of the Stellate and Thoracic Sympathetic Chain Ganglia with High-Resolution 3D-CISS MR Imaging

Abstract: The thoracic sympathetic chain ganglia can be identified on precontrast 3D-CISS MR imaging. This technique may aid in the initial evaluation of stellate ganglion and/or sympathetic chain ganglia size and signal change for comparison in future studies.

Cited by 8 publications

References 27 publications

Sono-anatomy of the middle cervical sympathetic ganglion verified with pathology

Sono-anatomy of the middle cervical sympathetic ganglion verified with pathology

The “question-mark” MR anatomy of the cervico-thoracic ganglia complex: can it help to avoid mistaking it for a malignant lesion on ⁶⁸Ga-PSMA-11 PET/MR?

Incidence of inadvertent intercostal or epidural spread during thoracic sympathetic ganglion block

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Detection of the Stellate and Thoracic Sympathetic Chain Ganglia with High-Resolution 3D-CISS MR Imaging

Abstract: The thoracic sympathetic chain ganglia can be identified on precontrast 3D-CISS MR imaging. This technique may aid in the initial evaluation of stellate ganglion and/or sympathetic chain ganglia size and signal change for comparison in future studies.

Cited by 8 publications

References 27 publications

Sono-anatomy of the middle cervical sympathetic ganglion verified with pathology

Sono-anatomy of the middle cervical sympathetic ganglion verified with pathology

The “question-mark” MR anatomy of the cervico-thoracic ganglia complex: can it help to avoid mistaking it for a malignant lesion on 68Ga-PSMA-11 PET/MR?

Incidence of inadvertent intercostal or epidural spread during thoracic sympathetic ganglion block

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The “question-mark” MR anatomy of the cervico-thoracic ganglia complex: can it help to avoid mistaking it for a malignant lesion on ⁶⁸Ga-PSMA-11 PET/MR?