Imaging of of the the Brachial Brachial Plexus Plexus Objectives •• Review of basic anatomy •• Original technique Original technique vsvs modified techniquemodified technique •• Basic pr
Trang 1Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
KATHLEEN MAILLY, RTR (MR) CARLOS TORRES ARBELÁEZ, MD.
RAQUEL del CARPIO RAQUEL del CARPIO O’DONOVAN, MD O’DONOVAN, MD
McGILL
McGILL UNIVERSITY HEALTH CENTRE UNIVERSITY HEALTH CENTRE MONTREAL GENERAL HOSPITAL DEPT OF RADIOLOGY AND DIAGNOSTIC IMAGING
Trang 3Imaging of of the the Brachial Brachial Plexus Plexus
Objectives
•• Review of basic anatomy
•• Original technique Original technique vsvs modified techniquemodified technique
•• Basic protocol parameters
•• Advantages
•• Pathology
Trang 4Anatomy of the Brachial Plexus
Trang 8Rami is the plural of ramus
Ventral rami are anterior roots of the spinal cord
Ventral rami of the spinal nerves contain
Anatomy
Ventral rami of the spinal nerves contain
sensory, motor and autonomic fibers
They carry efferent ( meaning away) motor axons from inside the central nervous
system to outside the CNS
They directly or indirectly control muscles
Trang 9Anatomy of the Brachial Plexus
Trang 10Anatomy of the Brachial Plexus
Trang 11Imaging of of the the Brachial Brachial Plexus Plexus
MAGNETIC RESONANCE IMAGING
•• Excellent Excellent soft soft tissue tissue contrast contrast resolution resolution
•• Excellent Excellent soft soft tissue tissue contrast contrast resolution resolution
•• Multiplanar Multiplanar capabilities capabilities
•• No No ionizing ionizing radiation radiation
•• DISADVANTAGE: LONG SCAN TIME
Trang 12Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
Modified
Modified scanning scanning technique technique of of the the Brachial Brachial Plexus Plexus
•• Diminish Diminish cardiac cardiac pulsation pulsation artifact artifact
•• Diminish Diminish cardiac cardiac pulsation pulsation artifact artifact
•• Improve Improve diagnostic diagnostic quality quality
•• ADVANTAGE: REDUCED SCAN TIME
Trang 13Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
BRACHIAL PLEXUS PROTOCOL:
•• Images Images were were obtained obtained on on a GE 1.5 tesla Signa Excite a GE 1.5 tesla Signa Excite magnet magnet
•• 8 8 channel channel neurovascular neurovascular coil coil
•• 3 3 plane plane localizer localizer
•• T1, T2 and T1, T2 and optional optional fast fast stir stir sequences sequences
•• Axial, coronal and Axial, coronal and sagittal sagittal planes planes
Trang 14Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
BRACHIAL PLEXUS PROTOCOL:
Parameters for FSE T1:
•• TR/TE: 500/10
•• Slice thickness/gap: 3/1
•• FOV: 22 FOV: 22 28 cm 28 cm
•• Matrix: 320x224
Trang 15Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
BRACHIAL PLEXUS PROTOCOL:
Parameters for FRFSE T2:
Trang 16Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
MODIFIED IMAGING TECHNIQUE:
•• LOCALIZER LOCALIZER in 3 planes in 3 planes with with 160 160 or or 192 192 phase phase to to better better visualize visualize anatomy
anatomy
•• Add Add slices slices in in the the coronal coronal plane plane depending depending on on the the size size of of the the patient patient
•• This This is is the the plane plane you you plan plan your your axial axial on on
Trang 17Modified Imaging of the Brachial Plexus
CONVENTIONAL TECHNIQUE MODIFIED TECHNIQUE
LOCALIZER
Trang 18Normal Brachial Plexus
Trang 19Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
Brachial nerves are
Isointense ( same intensity)
to the muscles on T1W
And mildly hyperintense ( increased signal )
on T2W
Trang 20Normal Brachial Plexus
Divisions: dot-like structures in a triangular
shaped cluster superior to the subclavian
Roots and trunks: round or oval shape, superior and posterior to the subclavian artery
Divisions: dot-like structures in a triangular
shaped cluster superior to the subclavian
artery
Cords: rounded or elongated structures
adjacent to the axillary artery
shaped cluster superior to the subclavian
artery
Cords: rounded or elongated structures
adjacent to the axillary artery
Trang 21SCL vein SCLartery
cords
SCL vein SCLartery
Trang 22Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
TRADITIONAL IMAGING TECHNIQUE:
Axials planned from coronal Coronal planned from axial Sagittal planned from axial
Trang 23Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus MODIFIED TECHNIQUE
Trang 24Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus MODIFIED TECHNIQUE
Trang 25Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
Brachial nerves are
Isointense ( same intensity)
to the muscles on T1W
And mildly hyperintense ( increased signal )
on T2W
Trang 26Modified Imaging of the Brachial Plexus
MODIFIED TECHNIQUE:
Trang 27Modified Imaging of the Brachial Plexus
MODIFIED TECHNIQUE:
Sagittals
Sagittals are are planned planned on on the the good good axials axials
Trang 28Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
TRADITIONAL TECHNIQUE MODIFIED TECHNIQUE
Trang 29Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
TRADITIONAL TECHNIQUE MODIFIED TECHNIQUE
Trang 30Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
TRADITIONAL TECHNIQUE MODIFIED TECHNIQUE
Trang 31Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
Sagittal T2: 7 min 32 T2: 7 min 32 sec sec 6 min 08 6 min 08 sec sec
TOTAL TIME: 41 min 22
TOTAL TIME: 41 min 22 sec sec 28 min 48 28 min 48 sec sec = $$$$$
Trang 32Modified Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
MODIFIED CORONAL IMAGES
Trang 33Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
MODIFIED AXIAL IMAGES
Trang 34Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
MODIFIED SAGITTAL IMAGES:
Branches
SCL artery
Trang 40Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
CLAVICLE FRACTURE:
Trang 41Modified Imaging Imaging Of Of The The Brachial Brachial Plexus Plexus
CLAVICLE FRACTURE:
Trang 42Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
Trang 43Metastatic Breast Cancer (24%)
Primary or metastatic lung cancer (19%)Metastatic Breast Cancer (24%)
Primary or metastatic lung cancer (19%)
Trang 45Radiation Fibrosis – MR
Findings
Radiation Fibrosis – MR
Findings
Diffuse thickening and enhancement of the
brachial plexus without focal mass
Diffuse enhancement months to years after
radiation can happen
Diffuse thickening and enhancement of the
brachial plexus without focal mass
Diffuse enhancement months to years after
radiation can happen
Soft tissue changes with low signal intensity (similar to muscles) on T1 and T2 weighted
images
radiation can happen
Soft tissue changes with low signal intensity (similar to muscles) on T1 and T2 weighted
images
Trang 46Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
POST RADIOTHERAPY CHANGES:
Trang 47Modified Imaging Imaging Of Of The The Brachial Brachial Plexus Plexus
POST RADIOTHERAPY CHANGES:
Trang 48Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
POST TRAUMATIC PSEUDOMENINGOCELE:
Trang 49Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
POST TRAUMATIC PSEUDOMENGOCELE:
Trang 50Modified Imaging Imaging of of the the Brachial Brachial Plexus Plexus
CONCLUSION:
•• Change Change from from straight straight axials axials to to axial axial obliques obliques
•• Change Change planning planning of coronal and of coronal and sagittal sagittal to to axial axial obliques obliques instead instead of of localizer localizer
•• Significant Significant reduction reduction of of scan scan time: time: 13 min 15 13 min 15 sec sec
•• Significant Significant reduction reduction of of scan scan time: time: 13 min 15 13 min 15 sec sec
•• Improved Improved visual visual continuity continuity between between the the brachial brachial plexus plexus segments segments
•• Good Good spatial spatial and and contrast contrast resolution resolution
•• Less Less artifacts artifacts from from patient patient motion motion and and cardiac cardiac pulses pulses
•• Improved Improved image image quality quality and and faster faster scan scan time time particularly particularly in in patients patients suffering suffering from
from traumatic traumatic injury injury or or with with infiltrative infiltrative tumors tumors