Invited Review: Magnetic resonance neurography in the diagnosis of neurological subtypes of thoracic outlet syndrome-Article

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The article reviews the role of magnetic resonance neurography (MRN) in diagnosing neurological subtypes of thoracic outlet syndrome (TOS), specifically neurogenic (NTOS) and disputed (DTOS) TOS. Diagnosing these conditions is complex due to variable clinical presentations and etiologies. NTOS typically involves compression of the C8/T1 nerve roots or lower trunk, often due to anatomical anomalies like cervical ribs or perineural scarring. MRN in these cases may show nerve impingement and T2-weighted signal hyperintensity. DTOS, on the other hand, often presents as signal hyperintensity and enlargement of the mid brachial plexus, especially at the trunk and division levels.<br /><br />The differentiation of these subtypes is crucial for determining appropriate management pathways. Nonsurgical treatments, including physiotherapy and image-guided injections, are generally preferred for DTOS. However, NTOS or cases of DTOS unresponsive to conservative treatment may require surgical intervention.<br /><br />The review underscores the importance of tailored MRN protocols to increase the conspicuity of nerve abnormalities, utilizing high spatial resolution and specialized fat suppression techniques. It also emphasizes dynamic imaging with different arm positions to evaluate changes in the thoracic outlet space.<br /><br />The key objectives are to train clinicians to gather focused clinical histories, recognize MRN findings characteristic of TOS, and implement appropriate management strategies. The review also addresses MRN's role in preoperative planning and identification of postsurgical complications, such as residual osseous impingements or perineural scarring.<br /><br />Despite alternative imaging modalities like ultrasound and computed tomography, MRN remains preferred for its detailed visualization capabilities, particularly for nerve segments not easily assessed by other methods. The article concludes with future directions, including advancements in MRI coil technology and potential use of diffusion-weighted imaging and tractography for better mapping of nerve fibers.

Keywords

Magnetic Resonance Neurography

Thoracic Outlet Syndrome

Neurogenic TOS

Disputed TOS

Nerve Impingement

T2-weighted Signal Hyperintensity

Brachial Plexus

Nonsurgical Treatments

Surgical Intervention

Dynamic Imaging