Clinical Impact of Magnetic Resonance Neurography in Patients with Brachial Plexus Neuropathies

Overview

Journal Br J Radiol

Publisher Oxford University Press

Specialty Radiology

Date 2016 Aug 26

PMID 27558928

Citations 12

Authors

Stephen Fisher

Vibhor Wadhwa

Christine Manthuruthil

Jonathan Cheng

Avneesh Chhabra

Affiliations

Soon will be listed here.

Abstract

Objective: To study the impact of brachial plexus MR neurography (MRN) in the diagnostic thinking and therapeutic management of patients with suspected plexopathy.

Methods: MRN examinations of adult brachial plexuses over a period of 18 months were reviewed. Relevant data collection included-patient demographics, clinical history, pre-imaging diagnostic impression, pre-imaging treatment plan, post-imaging diagnosis, post-imaging treatment plan, surgical notes and electrodiagnostic (ED) results. Impact of imaging on the pre-imaging clinical diagnosis and therapeutic management were classified as no change, mild change or substantial change.

Results: Final sample included 121 studies. The common aetiologies included inflammatory in 31 (25.6%) of 121 patients, trauma in 29 (23.9%) of 121 patients and neoplastic in 26 (21.5%) of 121 patients. ED tests were performed in 47 (38.8%) of 121 patients and these showed concordance with MRN findings in 31 (66.0%) of 47 patients. Following MRN, there was change in the pre-imaging clinical impression for 91 (75.2%) of 121 subjects, with a mild change in diagnosis in 57 (47.1%) of 121 patients and a substantial change in 34 (28.0%) of 121 patients. 19 (15.7%) of 121 patients proceeded to therapies that would not have been performed in the same manner without the information obtained from MRN.

Conclusion: MRN of the brachial plexus significantly impacts clinical decision-making and should be routinely performed in suspected brachial plexopathy. Advances in knowledge: MRN significantly impacts the diagnostic thinking and therapeutic management of patients with suspected brachial plexopathy. MRN not only provides concordant information to ED tests in majority of cases, but also supplements with additional diagnostic data in patients who are ED negative.

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References

Chhabra A . Peripheral MR neurography: approach to interpretation. Neuroimaging Clin N Am. 2013; 24(1):79-89. DOI: 10.1016/j.nic.2013.03.033. View

Wilbourn A . Thoracic outlet syndrome is overdiagnosed. Muscle Nerve. 1999; 22(1):130-6; discussion 136-7. DOI: 10.1002/(sici)1097-4598(199901)22:1<130::aid-mus22>3.0.co;2-s. View

Baumer P, Kele H, Kretschmer T, Koenig R, Pedro M, Bendszus M . Thoracic outlet syndrome in 3T MR neurography-fibrous bands causing discernible lesions of the lower brachial plexus. Eur Radiol. 2013; 24(3):756-61. DOI: 10.1007/s00330-013-3060-2. View

ROOS D . Thoracic outlet syndrome is underdiagnosed. Muscle Nerve. 1999; 22(1):126-9; discussion 137-8. DOI: 10.1002/(sici)1097-4598(199901)22:1<126::aid-mus21>3.0.co;2-s. View

Andreisek G, Burg D, Studer A, Weishaupt D . Upper extremity peripheral neuropathies: role and impact of MR imaging on patient management. Eur Radiol. 2008; 18(9):1953-61. DOI: 10.1007/s00330-008-0940-y. View

OShea K, Feinberg J, Wolfe S . Imaging and electrodiagnostic work-up of acute adult brachial plexus injuries. J Hand Surg Eur Vol. 2011; 36(9):747-59. DOI: 10.1177/1753193411422313. View

Chhabra A, Thawait G, Soldatos T, Thakkar R, Del Grande F, Chalian M . High-resolution 3T MR neurography of the brachial plexus and its branches, with emphasis on 3D imaging. AJNR Am J Neuroradiol. 2012; 34(3):486-97. PMC: 7964914. DOI: 10.3174/ajnr.A3287. View

Filler A, Maravilla K, Tsuruda J . MR neurography and muscle MR imaging for image diagnosis of disorders affecting the peripheral nerves and musculature. Neurol Clin. 2004; 22(3):643-82, vi-vii. DOI: 10.1016/j.ncl.2004.03.005. View

Baumer P, Weiler M, Ruetters M, Staub F, Dombert T, Heiland S . MR neurography in ulnar neuropathy as surrogate parameter for the presence of disseminated neuropathy. PLoS One. 2012; 7(11):e49742. PMC: 3498206. DOI: 10.1371/journal.pone.0049742. View

10.

Upadhyaya V, Upadhyaya D, Kumar A, Gujral R . MR neurography in traumatic brachial plexopathy. Eur J Radiol. 2015; 84(5):927-32. DOI: 10.1016/j.ejrad.2015.02.006. View

11.

Behrens L, Baumer P, Veltkamp R, Meinck H, Bendszus M, Pham M . MR neurography of acute and regenerated brachial plexus pressure palsy. J Neurol. 2013; 260(12):3176-7. DOI: 10.1007/s00415-013-7173-y. View

12.

Sakellariou V, Badilas N, Mazis G, Stavropoulos N, Kotoulas H, Kyriakopoulos S . Brachial plexus injuries in adults: evaluation and diagnostic approach. ISRN Orthop. 2014; 2014:726103. PMC: 4045362. DOI: 10.1155/2014/726103. View

13.

Tung T, Mackinnon S . Brachial plexus injuries. Clin Plast Surg. 2003; 30(2):269-87. DOI: 10.1016/s0094-1298(02)00094-9. View

14.

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(4 Suppl):A29-43. PMC: 2924821. DOI: 10.1227/01.NEU.0000351279.78110.00. View

15.

Schwarz D, Weiler M, Pham M, Heiland S, Bendszus M, Baumer P . Diagnostic signs of motor neuropathy in MR neurography: nerve lesions and muscle denervation. Eur Radiol. 2014; 25(5):1497-503. DOI: 10.1007/s00330-014-3498-x. View

16.

Chhabra A, Chalian M, Soldatos T, Andreisek G, Faridian-Aragh N, Williams E . 3-T high-resolution MR neurography of sciatic neuropathy. AJR Am J Roentgenol. 2012; 198(4):W357-64. DOI: 10.2214/AJR.11.6981. View

17.

Gasparotti R, Ferraresi S, Pinelli L, Crispino M, Pavia M, Bonetti M . Three-dimensional MR myelography of traumatic injuries of the brachial plexus. AJNR Am J Neuroradiol. 1997; 18(9):1733-42. PMC: 8338463. View

18.

Blum A, Lecocq S, Louis M, Wassel J, Moisei A, Teixeira P . The nerves around the shoulder. Eur J Radiol. 2011; 82(1):2-16. DOI: 10.1016/j.ejrad.2011.04.033. View

19.

Vargas M, Viallon M, Nguyen D, Beaulieu J, Delavelle J, Becker M . New approaches in imaging of the brachial plexus. Eur J Radiol. 2010; 74(2):403-10. DOI: 10.1016/j.ejrad.2010.01.024. View

20.

Tagliafico A, Succio G, Neumaier C, Serafini G, Ghidara M, Calabrese M . MR imaging of the brachial plexus: comparison between 1.5-T and 3-T MR imaging: preliminary experience. Skeletal Radiol. 2010; 40(6):717-24. DOI: 10.1007/s00256-010-1050-x. View