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MR Imaging of Nontraumatic Brachial Plexopathies: Frequency and Spectrum of Findings¹

¹ From the Department of Diagnostic Radiology, Mayo Clinic and Foundation, 200 First St SW, Rochester, MN 55905. Recipient of a Certificate of Merit for a scientific exhibit at the 1998 RSNA scientific assembly. Received April 5, 1999; revision requested May 14 and received July 6; accepted July 12. Address correspondence to M.C.A. (e-mail: wittenberg.keith@mayo.edu).

View larger version (53K): [in a new window]   Figure 1.   Normal anatomy of the brachial plexus.

View larger version (121K): [in a new window]   Figure 2a.   Normal anatomy at MR imaging in one patient. (a) Axial T1-weighted image through the apex of the lung shows the trunks of the brachial plexus (arrowheads) posterior to the subclavian artery (solid black arrow) and vein (open arrow) and just anterior to the serratus anterior muscle (white arrow). (b) Oblique sagittal T1-weighted image shows the individual cords of the brachial plexus (arrowheads) adjacent to the subclavian artery (straight arrow) and vein (curved arrow). (c) Coronal T1-weighted image demonstrates the cords of the brachial plexus (arrowheads) adjacent to the subclavian artery (solid arrow) and just superior to the subclavian vein (open arrow).

View larger version (126K): [in a new window]   Figure 2b.   Normal anatomy at MR imaging in one patient. (a) Axial T1-weighted image through the apex of the lung shows the trunks of the brachial plexus (arrowheads) posterior to the subclavian artery (solid black arrow) and vein (open arrow) and just anterior to the serratus anterior muscle (white arrow). (b) Oblique sagittal T1-weighted image shows the individual cords of the brachial plexus (arrowheads) adjacent to the subclavian artery (straight arrow) and vein (curved arrow). (c) Coronal T1-weighted image demonstrates the cords of the brachial plexus (arrowheads) adjacent to the subclavian artery (solid arrow) and just superior to the subclavian vein (open arrow).

View larger version (162K): [in a new window]   Figure 2c.   Normal anatomy at MR imaging in one patient. (a) Axial T1-weighted image through the apex of the lung shows the trunks of the brachial plexus (arrowheads) posterior to the subclavian artery (solid black arrow) and vein (open arrow) and just anterior to the serratus anterior muscle (white arrow). (b) Oblique sagittal T1-weighted image shows the individual cords of the brachial plexus (arrowheads) adjacent to the subclavian artery (straight arrow) and vein (curved arrow). (c) Coronal T1-weighted image demonstrates the cords of the brachial plexus (arrowheads) adjacent to the subclavian artery (solid arrow) and just superior to the subclavian vein (open arrow).

View larger version (139K): [in a new window]   Figure 3a.   Radiation fibrosis. (a, b) Invasive ductal carcinoma in a 51-year-old woman who had undergone radiation therapy to the axilla. Oblique sagittal T1-weighted (a) and axial fat-saturated gadolinium-enhanced T1-weighted (b) images show soft-tissue stranding (arrows in a) about the brachial plexus (arrowheads in b) with diffuse gadolinium enhancement. These findings had been stable for 6 years. In b, solid arrow = subclavian vein, open arrow = subclavian artery. (c) Breast cancer in a 69-year-old woman who had undergone radiation therapy. Oblique sagittal T1-weighted image shows diffuse thickening of the cords of the brachial plexus (solid straight arrows). The thickening was clinically stable over 4 years. Open arrow = subclavian artery, curved arrow = subclavian vein.

View larger version (137K): [in a new window]   Figure 3b.   Radiation fibrosis. (a, b) Invasive ductal carcinoma in a 51-year-old woman who had undergone radiation therapy to the axilla. Oblique sagittal T1-weighted (a) and axial fat-saturated gadolinium-enhanced T1-weighted (b) images show soft-tissue stranding (arrows in a) about the brachial plexus (arrowheads in b) with diffuse gadolinium enhancement. These findings had been stable for 6 years. In b, solid arrow = subclavian vein, open arrow = subclavian artery. (c) Breast cancer in a 69-year-old woman who had undergone radiation therapy. Oblique sagittal T1-weighted image shows diffuse thickening of the cords of the brachial plexus (solid straight arrows). The thickening was clinically stable over 4 years. Open arrow = subclavian artery, curved arrow = subclavian vein.

View larger version (121K): [in a new window]   Figure 3c.   Radiation fibrosis. (a, b) Invasive ductal carcinoma in a 51-year-old woman who had undergone radiation therapy to the axilla. Oblique sagittal T1-weighted (a) and axial fat-saturated gadolinium-enhanced T1-weighted (b) images show soft-tissue stranding (arrows in a) about the brachial plexus (arrowheads in b) with diffuse gadolinium enhancement. These findings had been stable for 6 years. In b, solid arrow = subclavian vein, open arrow = subclavian artery. (c) Breast cancer in a 69-year-old woman who had undergone radiation therapy. Oblique sagittal T1-weighted image shows diffuse thickening of the cords of the brachial plexus (solid straight arrows). The thickening was clinically stable over 4 years. Open arrow = subclavian artery, curved arrow = subclavian vein.

View larger version (119K): [in a new window]   Figure 4a.   Metastatic breast cancer in a 58-year-old woman. Axial T1-weighted image (a) and sagittal T1-weighted nonenhanced (b) and gadolinium-enhanced (c) images show an infiltrating mass (arrowheads) encasing the left subclavian vessels and brachial plexus. The subclavian vein (straight arrow) is nearly obliterated with what proved at biopsy to be metastatic breast cancer. Curved arrow = subclavian vein.

View larger version (122K): [in a new window]   Figure 4b.   Metastatic breast cancer in a 58-year-old woman. Axial T1-weighted image (a) and sagittal T1-weighted nonenhanced (b) and gadolinium-enhanced (c) images show an infiltrating mass (arrowheads) encasing the left subclavian vessels and brachial plexus. The subclavian vein (straight arrow) is nearly obliterated with what proved at biopsy to be metastatic breast cancer. Curved arrow = subclavian vein.

View larger version (134K): [in a new window]   Figure 4c.   Metastatic breast cancer in a 58-year-old woman. Axial T1-weighted image (a) and sagittal T1-weighted nonenhanced (b) and gadolinium-enhanced (c) images show an infiltrating mass (arrowheads) encasing the left subclavian vessels and brachial plexus. The subclavian vein (straight arrow) is nearly obliterated with what proved at biopsy to be metastatic breast cancer. Curved arrow = subclavian vein.

View larger version (116K): [in a new window]   Figure 5a.   Lung cancer: Pancoast tumor in a 57-year-old man. Oblique sagittal T1- (a) and T2-weighted (b) images and axial T2-weighted image (c) show a large right apical lung mass that invades and encases the roots of the right brachial plexus. The subclavian vessels and cords of the brachial plexus are not identifiable. The mass has an irregular interface (arrows in a) with the adjacent lung parenchyma. This mass was proved at biopsy to be a non-small cell lung cancer.

View larger version (134K): [in a new window]   Figure 5b.   Lung cancer: Pancoast tumor in a 57-year-old man. Oblique sagittal T1- (a) and T2-weighted (b) images and axial T2-weighted image (c) show a large right apical lung mass that invades and encases the roots of the right brachial plexus. The subclavian vessels and cords of the brachial plexus are not identifiable. The mass has an irregular interface (arrows in a) with the adjacent lung parenchyma. This mass was proved at biopsy to be a non-small cell lung cancer.

View larger version (90K): [in a new window]   Figure 5c.   Lung cancer: Pancoast tumor in a 57-year-old man. Oblique sagittal T1- (a) and T2-weighted (b) images and axial T2-weighted image (c) show a large right apical lung mass that invades and encases the roots of the right brachial plexus. The subclavian vessels and cords of the brachial plexus are not identifiable. The mass has an irregular interface (arrows in a) with the adjacent lung parenchyma. This mass was proved at biopsy to be a non-small cell lung cancer.

View larger version (128K): [in a new window]   Figure 6a.   Neurogenic tumor: neurofibromatosis type 1 in a 23-year-old man. (a) Oblique sagittal T1-weighted image shows a small mass (solid arrow and arrowheads) involving the inferior aspect of the brachial plexus. Open arrow = axillary artery. (b) Axial T2-weighted image obtained in the proximal arm demonstrates a lobulated mass with areas of central decreased T2 signal intensity typical of a neurofibroma.

View larger version (137K): [in a new window]   Figure 6b.   Neurogenic tumor: neurofibromatosis type 1 in a 23-year-old man. (a) Oblique sagittal T1-weighted image shows a small mass (solid arrow and arrowheads) involving the inferior aspect of the brachial plexus. Open arrow = axillary artery. (b) Axial T2-weighted image obtained in the proximal arm demonstrates a lobulated mass with areas of central decreased T2 signal intensity typical of a neurofibroma.

View larger version (99K): [in a new window]   Figure 7a.   Neurogenic tumor: neurofibrosarcoma in a 32-year-old woman. Axial (a) and oblique sagittal (b) T1-weighted images show an irregular mass (solid arrows) abutting the anterior portion of the brachial plexus (arrowheads in b). At surgery, this mass was found to be a neurofibrosarcoma. In b, open arrow = axillary artery.

View larger version (127K): [in a new window]   Figure 7b.   Neurogenic tumor: neurofibrosarcoma in a 32-year-old woman. Axial (a) and oblique sagittal (b) T1-weighted images show an irregular mass (solid arrows) abutting the anterior portion of the brachial plexus (arrowheads in b). At surgery, this mass was found to be a neurofibrosarcoma. In b, open arrow = axillary artery.

View larger version (82K): [in a new window]   Figure 8a.   Non-Hodgkin lymphoma in a 53-year-old man. Axial (a) and oblique sagittal (b) T1-weighted images show multiple small masses (solid arrows) in the base of the neck and involving the right brachial plexus (arrowheads). Also note the superior mediastinal adenopathy (curved arrow in b). In b, open straight arrow = subclavian artery.

View larger version (129K): [in a new window]   Figure 8b.   Non-Hodgkin lymphoma in a 53-year-old man. Axial (a) and oblique sagittal (b) T1-weighted images show multiple small masses (solid arrows) in the base of the neck and involving the right brachial plexus (arrowheads). Also note the superior mediastinal adenopathy (curved arrow in b). In b, open straight arrow = subclavian artery.

View larger version (116K): [in a new window]   Figure 9a.   Melanoma in a 35-year-old man. Axial T1- (a) and T2-weighted (b) images show a large mass in the right axilla (solid arrows in a) contiguous to and displacing the right brachial plexus (arrowhead in a). Note the subtle areas of increased T1 signal intensity within the mass that are characteristic of melanoma. Open arrow = subclavian artery.

View larger version (112K): [in a new window]   Figure 9b.   Melanoma in a 35-year-old man. Axial T1- (a) and T2-weighted (b) images show a large mass in the right axilla (solid arrows in a) contiguous to and displacing the right brachial plexus (arrowhead in a). Note the subtle areas of increased T1 signal intensity within the mass that are characteristic of melanoma. Open arrow = subclavian artery.

View larger version (96K): [in a new window]   Figure 10a.   Benign tumor: lipoma in a 19-year-old woman. Axial (a) and sagittal (b) T1-weighted images show a large lipoma (straight arrows) displacing the brachial plexus (arrowhead in a) and subclavian vessels. In b, curved white arrow = subclavian artery, curved black arrow = subclavian vein.

View larger version (114K): [in a new window]   Figure 10b.   Benign tumor: lipoma in a 19-year-old woman. Axial (a) and sagittal (b) T1-weighted images show a large lipoma (straight arrows) displacing the brachial plexus (arrowhead in a) and subclavian vessels. In b, curved white arrow = subclavian artery, curved black arrow = subclavian vein.

View larger version (141K): [in a new window]   Figure 11a.   Benign tumor: desmoid tumor in a 27-year-old woman. Oblique sagittal T1-weighted image (a), coronal T2-weighted image (b), and gadolinium-enhanced T1-weighted image (c) of the right brachial plexus demonstrate an irregular enhancing mass (arrowheads) infiltrating the brachial plexus (solid arrows). This mass has the characteristic decreased T2 signal intensity seen in desmoid tumors. In a, open arrow = subclavian vein.

View larger version (116K): [in a new window]   Figure 11b.   Benign tumor: desmoid tumor in a 27-year-old woman. Oblique sagittal T1-weighted image (a), coronal T2-weighted image (b), and gadolinium-enhanced T1-weighted image (c) of the right brachial plexus demonstrate an irregular enhancing mass (arrowheads) infiltrating the brachial plexus (solid arrows). This mass has the characteristic decreased T2 signal intensity seen in desmoid tumors. In a, open arrow = subclavian vein.

View larger version (136K): [in a new window]   Figure 11c.   Benign tumor: desmoid tumor in a 27-year-old woman. Oblique sagittal T1-weighted image (a), coronal T2-weighted image (b), and gadolinium-enhanced T1-weighted image (c) of the right brachial plexus demonstrate an irregular enhancing mass (arrowheads) infiltrating the brachial plexus (solid arrows). This mass has the characteristic decreased T2 signal intensity seen in desmoid tumors. In a, open arrow = subclavian vein.