Skip to main content

Advertisement

SpringerLink
Log in

Imaging tumours of the brachial plexus

  • Review Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Tumours of the brachial plexus are rare lesions and may be classified as benign or malignant. Within each of these groups, they are further subdivided into those that are neurogenic in origin (schwannoma, neurofibroma and malignant peripheral nerve sheath tumour) and those that are non-neurogenic. Careful pre-operative diagnosis and staging is essential to the successful management of these lesions. Benign neurogenic tumours are well characterized with pre-operative MRI, appearing as well-defined, oval soft-tissue masses, which are typically isointense on T1-weighted images and show the "target sign" on T2-weighted images. Differentiation between schwannoma and neurofibroma can often be made by assessing the relationship of the lesion to the nerve of origin. Many benign non-neurogenic tumours, such as lipoma and fibromatosis, are also well characterized by MRI. This article reviews the imaging features of brachial plexus tumours, with particular emphasis on the value of MRI in differential diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2A–E.
Fig. 3.
Fig. 4.
Fig. 5.
Fig. 6.
Fig. 7.
Fig. 8.
Fig. 9.
Fig. 10.
Fig. 11.
Fig. 12.
Fig. 13.
Fig. 14.
Fig. 15.
Fig. 16.
Fig. 17.
Fig. 18.

Similar content being viewed by others

References

  1. Lusk MD, Kline DG, Garcia CA. Tumors of the brachial plexus. Neurosurgery 1987; 21:439–453.

    CAS  PubMed  Google Scholar 

  2. Sheppard DG, Iyer RB, Fenstermacher MJ. Brachial plexus: demonstration at US. Radiology 1998; 208:402–406.

    CAS  PubMed  Google Scholar 

  3. Retzl G, Kapral S, Greher M, Mauritz W. Ultrasonographic findings of the axillary part of the brachial plexus. Anesth Analg 2001; 92:1271–1275.

    CAS  PubMed  Google Scholar 

  4. King AD, Ahuja AT, King W, Metreweli C. Sonography of peripheral nerve tumors of the neck. AJR Am J Roentgenol 1997; 169:1695–1698.

    CAS  PubMed  Google Scholar 

  5. Simonovsky V. Peripheral nerve schwannoma preoperatively diagnosed by sonography: report of three cases and discussion. Eur J Radiol 1997; 25:47–51.

    Article  CAS  PubMed  Google Scholar 

  6. Castagno AA, Shuman WP. MR imaging in clinically suspected brachial plexus tumor. AJR Am J Roentgenol 1987; 149:1219–1222.

    CAS  PubMed  Google Scholar 

  7. Rapoport S, Blair DN, McCarthy SM, Desser TS, Hammers LW, Sostman HD. Brachial plexus: correlation of MR imaging with CT and pathologic findings. Radiology 1988; 167:161–165.

    CAS  PubMed  Google Scholar 

  8. Posniak HV, Olson MC, Dudiak CM, Wisniewski R, O'Malley C. MR imaging of the brachial plexus. AJR Am J Roentgenol 1993; 161:373–379.

    CAS  PubMed  Google Scholar 

  9. de Verdier HJ, Colletti PM, Terk MR. MRI of the brachial plexus: a review of 51 cases. Comput Med Imaging Graph 1993; 17:45–50.

    PubMed  Google Scholar 

  10. Sherrier RH, Sostman HD. Magnetic resonance imaging of the brachial plexus. J Thorac Imaging 1993; 8:27–33.

    CAS  PubMed  Google Scholar 

  11. Bilbey JH, Lamond RG, Mattrey RF. MR imaging of disorders of the brachial plexus. J Magn Reson Imaging 1994; 4:13–18.

    CAS  PubMed  Google Scholar 

  12. Wittenberg KH, Adkins MC. MR Imaging of non-traumatic brachial plexopathies: frequency and spectrum of findings. Radiographics 2000; 20:1023–1032.

    CAS  PubMed  Google Scholar 

  13. van Es HW. MRI of the brachial plexus. Eur Radiol 2001; 11:325–336.

    PubMed  Google Scholar 

  14. Levine E, Huntrakoon M, Wetzel LH. Malignant nerve-sheath neoplasms in neurofibromatosis: distinction from benign tumors by using imaging techniques. AJR Am J Roentgenol 1987; 149:1059–1064.

    CAS  PubMed  Google Scholar 

  15. Stull MA, Moser RP Jr, Kransdorf MJ, Bogumill GP, Nelson MC. Magnetic resonance appearance of peripheral nerve sheath tumors. Skeletal Radiol 1991; 20:9-14.

    CAS  PubMed  Google Scholar 

  16. Cerofolini E, Landi A, DeSantis G, Maiorana A, Canossi G, Romagnoli R. MR of benign peripheral nerve sheath tumors. J Comput Assist Tomogr 1991; 15:593–597.

    CAS  PubMed  Google Scholar 

  17. Suh JS, Abenoza P, Galloway HR, Everson LI, Griffiths HJ. Peripheral (extracranial) nerve tumors: correlation of MR imaging and histologic findings. Radiology 1992; 183:341–346.

    CAS  PubMed  Google Scholar 

  18. Verstraete KL, Achten E, De Schepper A, et al. Nerve sheath tumors: evaluation with CT and MR imaging. J Belge Radiol 1992; 75:311–320.

    CAS  PubMed  Google Scholar 

  19. Varma DG, Moulopoulos A, Sara AS et al. MR imaging of extracranial nerve sheath tumors. J Comput Assist Tomogr 1992; 16:448–453.

    Google Scholar 

  20. Soderlund V, Goranson H, Bauer HC. MR imaging of benign peripheral nerve sheath tumors. Acta Radiol 1994; 35:282–286.

    CAS  PubMed  Google Scholar 

  21. Bhargava R, Parham DM, Lasater OE, Chari RS, Chen G, Fletcher BD. MR imaging differentiation of benign and malignant peripheral nerve sheath tumors: use of the target sign. Pediatr Radiol 1997; 27: 124–129.

    Article  CAS  PubMed  Google Scholar 

  22. Beggs I. Pictorial review: imaging of peripheral nerve tumours. Clin Radiol 1997; 52:8-17.

    CAS  PubMed  Google Scholar 

  23. Lin J, Martel W. Cross-sectional imaging of peripheral nerve sheath tumors: characteristic signs on CT, MR imaging, and sonography. AJR Am J Roentgenol 2001; 176:75–82.

    CAS  PubMed  Google Scholar 

  24. Greenfield GB, Arrington JA, Kudryk BT. MRI of soft tissue tumors. Skeletal Radiol 1993; 22:77–84.

    CAS  PubMed  Google Scholar 

  25. De Schepper AM, De Beuckeleer L, Vandevenne J, Somville J. Magnetic resonance imaging of soft tissue tumors. Eur Radiol 2000; 10: 213–223.

    PubMed  Google Scholar 

  26. Siegel MJ. Magnetic resonance imaging of musculoskeletal soft tissue masses. Radiol Clin North Am 2001; 39:701–720.

    CAS  PubMed  Google Scholar 

  27. Mukherji S, Castillo M, Wagle AG. The brachial plexus. Semin US CT MRI 1996; 17:519–538.

    CAS  Google Scholar 

  28. Sakai F, Sone S, Kiyono K, et al. Magnetic resonance imaging of neurogenic tumors of the thoracic inlet: determination of the parent nerve. J Thorac Imaging 1996; 11:272–278.

    CAS  PubMed  Google Scholar 

  29. Sell PJ, Semple JC. Primary nerve tumours of the brachial plexus. Br J Surg 1987; 74:73–74.

    CAS  PubMed  Google Scholar 

  30. Ogose A, Hotta T, Morita T. Tumors of peripheral nerves: correlation of symptoms, clinical signs, imaging features, and histologic diagnosis. Skeletal Radiol 1999; 28:183–188.

    Article  CAS  PubMed  Google Scholar 

  31. Boutsen Y, De Coene B, Hanson P, Deltombe T, Gilliard C, Esselinckx W. Axillary schwannoma masquerading as cervical radiculopathy. Clin Rheumatol 1999; 18:174–176.

    Article  CAS  PubMed  Google Scholar 

  32. Ganju A, Roosen N, Kline DG, Tiel RL. Outcomes in a consecutive series of 111 surgically treated plexal tumors: a review of the experience at the Louisiana State University Health Sciences Center. J Neurosurg 2001; 95:51–60.

    Article  CAS  Google Scholar 

  33. Nakamichi K, Tachibana S. Intraneural ganglion of the branchial plexus. J Hand Surg [Br] 1998; 23:123-125.

    Google Scholar 

  34. Pechman D, Kenan S, Abdelwahab IF, Klein MJ, Lewis MM. Case report 839: Elastofibroma of the right shoulder causing brachial plexus impingement. Skeletal Radiol 1994; 23:459–461.

    CAS  PubMed  Google Scholar 

  35. Price AJ, Compson JP, Calonje E. Fibrolipomatous hamartoma of nerve arising in the brachial plexus. J Hand Surg [Br] 1995; 20:16–18.

    Google Scholar 

  36. Foley KM, Woodruff JM, Ellis FT, Posner JB. Radiation-induced malignant and atypical peripheral nerve sheath tumors. Ann Neurol 1980; 7:311–318.

    CAS  PubMed  Google Scholar 

  37. Gorson KC, Musaphir S, Lathi ES, Wolfe G. Radiation-induced malignant fibrous histiocytoma of the brachial plexus. J Neurooncol 1995; 26:73–77.

    CAS  PubMed  Google Scholar 

  38. Hussussian CJ, Mackinnon SE. Postradiation neural sheath sarcoma of the brachial plexus: a case report. Ann Plast Surg 1999; 43:313–317.

    CAS  PubMed  Google Scholar 

  39. Tacconi L, Thom M, Thomas DG. Primary monophasic synovial sarcoma of the brachial plexus: report of a case and review of the literature. Clin Neurol Neurosurg 1996; 98:249–252.

    Article  CAS  PubMed  Google Scholar 

  40. Swarnkar A, Fukui MB, Fink DJ, Rao GR. MR imaging of brachial plexopathy in neurolymphomatosis. AJR Am J Roentgenol 1997; 169:1189–1190.

    CAS  PubMed  Google Scholar 

  41. Jeffery AR, Ellis FJ, Repka MX, Buncic JR. Pediatric Horner syndrome. J AAPOS 1998; 2:159–167.

    CAS  PubMed  Google Scholar 

  42. Horowitz J, Kline DG, Keller SM. Schwannoma of the brachial plexus mimicking an apical lung tumor. Ann Thorac Surg 1991; 52:555–556.

    CAS  PubMed  Google Scholar 

  43. Beggs I. The ring sign: a new ultrasound sign of peripheral nerve tumours. Clin Radiol 1998; 53:849–850.

    CAS  PubMed  Google Scholar 

  44. Maiuri F, Donzelli R, Benvenuti D, Sardo L, Cirillo S. Schwannomas of the brachial plexus: diagnostic and surgical problems. Zentralbl Neurochir 2001; 62:93–97.

    Article  CAS  PubMed  Google Scholar 

  45. Romner B, Nygaard O, Ingebrigtsen T, Anke IM, Trumpy JH. Large peripheral cystic schwannomas. Two case reports and a review. Scand J Plast Reconstr Surg Hand Surg 1994; 28:231–234.

    CAS  PubMed  Google Scholar 

  46. van der Woude HJ, Verstraete KL, Hogendoorn PCW, Taminiau AHM, Hermans J, Bloem JL. Musculoskeletal tumours: does fast dynamic contrast-enhanced subtraction MR imaging contribute to the characterization? Radiology 1998; 208:821–828.

    PubMed  Google Scholar 

  47. Baur A, Reiser MF. Diffusion-weighted imaging of the musculoskeletal system in humans. Skeletal Radiol 2000; 29:555–562.

    Article  CAS  PubMed  Google Scholar 

  48. Ferner RE, Lucas JD, O'Doherty MJ, et al. Evaluation of [18]fluorodeoxyglucose positron emission tomography ([18]FDG PET) in the detection of malignant peripheral nerve sheath tumours arising from within plexiform neurofibromas in neurofibromatosis J Neurol Neurosurg Psychiatry 2000; 68:353–357.

    Article  CAS  Google Scholar 

  49. Hoos A, Lewis JJ, Urist MJ, et al. Desmoid tumors of the head and neck: a clinical study of a rare entity. Head Neck 2000; 22:814–821.

    Article  CAS  PubMed  Google Scholar 

  50. O'Keefe F, Kim EE, Wallace S. Magnetic resonance imaging in aggressive fibromatosis. Clin Radiol 1990; 42:170–173.

    CAS  PubMed  Google Scholar 

  51. Garant M, Remy H, Just N. Aggressive fibromatosis of the neck: MR findings. AJNR Am J Neuroradiol 1997; 18:1429–1431.

    CAS  PubMed  Google Scholar 

  52. Robbin MR, Murphey MD, Temple HT, Kransdorf MJ, Choi JJ. Imaging of musculoskeletal fibromatosis. Radiographics 2001; 21:585–600.

    CAS  PubMed  Google Scholar 

  53. Gaposchkin CG, Bilsky MH, Ginsberg R, Brennan MF. Function-sparing surgery for desmoid tumors and other low-grade fibrosarcomas involving the brachial plexus. Neurosurgery 1998; 42:1297–1301.

    CAS  PubMed  Google Scholar 

  54. Kransdorf MJ, Bancroft LW, Peterson JJ, Murphey MD, Foster WC, Temple HT. Imaging of fatty tumors: distinction of lipoma and well-differentiated liposarcoma. Radiology 2002; 224:99–104.

    PubMed  Google Scholar 

  55. Simmons Z, Mahadeen ZI, Kothari MJ, Powers S, Wise S, Towfighi J. Localized hypertrophic neuropathy: magnetic resonance imaging findings and long-term follow-up. Muscle Nerve 1999; 22:28–36.

    Article  CAS  PubMed  Google Scholar 

  56. Snyder M, Cancilla PA, Batzdorf U. Hypertrophic neuropathy simulating a neoplasm of the brachial plexus. Surg Neurol 1977; 7:131–134.

    CAS  PubMed  Google Scholar 

  57. Van den Bergh PY, Thonnard JL, Duprez T, Laterre EC. Chronic demyelinating hypertrophic brachial plexus neuropathy. Muscle Nerve 2000; 23:283–288.

    Article  PubMed  Google Scholar 

  58. Stumpo M, Foschini MP, Poppi M, Cenacchi G, Martinelli P. Hypertrophic inflammatory neuropathy involving bilateral brachial plexus. Surg Neurol 1999; 52:458–464.

    Article  CAS  PubMed  Google Scholar 

  59. De Maeseneer M, Jaovisidha S, Lenchik L, et al. Fibrolipomatous hamartoma: MR imaging findings. Skeletal Radiol 1997; 26:155–160.

    Article  PubMed  Google Scholar 

  60. Ducatman BS, Scheithauer BW, Piepgras DG, Reiman HM, Ilstrup DM. Malignant peripheral nerve sheath tumors. A clinicopathologic study of 120 cases. Cancer 1986; 57:2006–2021.

    CAS  PubMed  Google Scholar 

  61. Meller I, Alkalay D, Mozes M, Geffen DB, Ferit T. Isolated metastases to peripheral nerves. Report of five cases involving the brachial plexus. Cancer 1995; 76:1829–1832.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, HA7 4LP, UK

    Asif Saifuddin

Authors
  1. Asif Saifuddin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Asif Saifuddin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Saifuddin, A. Imaging tumours of the brachial plexus. Skeletal Radiol 32, 375–387 (2003). https://doi.org/10.1007/s00256-003-0618-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-003-0618-0

Keywords

Search

Navigation