Feasibility study of 3D MRI in diagnosis of thoracic outlet syndrome with simultaneous brachial plexus and vascular imaging

Abstract

Objective To explore the feasibility of 3D MRI with the simultaneous brachial plexus and vascular imaging and its diagnostic value for thoracic outlet syndrome (TOS). Methods From January 2016 to December 2017, 14 patients with TOS were initially diagnosed. 4 cases received surgical treatment and 10 received conservative treatment. Three-dimensional reconstruction was performed by 3D MRI neurovascular fusion technology before operation. According to the three-dimensional anatomical model, the abnormalities of multiple subclavian arteries and brachial plexus nerves were found and the treatment strategy was made. The application value of the auxiliary diagnostic technique was evaluated by the comparison of preoperative and intraoperative findings. Results The brachial plexus, subclavian artery and the surrounding important anatomical structures were reconstructed in three dimensions and digitally fused in all the patients. The symptoms and signs of 10 patients with conservative treatment improved significantly. Among 4 patients underwent surgical treatment, 1 patient with anterior scalenus compression obtained scalenus resection intraoperatively; 1 patient with overly long seventh transverse cervical process obtained the small oblique tendon bundle resection intraoperatively; 1 patient with neurilemmoma obtained schwannoma cutting; 1 patient with metastasis of breast cancer obtained intraoperative biopsy for pathological examination considering the high risk of resection. The symptoms of the first 3 patients improved significantly after operation. The reconstructed model was consistent with the preoperative diagnostic basis and intraoperative findings. Conclusion 3D MRI with the simultaneous brachial plexus and vascular imaging can display the position of brachial plexus nerve and blood vessel visually and reliably, and show the three-dimensional relationship between blood vessel, nerve and the surrounding important anatomical structures, which provides imaging basis for clinical diagnosis of TOS. Key words: Magnetic resonance imaging; Brachial plexus; Subclavian artery