Purpose

The inherent complexity of the brachial plexus has the potential to make magnetic resonance imaging (MRI) evaluation a daunting task. In response to these challenges, this educational exhibit aims to make the anatomy, MRI techniques, and pathology easily approachable with the end goal of empowering trainees and general radiologists to approach these exams with confidence.

Outline of Content

While exams can be performed on a 1.5 Tesla (T) or 3T scanner, images are ideally obtained on a 3T MRI and a practical approach for developing MRI protocols for clinically relevant and efficient image acquisition is discussed. Schematic and MRI anatomy is correlated for the benefit of the viewer, with attention to vital landmarks and sites of potential pathology. An essential part of interpretation includes pre- and post-ganglionic localization, segmental location (i.e. within the roots, trunks, etc…), as well as the anatomic relationship with surrounding structures. Building upon the anatomy, a workable method for detecting and organizing brachial plexus pathology is presented. Evaluation includes a strict search pattern that utilizes three planes for optimal assessment of specific areas of interest and takes in account lesion morphology and pattern of enhancement to help confirm the location. Traumatic and non-traumatic pathologies will be discussed with a focus on common etiologies, although more unusual disease processes, including herpes zoster and heroin-related brachial plexopathy cases will also be presented. As clinical history plays an important role in synthesizing an appropriate differential for brachial plexus pathology, a case-based approach will be utilized for presentation and educational purposes.

Summary

MRI evaluation of the brachial plexus can be confidently and efficiently interpreted with a fundamental understanding of MRI protocols, brachial plexus anatomy, and pathology.

Acknowledgements

No acknowledgement found.