Diffusion-weighted MR neurography for the assessment of brachial plexopathy in oncological practice.
BACKGROUND
To evaluate diffusion-weighted MR neurography (DW-MRN) for visualizing the brachial plexus and for the assessment of brachial plexopathy.


METHODS
40 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.


RESULTS
DW-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.


CONCLUSIONS
DW-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.
Department of Radiology, Royal Marsden, Sutton, Surrey, UK. drandreou@hotmail.com.
Adrian
A
Andreou
Department of Radiology, Royal Marsden, Sutton, Surrey, UK. aslam.sohaib@rmh.nhs.uk.
Aslam
A
Sohaib
CR UK Clinical Magnetic Resonance Research Group, Institute of Cancer Research, Sutton, Surrey, UK. david.collins@icr.ac.uk.
David J
DJ
Collins
Department of Radiology, University Medical Center, Utrecht, Netherlands. tarorin@gmail.com.
Taro
T
Takahara
Department of Radiology, University Medical Center, Utrecht, Netherlands. thomaskwee@gmail.com.
Thomas C
TC
Kwee
CR UK Clinical Magnetic Resonance Research Group, Institute of Cancer Research, Sutton, Surrey, UK. martin.leach@icr.ac.uk.
Martin O
MO
Leach
Department of Radiology, Royal Marsden, Sutton, Surrey, UK. david.macvicar@rmh.nhs.uk.
David A
DA
MacVicar
Department of Radiology, Royal Marsden, Sutton, Surrey, UK. dowmukoh@icr.ac.uk.
Dow-Mu
DM
Koh
D000328:Adult; D001917:Brachial Plexus / Q000473:pathology*; D020516:Brachial Plexus Neuropathies / Q000175:diagnosis*; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000473:pathology; D015897:Comorbidity; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged