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Review of Brachial Plexus MRI 2014

Category General Spine Brian S. Dupree John Holbrook Purpose Brachial plexus pathology can have a myriad of clinical presentations, depending upon the location of involvement. It poses a clinical dilemma because this area is difficult to palpate and electromyography can only delineate between central or peripheral lesions. This makes MRI the examination of choice because of its high soft tissue contrast and ability visualize the course of the brachial plexus from the cervical spine to the peripheral nerves to the axilla. (1) The purpose of this educational exhibit is to discuss brachial plexus MRI beginning with a discussion of our institutions MR protocol, followed by depiction of normal anatomy, and then several image rich cases of brachial plexus pathology. Materials & Methods Objectives: Using an image rich format, this educational poster will discuss: -MR Protocol for the brachial plexus -Pulse sequences -Patient positioning -Decision for contrast administration -Normal anatomy -Brachial Plexus Pathology (2) -Trauma (3) -Non-Trauma (4) - including: Infectious/Inflammatory causes Impingement (thoracic outlet syndrome) Autoimmune Radiation Fibrosis Masses Results Learning Points: Review and attempt to simplify brachial plexus anatomy. Discuss brachial plexus pathology and some interesting treatment options. Conclusion Brachial plexus pathology can be a diagnostic dilemma for clinicians. Basic knowledge of brachial plexus anatomy and potential causes of brachial plexopathies can help radiologists recognize and localize abnormalities and hopefully aid clinicians in treatment management. References 1. Wittenberg KH, Adkins MC. MR Imaging of Nontraumatic Brachial Plexopathies: Frequency and Spectrum of Findings1. Radiographics. 2000;20(4):1023–1032. 2. Sureka J, Cherian R, Alexander M, Thomas B. MRI of brachial plexopathies. Clinical radiology. 2009;64(2):208–218. 3. Yoshikawa T, Hayashi N, Yamamoto S, et al. Brachial Plexus Injury: Clinical Manifestations, Conventional Imaging Findings, and the Latest Imaging Techniques1. Radiographics. 2006;26(Supplement 1):S133–S143. 4. Castillo M. Imaging the Anatomy of the Brachial Plexus: Review and Self-Assessment Module. American Journal of Roentgenology. 2005;185(6 Supplement):S196–S204.