Abstract
BackgroundTo evaluate diffusion-weighted MR neurography (DW-MRN) for visualizing the brachial plexus and for the assessment of brachial plexopathy.Methods40 oncological patients with symptoms of brachial plexopathy underwent 1.5 T MRI using conventional MR sequences and unidirectional DW-MRN. The images were independently reviewed by two radiologists. Anatomic visualization of the brachial plexus was scored using a 5 point scale on conventional MR sequences and then combined with DW-MRN. A brachial plexus abnormality was also scored using a 5 point scale and inter-observer agreement determined by kappa statistics. Diagnostic accuracy for brachial plexopathy assessed by conventional MRI alone versus conventional MRI combined with DW-MRN was compared by ROC analysis using reference standards.ResultsDW-MRN significantly improved visualization of the brachial plexus compared with conventional MRI alone (P < 0.001). When assessing brachial plexopathy, inter-observer agreement was moderate for conventional MRI (kappa = 0.48) but good for conventional MRI with DW-MRN (kappa = 0.62). DW-MRN combined with conventional MRI significantly improved diagnostic accuracy in one observer (P < 0.05) but was similar in the other observer.ConclusionDW-MRN improved visualization of the brachial plexus. Combining DW-MRN with conventional MRI can improve inter-observer agreement and detection of brachial plexopathy in symptomatic oncological patients.
Highlights
To evaluate diffusion-weighted MR neurography (DW-MRN) for visualizing the brachial plexus and for the assessment of brachial plexopathy
Anatomic visualization The combination of conventional MRI and DW-MRN significantly improved the anatomic visualization of the brachial plexus, compared to conventional MRI alone (P < 0.01)
For the assessment of the presence of a brachial plexus abnormality, on a per region basis, the inter-observer agreement was moderate for conventional MRI alone but good for the combination of conventional MRI and DW-MRN
Summary
To evaluate diffusion-weighted MR neurography (DW-MRN) for visualizing the brachial plexus and for the assessment of brachial plexopathy. The brachial plexus is a network of nerves formed by the ventral branches of the spinal nerves C5 - T1 in the posterior triangle of the neck, which provides motor and sensory innervation to the upper extremity. The roots of the brachial plexus combine to form three trunks, which in turn divide to form anterior and posterior divisions. At the level of the lateral margin of the first rib, the divisions combine to form the three cords, which in the axilla give rise to the peripheral nerves of the upper limb. Secondary tumours involving the brachial plexus are more common than primary neurogenic tumours. Brachial plexopathy from malignant disease most frequently arises from breast or lung carcinoma [1,2]. The fundamental distinction is between tumour recur-
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