THE ANATOMY OF THE BRACHIAL-PLEXUS AS DISPLAYED BY MAGNETIC-RESONANCE-IMAGING - TECHNIQUE AND APPLICATION

Full field of view coronal chest magnetic resonance imaging (MRI) rout inely displays bilateral images of the brachial plexus, surface anatom y, and anatomic structures. Eighty patients had chest radiographs corr elated with surgery for thoracic outlet syndrome. The PA chest film fi ndings correlated with the surgical findings: smaller thoracic inlet o n the concave side of the cervicothoracic spine scoliosis, shorter dis tance between the dorsal spine of the second or third thoracic vertebr al body to the concavity of the first ribs, asymmetric clavicles and c oracoid processes, synchondrosis of the first and second ribs, and mus cle atrophy on the side of the clinical complaints. More than 235 pati ents were imaged. One hundred sixty-five of these were imaged with a 1 .5-T unit and 3-D reconstruction MRI. Coronal, transverse (axial), obl ique transverse, and sagittal plane T1-weighted, selected T2-weighted, and fast spine echo pulse sequences were obtained, 4- to 5-mm slice t hickness, 40 to 45 cm full field of view, 512x256 matrix and 2 NEX. Tw o-dimensional time of flight (2D TOF), magnetic resonance angiography (MRA) sequences were obtained in selected patients. Coronal, transvers e, and sagittal sequences were reformatted for evaluation. Saline wate r bags were placed between the neck and thorax to enhance the signal-t o-noise ratio. Compromising abnormalities of the brachial plexus were confirmed at surgery. Compromise of the neurovascular supply seemed to be one etiology that could be demonstrated. The clinical history, tec hnique, and anatomic bilateral brachial plexus imaging is stressed to improve patient care. The cervical rib is one of the compromising brac hial plexopathies selected for this presentation.