Neurogenic thoracic outlet syndrome: current diagnostic criteria and advances in MRI diagnostics.
Neurogenic thoracic outlet syndrome (nTOS) is caused by compression of the brachial plexus as it traverses from the thoracic outlet to the axilla. Diagnosing nTOS can be difficult because of overlap with other complex pain and entrapment syndromes. An nTOS diagnosis is made based on patient history, physical exam, electrodiagnostic studies, and, more recently, interpretation of MR neurograms with tractography. Advances in high-resolution MRI and tractography can confirm an nTOS diagnosis and identify the location of nerve compression, allowing tailored surgical decompression. In this report, the authors review the current diagnostic criteria, present an update on advances in MRI, and provide case examples demonstrating how MR neurography (MRN) can aid in diagnosing nTOS. The authors conclude that improved high-resolution MRN and tractography are valuable tools for identifying the source of nerve compression in patients with nTOS and can augment current diagnostic modalities for this syndrome.
Departments of 1 Neurological Surgery and.
Stephen T
ST
Magill
Radiology and Biomedical Imaging, University of California, San Francisco, California.
Marcel
M
Brus-Ramer
Departments of 1 Neurological Surgery and.
Philip R
PR
Weinstein
Radiology and Biomedical Imaging, University of California, San Francisco, California.
Cynthia T
CT
Chin
Departments of 1 Neurological Surgery and.
Line
L
Jacques
D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis* / Q000601:surgery
ACDF = anterior cervical discectomy and fusion; DTI; DTI = diffusion tensor imaging; MR neurogram; MR tractography; MRC = Medical Research Council; MRI; MRN = magnetic resonance neurography; NCS = nerve conduction study; NEE = needle electrode examination; SPAIR = spectral adiabatic inversion recovery; STIR = short-tau inversion recovery; diffusion tensor imaging; nTOS = neurogenic thoracic outlet syndrome; neurogenic thoracic outlet syndrome