The anatomy of the brachial plexus roots, trunks, divisions and cords is well demonstrated on mri due to inherent contrast differences which exist between nerves and adjacent fat. The basic protocol provides the core component of this procedure and an alternate protocol is presented for the case of avulsion injury from trauma. Mri abdomen without contrast 74181 abdomen kidneys liver mass mre mri abdomen without and with contrast 74183 abdomen mra renal arteries mesenteric ischemia mra abdomen without and with contrast 74185 brachial plexus brachial plexus neuropathy mri chest without contrast 71550 chest mra thoracic aorta vascular anomalies. The brachial plexus is an arrangement of nerve fibres, running from the spine, formed by the ventral rami of the lower cervical and upper thoracic nerve roots it includes from above the fifth cervical vertebra to underneath the first thoracic vertebrac5t1. Electrodiagnosis of brachial plexopathies and proximal upper.
Magnetic resonance neurography of the brachial plexus. Physiotherapy protocols for the management of different types of brachial plexus injuries introduction as such, protocols in the management of brachial plexus injuries bpi are a bit of a misnomer. Optimization of a practical bp imaging protocol is paramount to identify normal anatomy and associated pathology. Compromising abnormalities of the brachial plexus as. Mri nurse will inject diamox inject diamox nurse will inject and wait 20 minutes before second perfusion post.
At this level the roots of the brachial plexus are seen as lowdensity linear. The spinal cord should be centered within the thecal sac and without contour abnormality. Magnetic resonance imaging of adult traumatic brachial. Ultrasonography of the brachial plexus, normal appearance and. Brachial plexus contouring with ct and mr imaging in.
Magnetic resonance imaging mri is the imaging modality of choice to depict normal anatomy and pathology of the brachial plexus. Abdominal x breast x cardiac x chest x ct x emergency x gi x gu x headneck x ir x molecular x msk x mri x nuc med x neuro x obgyn x oncologic x other x peds x qi x research x us x vascular x afrikaans x albanian x arabic x belarusian x bulgarian x catalan x chinese x croatian x czech x danish x dutch x english x estonian x farsi persian x. The brachial plexus is difficult to examine clinically because a b fig. Axial section is obtained at level of thyroid bed, which lies at approximately the level of fifth cervical vertebral body. The brachial plexus appears unremarkable, with no convincing t2 signal abnormality or regional abnormal enhancement. Mri is currently the preferred modality for brachial plexus assessment.
Low interrater reliability of brachial plexus mri in. Magnetic resonance imaging mri is being increasingly recognised all over the world as the imaging modality of choice for brachial plexus and peripheral nerve lesions. Mr neurography imaging peripheral nerves kenneth r. The brachial plexus consists of roots, trunks, divisions, cords and terminal branches as it travels from proximal to distal upper limb.
A comparative study of brachial plexus sonography and. These nerves originate in the fifth, sixth, seventh and eighth cervical c5c8, and first thoracic t1 spinal nerves, and innervate the muscles and skin of the chest, shoulder, arm and. Brachial plexus disorders can be diagnostic challenges, owing to the regions complex anatomy and nonspecific symptomatology. Trauma is the most common cause of brachial plexopathy. Magnetic resonance imaging mri of the brachial plexus is the imaging modality of first choice for depicting anatomy and pathology of the brachial plexus. Mri lumbosacral plexus mri pelvis without contrast 72195 leg painsciatica lumbar plexopathy radiculopathy sacralcoccyx pain no neurology mri brachial plexus mri upper extremity nonjoint with and without contrast 73220 shoulder injury brachial plexopathy nerve avulsion determined by radiologist. In addition other investigations such as neurophysiology tests and mri will already have been done.
Different imaging modalities can be used to study the brachial plexus, including magnetic resonance imaging mri, computed tomography ct and ultrasound us 1, however mri is the imaging modality of choice for the evaluation of the brachial plexus due to its. A promising alterna ve to tradi onal ct myelography. A thorough understanding of the anatomy of this region provides the clinician with valuable. Brachial plexus mri protocols and planning indications for. Brachial plexus injury the brachial plexus is a group of nerves that come from the spinal cord in the neck and travel down the arm see figure 1. Brachial plexus injuries are usually caused by trauma to the roots of the plexus as they exit the cervical spine. Posttraumatic brachial plexus mri in practice sciencedirect. Diagnosing brachial plexus pathology can be clinically challenging, often necessitating further evaluation with mri. The brachial plexus can be efficiently imaged and effectively interpreted by the general radiologist when approached from a practical standpoint.
It often can show the extent of the damage caused by a brachial plexus injury and can help assess the status of arteries that are important for the limb or for reconstruction of it. Ultrasonography of the brachial plexus, normal appearance. Brachialplexus clavian vein as demonstrated on transverse mri sequences. Most patients with brachial plexopathies complain of vague ipsilateral and nonspecific symptoms. It proceeds through the neck, the axilla and into the arm. Abdomen mre rad095 mri abdomen without and with contrast 74183 abdomen mra rad07011 mra abdomen without and with contrast 74185 brachial plexus bilat rad07268 left rad07052 right rad07266 mri chest without contrast 71550 brachial plexus bilat rad07051 left rad07053 right rad07264. Mri search pattern a suggested basic search pattern for evaluation of a brachial plexus mri study begins with an axial t2weighted sequence. The brachial plexus is a major neural structure, providing motor and sensory innervation to the upper extremity. The use of ultrasound for imaging of the brachial plexus has advantages over other imaging modalities, such as computed tomography ct and magnetic resonance imaging mri. Plexus mri pelvis without contrast 72195 leg painsciatica lumbar plexopathy radiculopathy sacralcoccyx pain no neurology mri brachial plexus mri upper extremity nonjoint with and without contrast 73220 shoulder injury brachial plexopathy nerve avulsion determined by radiologist neurology mri chest mediastinum mri chestmediastinum with and. The bpl is a part of the peripheral nervous system.
Mri of the brachial plexus was requested figure 18, figure 19. This mnemonic describes the order of these subdivisions. The educational objectives of this continuing medical education activity are to describe the normal anatomy of the brachial plexus, to name the most common symptoms associated with a brachial plexopathy, to describe the most common imaging findings resulting from trauma to the brachial plexus, to describe the imaging manifestations of common. Anatomy of the brachial plexus the brachial plexus is a large network of nerves arising from the ventral rami at levels c5 through t1 of the spinal cord to innervate the upper limb.
Brachial plexus is a complex network of nerves, which is responsible for the innervation of the upper extremity. Electrodiagnosis of brachial plexopathies 15 plexus, there is a minimal contribution from c5 and a more substantial contribution from t2, resulting in the plexus being shifted one root level inferiorly. Brachial plexus injuries are a spectrum of upper limb neurological deficits secondary to partial or complete injury to the brachial plexus, which provides the nerve supply of upper limb muscles. No invading mass or focal abnormality of the lung apex or regional soft tissues. It is formed in the posterior cervical triangle by the union of ventral rami of 5th, 6th, 7th, and 8th cervical nerve roots and 1st thoracic nerve root. Threedimensional mr imaging of the brachial plexus. Highresolution 3t mr neurography of the brachial plexus and.
Pdf threedimensional mr imaging of the brachial plexus. Brachial plexus injury symptoms, diagnosis and treatment. Although a number of modalities are available for imaging of the brachial plexusincluding magnetic resonance mr imaging, computed tomography ct, 1, 5, and most recently ultrasonography us, 6mr imaging is the. With advancement in 3d imaging, better fatsuppression techniques, and superior coil designs for mr imaging and the increasing availability and use of 3t magnets, the visualization of the complexity of the brachial plexus has become facile. Brachial plexus injury diagnosis and treatment mayo clinic. Mri brachial plexus anatomy free mri coronal cross. The anatomy of the roots, trunks, divisions and cords is very well depicted due to the inherent contrast differences between the nerves and the surrounding fat. Brachial plexus injuries radiology reference article. Radiologists work closely with ohsu mri techs in the art of creating optimal images from current technology. Other assessment tools used at the department are the dash questionnaire, and the narakas score. This test uses a powerful magnetic field and radio waves to produce detailed views of your body in multiple planes. Ninety percent of cases are due to motorbike accidents.
A brachial plexus injury bpi, also known as brachial plexus lesion, is an injury to the brachial plexus, the network of nerves that conducts signals from the spinal cord to the shoulder, arm and hand. Athin layer ofdeepfascia envelopes the neurovascu lar bundle of the upper limb. They will usually have been assessed at the brachial plexus injuries clinic preoperatively. Physiological and clinical advantages of median nerve fascicle transfer to the musculocutaneous nerve following brachial plexus root avulsion injury. Recent refinements in mri protocols have helped in imaging nerve tissue with greater clarity thereby helping in the identification, localisation and classification of nerve. This mri brachial plexus cross sectional anatomy tool is absolutely free to use. The mechanism of the injury involves stretching of the brachial plexus nerves which may lead to two types of damage. Ultrasound equipment is relatively inexpensive and portable, and can be brought to the bedside for examination in patients who cannot readily be transported. Brachial plexus mri was performed for diagnostic purposes and was reassessed for this study. To show examples of the pathology that may affect the bp methods and materials protocol.
In our study, we emphasis on mri anatomy of brachial plexus, evaluating the site of. Mri of the brachial plexus is a valuable diagnostic tool for detection and preoperative staging of mass lesions involving the brachial plexus, in evaluating inflammatory and traumatic brachial plexus changes. Mr neurography brachial plexus clinical case and images provided by avneesh chhabra, m. Different imaging modalities can be used to study the brachial plexus, including magnetic resonance imaging mri, computed tomography ct and ultrasound us 1, however mri is the imaging modality of choice for the evaluation of the. The ventral rami exit through the neural foramina of the cervical vertebrae posterior to the vertebral artery. This unit presents protocols to diagnose the cause of brachial plexus. Compromising abnormalities of the brachial plexus 3 fig. Roots are formed between the scalenus anterior and scalenus medius muscles by the anterior rami of c5c8 and t1 nerve roots. Practical and useful information that can help the referring physician include, pre. To choose the appropriate mri protocol of sequences for each clinical context 3. To identify the structures which make up the brachial plexus bp in magnetic resonance imaging mri. Imaging of the brachial plexus or the lumbosacral plexus will require the.
Brachial plexus takahashi 2001 current protocols in. Four spaces are formed from the root ofthe neckto the lowerpart. Magnetic resonance imaging of adult traumatic brachial plexus. T1weighted sagittal slices of the right brachial plexus passing respectively through the interscalene groove, the costoclavicular gap and the tunnel under the pectoralis minor. Mri is the primary imaging modality used to diagnose the cause of brachial plexopathy. The educational objectives of this continuing medical education activity are to describe the normal anatomy of the brachial plexus, to name the most common symptoms associated with a brachial plexopathy, to describe the most common imaging findings resulting from trauma to the brachial plexus, to describe the imaging manifestations of common neoplasias affecting the. Electrodiagnosis of brachial plexopathies 15 plexus, there is a minimal contribution from c5 and a more substantial contribution from t2, resulting in the. The pediatric radiologists will usually protocol specific sequences they need in ris.
This may be due to the involvement of the spinal cord in a severe injury but can also be found in the child with a more mild injury. This is the gross neurovascular specimen of the brachial plexus, artery and vein which was used to monstrate nerves on the axillary nerve black arrowheads originates from the radial nerve nlwhich is bound curved white arrow to the axillary artery a. Magnetic resonance imaging mri is the modality of choice because of multiplanar and better soft tissue resolution. Mri aids in localizing and assessing the severity of the damage. A three plane localiser must be taken in the beginning to localise and plan the sequences. Highresolu on mri evalua on of neonatal brachial plexus palsy. The brachial plexus is a complex anatomical network of nerves that mainly supplies the upper limb. If not, follow the adult protocol, but make changes to the slice, gap, and fov as needed. Use the mouse scroll wheel to move the images up and down alternatively use the tiny arrows on both side of the image to move the images. The brachial plexus is a major neural structure that provides sensory and motor innervation to the upper extremity.
Mr imaging findings in brachial plexopathy with thoracic. The cervical spine appears unremarkable, with all neural exit foramina appearing capacious. Infection of the brachial plexus bp is rare and may occur after lung disease, such as fungal infection or tuberculosis, or after surgery or trauma. Electrodiagnosis of brachial plexopathies and proximal. Highresolution 3t mr neurography of the brachial plexus. The brachial plexus is a somatic nerve plexus formed by intercommunications among the ventral rami of the nerve roots c5, c6, c7, c8 and t1 with occasional contributions from c4 and t2. The relevant imaging findings are described for normal and pathologic conditions of the brachial plexus. Brachial plexus injury bpi is a severe peripheral nerve injury affecting upper extremities, causing functional damage and physical disability. Reliable fat suppression on t2weighted images is an absolute essential for successful brachial plexus mr imaging. The brachial plexus is the network of nerves that originate from cervical and upper. Mri remains the best modality for assessing the brachial plexus bp, due to its superior softtissue contrast compared to ct or ultrasound.