Download PDF
Semin Musculoskelet Radiol 2019; 23(04): 405-418
DOI: 10.1055/s-0039-1694753
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Top-Ten Tips for Imaging the Brachial Plexus with Ultrasound and MRI

James F. Griffith
1   Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong
,
Radhesh Krishna Lalam
2   Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
11 September 2019 (online)

Also available at
   Permissions and Reprints

Abstract

When it comes to examining the brachial plexus, ultrasound (US) and magnetic resonance imaging (MRI) are complementary investigations. US is well placed for screening most extraforaminal pathologies, whereas MRI is more sensitive and accurate for specific clinical indications. For example, MRI is probably the preferred technique for assessment of trauma because it enables a thorough evaluation of both the intraspinal and extraspinal elements, although US can depict extraforaminal neural injury with a high level of accuracy. Conversely, US is probably the preferred technique for examination of neurologic amyotrophy because a more extensive involvement beyond the brachial plexus is the norm, although MRI is more sensitive than US for evaluating muscle denervation associated with this entity. With this synergy in mind, this review highlights the tips for examining the brachial plexus with US and MRI.

Keywords

brachial plexus - ultrasound - magnetic resonance imaging - inflammation - trauma
 

  • References

  • 1 Klaassen Z, Sorenson E, Tubbs RS. , et al. Thoracic outlet syndrome: a neurological and vascular disorder. Clin Anat 2014; 27 (05) 724-732
    CrossrefPubMedSearch in Google Scholar
  • 2 González-Arnay E, Jiménez-Sánchez L, García-Simón D. , et al. Ultrasonography-guided anterior approach for axillary nerve blockade: an anatomical study. Clin Anat 2019 ; May 3 [Epub ahead of print]
    PubMedSearch in Google Scholar
  • 3 Faruch Bilfeld M, Lapègue F, Sans N, Chiavassa Gandois H, Laumonerie P, Larbi A. Ultrasonography study of the suprascapular nerve. Diagn Interv Imaging 2017; 98 (12) 873-879
    CrossrefPubMedSearch in Google Scholar
  • 4 Leonhard V, Smith R, Caldwell G, Smith HF. Anatomical variations in the brachial plexus roots: implications for diagnosis of neurogenic thoracic outlet syndrome. Ann Anat 2016; 206: 21-26
    CrossrefPubMedSearch in Google Scholar
  • 5 Roos DB. Congenital anomalies associated with thoracic outlet syndrome. Anatomy, symptoms, diagnosis, and treatment. Am J Surg 1976; 132 (06) 771-778
    CrossrefPubMedSearch in Google Scholar
  • 6 Ustuner E, Yılmaz A, Özgencil E, Okten F, Turhan SC. Ultrasound anatomy of the brachial plexus nerves in the neurovascular bundle at the axilla in patients undergoing upper-extremity block anesthesia. Skeletal Radiol 2013; 42 (05) 707-713
    CrossrefPubMedSearch in Google Scholar
  • 7 Mian A, Chaudhry I, Huang R, Rizk E, Tubbs RS, Loukas M. Brachial plexus anesthesia: a review of the relevant anatomy, complications, and anatomical variations. Clin Anat 2014; 27 (02) 210-221
    CrossrefPubMedSearch in Google Scholar
  • 8 Nowakowski P, Bieryło A. Ultrasound guided axillary brachial plexus plexus block. Part 1—basic sonoanatomy. Anaesthesiol Intensive Ther 2015; 47 (04) 409-416
    CrossrefPubMedSearch in Google Scholar
  • 9 Han JH, Kim YJ, Kim JH, Kim DY, Lee GY, Kim CH. Topographic pattern of the brachial plexus at the axillary fossa through real-time ultrasonography in Koreans. Korean J Anesthesiol 2014; 67 (05) 310-316
    CrossrefPubMedSearch in Google Scholar
  • 10 Sinha C, Kumar N, Kumar A, Kumar A, Kumar A. Comparative evaluation of two approaches of infraclavicular brachial plexus block for upper-limb surgeries. Saudi J Anaesth 2019; 13 (01) 35-39
    CrossrefPubMedSearch in Google Scholar
  • 11 Griffith JF. Ultrasound of the brachial plexus. Semin Musculoskelet Radiol 2018; 22 (03) 323-333
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Caldana WCI, Kodaira SK, Cavalcanti CFA, Rodrigues MB, Saito OC, Buchpiguel CA. Value of ultrasound in the anatomical evaluation of the brachial plexus: correlation with magnetic resonance imaging. Radiol Bras 2018; 51 (06) 358-365
    CrossrefPubMedSearch in Google Scholar
  • 13 Kumar A, Kumar A, Sinha C, Sawhney C, Kumar R, Bhoi D. Topographic sonoanatomy of infraclavicular brachial plexus: variability and correlation with anthropometry. Anesth Essays Res 2018; 12 (04) 814-818
    PubMedSearch in Google Scholar
  • 14 Sneag DB, Mendapara P, Zhu JC. , et al. Prospective respiratory triggering improves high-resolution brachial plexus MRI quality. J Magn Reson Imaging 2019; 49 (06) 1723-1729
    CrossrefPubMedSearch in Google Scholar
  • 15 Upadhyaya V, Upadhyaya DN. Current status of magnetic resonance neurography in evaluating patients with brachial plexopathy. Neurol India 2019; 67 (Suppl): S118-S124
    CrossrefPubMedSearch in Google Scholar
  • 16 Oudeman J, Verhamme C, Engbersen MP. , et al. Diffusion tensor MRI of the healthy brachial plexus. PLoS One 2018; 13 (05) e0196975
    CrossrefPubMedSearch in Google Scholar
  • 17 Tagliafico A, Calabrese M, Puntoni M. , et al. Brachial plexus MR imaging: accuracy and reproducibility of DTI-derived measurements and fibre tractography at 3.0-T. Eur Radiol 2011; 21 (08) 1764-1771
    CrossrefPubMedSearch in Google Scholar
  • 18 Ho MJ, Manoliu A, Kuhn FP. , et al. Evaluation of reproducibility of diffusion tensor imaging in the brachial plexus at 3.0 T. Invest Radiol 2017; 52 (08) 482-487
    CrossrefPubMedSearch in Google Scholar
  • 19 Graf A, Yang K, King D, Dzwierzynski W, Sanger J, Hettinger P. Lipomas of the brachial plexus: a case series and review of the literature. Hand (N Y) 2019; 14 (03) 333-338
    CrossrefPubMedSearch in Google Scholar
  • 20 Hung EH, Griffith JF. Pitfalls in ultrasonography of soft tissue tumors. Semin Musculoskelet Radiol 2014; 18 (01) 79-85
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 King AD, Ahuja AT, King W, Metreweli C. Sonography of peripheral nerve tumors of the neck. AJR Am J Roentgenol 1997; 169 (06) 1695-1698
    CrossrefPubMedSearch in Google Scholar
  • 22 Tagliafico AS, Isaac A, Bignotti B, Rossi F, Zaottini F, Martinoli C. Nerve tumors: what the MSK radiologist should know. Semin Musculoskelet Radiol 2019; 23 (01) 76-84
    Thieme ConnectPubMedSearch in Google Scholar
  • 23 Soldatos T, Fisher S, Karri S, Ramzi A, Sharma R, Chhabra A. Advanced MR imaging of peripheral nerve sheath tumors including diffusion imaging. Semin Musculoskelet Radiol 2015; 19 (02) 179-190
    Thieme ConnectPubMedSearch in Google Scholar
  • 24 Mazal AT, Ashikyan O, Cheng J, Le LQ, Chhabra A. Diffusion-weighted imaging and diffusion tensor imaging as adjuncts to conventional MRI for the diagnosis and management of peripheral nerve sheath tumors: current perspectives and future directions. Eur Radiol 2019; 29 (08) 4123-4132
    CrossrefPubMedSearch in Google Scholar
  • 25 Warade AC, Jha AK, Pattankar S, Desai K. Radiation-induced brachial plexus neuropathy: a review. Neurol India 2019; 67 (Suppl): S47-S52
    CrossrefPubMedSearch in Google Scholar
  • 26 Delanian S, Lefaix JL, Pradat PF. Radiation-induced neuropathy in cancer survivors. Radiother Oncol 2012; 105 (03) 273-282
    CrossrefPubMedSearch in Google Scholar
  • 27 Dropcho EJ. Neurotoxicity of radiation therapy. Neurol Clin 2010; 28 (01) 217-234
    CrossrefPubMedSearch in Google Scholar
  • 28 Kori SH. Diagnosis and management of brachial plexus lesions in cancer patients. Oncology (Williston Park) 1995; 9 (08) 756-760 ; discussion 765
    PubMedSearch in Google Scholar
  • 29 Vargas MI, Viallon M, Nguyen D, Beaulieu JY, Delavelle J, Becker M. New approaches in imaging of the brachial plexus. Eur J Radiol 2010; 74 (02) 403-410
    CrossrefPubMedSearch in Google Scholar
  • 30 Goedee HS, van der Pol WL, van Asseldonk JH. , et al. Diagnostic value of sonography in treatment-naive chronic inflammatory neuropathies. Neurology 2017; 88 (02) 143-151
    CrossrefPubMedSearch in Google Scholar
  • 31 Zaidman CM, Pestronk A. Nerve size in chronic inflammatory demyelinating neuropathy varies with disease activity and therapy response over time: a retrospective ultrasound study. Muscle Nerve 2014; 50 (05) 733-738
    CrossrefPubMedSearch in Google Scholar
  • 32 Goedee HS, van der Pol WL, Hendrikse J, van den Berg LH. Nerve ultrasound and magnetic resonance imaging in the diagnosis of neuropathy. Curr Opin Neurol 2018; 31 (05) 526-533
    CrossrefPubMedSearch in Google Scholar
  • 33 Goedee HS, Jongbloed BA, van Asseldonk JH. , et al. A comparative study of brachial plexus sonography and magnetic resonance imaging in chronic inflammatory demyelinating neuropathy and multifocal motor neuropathy. Eur J Neurol 2017; 24 (10) 1307-1313
    CrossrefPubMedSearch in Google Scholar
  • 34 Tanaka K, Mori N, Yokota Y, Suenaga T. MRI of the cervical nerve roots in the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy: a single-institution, retrospective case-control study. BMJ Open 2013; 3 (08) e003443
    CrossrefPubMedSearch in Google Scholar
  • 35 Lee RKL, Griffith JF, Ng AWH. , et al. Cross-sectional area of the median nerve at the wrist: comparison of sonographic, MRI, and cadaveric measurements. J Clin Ultrasound 2019; 47 (03) 122-127
    CrossrefPubMedSearch in Google Scholar
  • 36 Ferrante MA. The distribution of neuralgic amyotrophy lesions is overwhelmingly extraplexal. Muscle Nerve 2018; 58 (03) 325-326
    CrossrefPubMedSearch in Google Scholar
  • 37 van Rosmalen M, Lieba-Samal D, Pillen S, van Alfen N. Ultrasound of peripheral nerves in neuralgic amyotrophy. Muscle Nerve 2019; 59 (01) 55-59
    CrossrefPubMedSearch in Google Scholar
  • 38 Abraham A, Izenberg A, Dodig D, Bril V, Breiner A. Peripheral nerve ultrasound imaging shows enlargement of peripheral nerves outside the brachial plexus in neuralgic amyotrophy. J Clin Neurophysiol 2016; 33 (05) e31-e33
    CrossrefPubMedSearch in Google Scholar
  • 39 ArÁnyi Z, Csillik A, DéVay K. , et al. Ultrasonography in neuralgic amyotrophy: Sensitivity, spectrum of findings, and clinical correlations. Muscle Nerve 2017; 56 (06) 1054-1062
    CrossrefPubMedSearch in Google Scholar
  • 40 Landau ME, Campbell WW. Clinical features and electrodiagnosis of ulnar neuropathies. Phys Med Rehabil Clin N Am 2013; 24 (01) 49-66
    CrossrefPubMedSearch in Google Scholar
  • 41 Sneag DB, Saltzman EB, Meister DW, Feinberg JH, Lee SK, Wolfe SW. MRI bullseye sign: an indicator of peripheral nerve constriction in Parsonage-Turner syndrome. Muscle Nerve 2017; 56 (01) 99-106
    CrossrefPubMedSearch in Google Scholar
  • 42 Sneag DB, Rancy SK, Wolfe SW. , et al. Brachial plexitis or neuritis? MRI features of lesion distribution in Parsonage-Turner syndrome. Muscle Nerve 2018; 58 (03) 359-366
    CrossrefPubMedSearch in Google Scholar
  • 43 Gruber L, Loizides A, Löscher W, Glodny B, Gruber H. Focused high-resolution sonography of the suprascapular nerve: a simple surrogate marker for neuralgic amyotrophy?. Clin Neurophysiol 2017; 128 (08) 1438-1444
    CrossrefPubMedSearch in Google Scholar
  • 44 Cup EH, Ijspeert J, Janssen RJ. , et al. Residual complaints after neuralgic amyotrophy. Arch Phys Med Rehabil 2013; 94 (01) 67-73
    CrossrefPubMedSearch in Google Scholar
  • 45 Walden MJ, Adin ME, Visagan R. , et al. Cervical ribs: identification on MRI and clinical relevance. Clin Imaging 2013; 37 (05) 938-941
    CrossrefPubMedSearch in Google Scholar
  • 46 Viertel VG, Intrapiromkul J, Maluf F. , et al. Cervical ribs: a common variant overlooked in CT imaging. AJNR Am J Neuroradiol 2012; 33 (11) 2191-2194
    CrossrefPubMedSearch in Google Scholar
  • 47 Jones MR, Prabhakar A, Viswanath O. , et al. Thoracic outlet syndrome: a comprehensive review of pathophysiology, diagnosis, and treatment. Pain Ther 2019; 8 (01) 5-18
    CrossrefPubMedSearch in Google Scholar
  • 48 Illig KA. Thoracic Outlet Syndrome. New York, NY: Springer Science and Business Media; 2014
    Search in Google Scholar
  • 49 Orlando MS, Likes KC, Mirza S. , et al. Preoperative duplex scanning is a helpful diagnostic tool in neurogenic thoracic outlet syndrome. Vasc Endovascular Surg 2016; 50 (01) 29-32
    CrossrefPubMedSearch in Google Scholar
  • 50 Lapegue F, Faruch-Bilfeld M, Demondion X. , et al. Ultrasonography of the brachial plexus, normal appearance and practical applications. Diagn Interv Imaging 2014; 95 (03) 259-275
    CrossrefPubMedSearch in Google Scholar
  • 51 Aralasmak A, Cevikol C, Karaali K. , et al. MRI findings in thoracic outlet syndrome. Skeletal Radiol 2012; 41 (11) 1365-1374
    CrossrefPubMedSearch in Google Scholar
  • 52 Braun RM, Shah KN, Rechnic M, Doehr S, Woods N. Quantitative assessment of scalene muscle block for the diagnosis of suspected thoracic outlet syndrome. J Hand Surg Am 2015; 40 (11) 2255-2261
    CrossrefPubMedSearch in Google Scholar
  • 53 Torriani M, Gupta R, Donahue DM. Sonographically guided anesthetic injection of anterior scalene muscle for investigation of neurogenic thoracic outlet syndrome. Skeletal Radiol 2009; 38 (11) 1083-1087
    CrossrefPubMedSearch in Google Scholar
  • 54 Lum YW, Brooke BS, Likes K. , et al. Impact of anterior scalene lidocaine blocks on predicting surgical success in older patients with neurogenic thoracic outlet syndrome. J Vasc Surg 2012; 55 (05) 1370-1375
    CrossrefPubMedSearch in Google Scholar
  • 55 Narakas AO. The treatment of brachial plexus injuries. Int Orthop 1985; 9 (01) 29-36
    CrossrefPubMedSearch in Google Scholar
  • 56 Shin AY, Spinner RJ, Steinmann SP, Bishop AT. Adult traumatic brachial plexus injuries. J Am Acad Orthop Surg 2005; 13 (06) 382-396
    CrossrefPubMedSearch in Google Scholar
  • 57 Gunes A, Bulut E, Uzumcugil A, Oguz KK. Brachial plexus ultrasound and MRI in children with brachial plexus birth injury. AJNR Am J Neuroradiol 2018; 39 (09) 1745-1750
    CrossrefPubMedSearch in Google Scholar
  • 58 Qi L, Xu L, Wang WT. , et al. Dynamic contrast-enhanced magnetic resonance imaging in denervated skeletal muscle: experimental study in rabbits. PLoS One 2019; 14 (04) e0215069
    CrossrefPubMedSearch in Google Scholar