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Thoracic Outlet Syndrome: Spectrum of Imaging Findings on Magnetic Resonance Neurography 2014

Category General Spine Gregory E. Punch, MD Cynthia Chin Purpose Thoracic outlet syndrome (TOS) complex is a group of related disorders typically presenting with intermittent upper extremity symptoms involving the C8 and T1 spinal nerves or lower trunk of the brachial plexus. Recent advances in magnetic resonance imaging, including higher field strengths and improved pulse sequences, enable the radiologist to image the brachial plexus with high resolution, facilitating the diagnosis of this enigmatic clinical entity. A. To review the “classic” or neurogenic sub-type of thoracic outlet syndrome including the spectrum of pathophysiologic considerations. B. To illustrate the MR Neurography imaging findings in a variety of pathologic mechanisms. C. To discuss imaging and interpretation strategies to provide added value to the patient and clinical care team. Materials & Methods Magnetic resonance neurography of patients presenting with clinical symptoms suggestive of and surgically confirmed thoracic outlet syndrome are reviewed using selected cases along with graphic illustrations. Imaging anatomy of the various pathophysiologies of classic thoracic outlet syndrome will be reviewed, including: cervical ribs, elongated transverse process, fibrous bands, vascular and muscular compression. Results This educational exhibit reviews the spectrum of MR Neurography imaging findings in a variety of clinical cases of classic neurogenic thoracic outlet syndrome. Targeted imaging and interpretation strategies are also discussed to provide added value to the patient and clinical care team. Conclusion After reviewing this exhibit, the viewer will be familiar with the MR neurography imaging findings in clinical cases of “classic” or neurogenic thoracic outlet syndrome. The imaging features and imaging strategies of a variety of causes are discussed. References Mikityanksy, I et al. MR Imaging of the Brachial Plexus. Magnetic Resonsonce Clinics of North America. 20 (2012); 791-826 Paumer, P et al. Thoracic outlet Syndrome in 3T MR Neurography--fibrous bands causing discernable lesions of the lower brachial plexus. European radiology. [EPub 22 November 2013] Ahead of print. Klaassen Z et al. Thoracic outlet syndrome: A neurological and vascular disorder. Clinical Anatomy. [Epub 2013 May 29] Ahead of print.