Significance of magnetic resonance imaging in differential diagnosis of nontraumatic brachial plexopathy

Abstract

Background/Aim. Nontraumatic brachial plexopathies may be caused by primary or secondary tumors, radiation or inflammation. The aim of this study was to present the significance of MRI in revealing the cause of nontraumatic brachial plexopathy. Methods. A two-year retrospective study included 22 patients with nontraumatic brachial plexopathy. In all the patients typical clinical findings were confirmed by upper limb neurophysiological studies. In all of them MRI of brachial plexus was performed by 1.5 T scanner in T1 and T1 FS sequence with and without contrast, as well as in T2 and T2 FS sequences. Results. Seven (32%) patients had brachial plexopathy with signs of inflammatory process, 5 (23%) patients had secondary tumors, in 4 (18%) patients multifocal motor neuropathy was established and in the same number (18%) of the patients postradiation fibrosis was found. Two patients (9%) had primary neurogenic tumors. Conclusion. According to the results of this study MRI is a method which may determine localization and cause of brachial plexopathy. MRI can detect focal nerve lesions when other methods fail to find them. Thus, MRI has a direct impact on further diagnostic and therapeutical procedures.Uvod/Cilj. Netraumatske brahijalne pleksopatije mogu izazvati primarni ili sekundarni tumori, zracenje i upala. Cilj ove studije bio je da se prikaze znacaj magnetne rezonance (MR) kao sofisticirane dijagnosticke metode u otkrivanju uzroka netraumatskih brahijalnih pleksopatija u nasoj sredini. Metode. Dvogodisnja retrospektivna studija ukljucila je 22 bolesnika sa netraumatskom brahijalnom pleksopatijom. Kod svih ispitanika tipican klinicki nalaz ostecenja brahijalnog pleksusa potvrdjen je elektromioneurografskim pregledom. Svim bolesnicima uradjen je potom MR pregled brahijalnog pleksusa u T1 i T2 sekvenci, T1 FS sekvenci sa kontrastom i T2FS sekvenci, aparatom jacine 1,5 T. Rezultati. Kod sedam (32%) bolesnika MR pregled pokazao je znake jasne inflamacije brahijalnog pleksusa, pet (23%) bolesnika imalo je sekundarne tumore, kod cetiri (18%) utvrdjena je multifokalna motorna neuropatija, kod cetiri (18%) postiradijaciona fibroza i kod 2 (9%) bolesnika primarni neurogeni tumori. Zakljucak. Primena MR pregleda, a posebno T2 sekvence sa kontrastom, omogucava lokalizaciju i identifikaciju promena brahijalnog pleksusa i suzava spektar mogucih uzoraka brahijalne pleksopatije. Poseban znacaj MR pregled ima za otkrivanje fokalnih lezija brahijalnog pleksusa koje se ne mogu otkriti drugim metodama. Na ovaj nacin MR direktno utice na izbor daljih postupaka u dijagnostici i lecenju bolesnika sa ostecenjem brahijalnog pleksusa.