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Do not forget the brachial plexus—prevalence of distal brachial plexus pathology on routine shoulder MRI

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Most of the shoulder magnetic resonance imaging (MRI) examination focuses on internal joint structures but disregarding other structures like the distal brachial plexus, which may miss important findings. Hereby, we attempt to evaluate the prevalence of distal brachial plexus abnormalities and/or muscular denervation changes seen on routine shoulder MRI examinations and discuss common pathologies affecting the distal brachial plexus.

Material and methods

A total of 701 routine shoulder MRI studies were evaluated. The evaluation of each exam was focused on the visualized brachial plexus elements and musculature abnormalities in each case. If any abnormalities of plexus and/or musculature were found, potential underlying etiologies such as paralabral or spinoglenoid notch cysts, infiltrative/primary masses on imaging, history of prior viral illness, and radiation therapy were searched. It was then confirmed whether the abnormal findings were mentioned in the exam reports or not.

Results

Thirty-four cases (4.85%) demonstrated abnormal findings of the visualized brachial plexus cords or branches and/or musculature. It was observed that in 35.3% of exam reports these findings were not mentioned, mainly missing subtle nerve abnormalities, but correctly reporting and interpreting the encountered muscle abnormalities.

Conclusion

The distal brachial plexus and its branches should be included in the search pattern for shoulder MRI examinations.

Key Points

• Normal T2 signal of the brachial plexus is iso- to slightly hyperintense to muscle but less signal intense than fluid.

• Diffuse, geographic muscle edema is an indirect sign of brachial plexus pathology.

• Increased T2-weighted nerve signal with or without caliber or course change should be reported and followed up to find the underlying etiology.

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Abbreviations

BNB:

Blood nerve barrier

CIPN:

Chemotherapy-induced peripheral neuropathy

FOV:

Field of view

HIPAA:

Health Insurance Portability and Accountability Act

IRB:

Institutional review board

ISP:

Infraspinatus muscle

PACS:

Picture archiving and communication system

PDFS:

Fat-saturated proton density

weighted sequence

RIBP:

Radiation-induced brachial plexopathy

SSC:

Subscapularis muscle

SSP:

Supraspinatus muscle

T1FS + C:

Contrast-enhanced, fat-saturated T1-weighted sequence

T2FS:

Fat-saturated T2-weighted sequence

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Acknowledgments

The authors acknowledge Amy Thomas for her help with the creation of the brachial plexus anatomy sketch.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Stanford University, School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA

    Neha Antil, Yehia ElGuindy & Amelie M. Lutz

  2. Division of Musculoskeletal Radiology, Department of Radiology, Stanford University, School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA

    Amelie M. Lutz

Authors
  1. Neha Antil
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  2. Yehia ElGuindy
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  3. Amelie M. Lutz
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Corresponding author

Correspondence to Amelie M. Lutz.

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Guarantor

The scientific guarantor of this publication is Amelie M. Lutz, MD.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Amelie M. Lutz, MD, received research funding from GE Healthcare for projects not related to this study.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board due to the retrospective analysis manner of the research project.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• cross-sectional study, observational

• performed at one institution

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Antil, N., ElGuindy, Y. & Lutz, A.M. Do not forget the brachial plexus—prevalence of distal brachial plexus pathology on routine shoulder MRI. Eur Radiol 31, 3555–3563 (2021). https://doi.org/10.1007/s00330-020-07476-3

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  • DOI: https://doi.org/10.1007/s00330-020-07476-3

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