MR imaging of the brachial plexus: Current imaging sequences, normal findings, and findings in a spectrum of focal lesions with MR-pathologic correlation

Kichari, Jayant R.; Hussain, Shahid; Hollander, Jan C. den; Krestin, Gabriël P.

doi:10.1067/mdr.2003.12007

Cited by 30 publications

(11 citation statements)

References 17 publications

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“…MRI is now regarded as the imaging modality of choice in brachial plexopathy [11][12][13]. While MRI demonstrated structural integrity of the cervical roots and brachial plexus, which corroborated our observations of progressive clinical improvement, electrophysiology was adjunctive in providing evidence for functional aspects.…”

Section: Discussionsupporting

confidence: 81%

Motor root conduction block in traumatic brachial plexopathy

Tan

2004

Journal of the Neurological Sciences

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Section: Discussionsupporting

confidence: 81%

Motor root conduction block in traumatic brachial plexopathy

Tan

2004

Journal of the Neurological Sciences

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“…MRI is currently the preferred modality for brachial plexus assessment . Routine examination protocols typically consist of 2D acquisitions in multiple anatomical planes, 3D imaging, or some combination of both . Recently, Tagliafico et al showed that 2D and 3D sequences generate similar image quality and nerve conspicuity for plexus MRI .…”

Section: Discussionmentioning

confidence: 99%

“…Vargas et al prescribed quiet breathing during data collection to minimize lung motion . Alternatively, Kichari et al employed a combination of breath holding and RT . However, quiet breathing and/or breath holding are not always clinically feasible and are unreliable for motion suppression, as they require adequate patient compliance.…”

Section: Discussionmentioning

confidence: 99%

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Prospective respiratory triggering improves high‐resolution brachial plexus MRI quality

Sneag

Mendapara

Zhu

et al. 2018

Magnetic Resonance Imaging

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Background Oblique sagittal MRI sequences, orthogonal to the longitudinal axis of the brachial plexus, can reliably depict morphologic and signal abnormalities. However, nerve visualization may be obscured by ghosting artifact from periodic respiratory motion. Respiratory triggering (RT) with a thoracoabdominal bellows can reduce ghosting artifact, but it is not routinely used for brachial plexus MRI. Furthermore, the efficacy of prospective RT for brachial plexus imaging has not yet been reported. Purpose To compare brachial plexus MRI sequences acquired with and without respiratory triggering. Study Type Prospective. Subjects Five volunteers and 20 patients were included. Each subject was imaged with and without RT during the same session. Field Strength/Sequence Proton density or T2‐weighted Dixon fat suppressed sequences were obtained at 3.0T using receive‐only 16‐channel flexible array coils. Assessment Three musculoskeletal radiologists blindly evaluated each sequence using subjective scoring criteria for ghosting artifact, nerve conspicuity, and diagnostic confidence. Nerve conspicuity scores at three distinct plexus levels were summed to calculate an overall image quality score. Statistical Tests Marginal proportional odds logistic regression models were used to compare all scores between RT and non‐RT. Gwet's agreement coefficient was used to assess interobserver and intraobserver reliability. Results Mean scan time per sequence increased from 4:25 minutes (95% confidence interval [CI], 4:02–4:49 min) with non‐RT to 6:09 minutes (95% CI, 5:42–6:35 min) with RT. RT reduced ghosting artifact (odds ratio [OR] = 0.21, 95% CI: 0.09–0.46, P < 0.001), improved overall image quality (OR = 4.88, 95% CI: 2.18–10.95, P < 0.001), and increased diagnostic confidence (OR = 3.72, 95% CI: 1.61–8.63, P = 0.002) for all readers. Interobserver agreement for ghosting artifact and image quality was substantial to almost perfect (AC2 = 0.74–0.85). Interobserver agreement for all other scores was moderate to almost perfect (AC2 = 0.61–0.82). Intraobserver agreement was substantial to almost perfect for all parameters (AC2 = 0.76–1.0). Data Conclusion Prospective RT with bellows can effectively minimize ghosting artifact and improve image quality for brachial plexus MRI within clinically optimal acquisition times. Level of Evidence: 1 Technical Efficacy: Stage 2

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“…These were apparent on the physical examination in 22 patients, but, like others, we found imaging necessary to detect brachial plexus involvement in M0, no distant metastases other than axillary nodes c N0, no involved axillary nodes; N1, at least one axillary node; N2, matted axillary nodes d M1, metastases to distant sites, such as bone or lung, detectable by imaging e The supraclavicular and axillary regions were included in the radiation portal in 10 of the 13 patients who received primary radiation f Adjuvant or neoadjuvant chemotherapy, or initial chemotherapy for those patients who presented with metastatic disease g Long-term tamoxifen or anastrazole therapy; all these patients previously had chemotherapy h Months elapsing between original breast cancer presentation and fi rst evidence of brachial plexus syndrome a Narcotic analgesics not necessary to control pain b Narcotic analgesics necessary to control pain c Paresis relative to contralateral arm d Severe disability or complete paralysis e C5-6 Division involvement f C7-T1 Division involvement some patients. [11][12][13][14][15][16] In one patient computer-automated tomography, and in 4 magnetic resonance imaging (MRI) was necessary to demonstrate loco-regional metastases, including tumor within the brachial plexus. Two patients without loco-regional metastases developed pain and arm weakness 14 and 32 months after surgery and radiation.…”

Section: Methodsmentioning

confidence: 99%