In the post-treatment setting, MRI can help differentiate radiation plexopathy from neoplastic plexopathy [20,79,80]. Research is ongoing into new MRI sequences that might improve evaluation of neoplastic brachial plexopathy, but these are not routinely performed outside of a research setting. For example, Yuh et al [20] in a retrospective review of 23 patients who underwent brachial plexus MRI with diffusion-weighted imaging for evaluation of a mass-like or infiltrative lesion found that apparent diffusion coefficient values were significantly different between malignant tumors and postradiation changes or benign tumors. MRI with and without IV contrast can provide additional information over MRI without IV contrast in the setting of malignancy or post-treatment syndromes, as it can improve delineation of tumor margins and/or fibrosis [5,6,9,10,27]. MRI Cervical Spine There is no relevant literature to support the use of MRI of the cervical spine (without dedicated plexus imaging) for evaluation of brachial plexopathy in the setting of known malignancy or post-treatment syndrome. However, MRI cervical spine may be complementary in this clinical scenario because it can better assess for cervical spinal metastases with extraosseous extension of tumor into the neural foramina and epidural space that can compress the brachial plexus nerve roots or spinal cord. In the post-treatment setting, radiation injury or tumor recurrence involving the intradural nerve roots would also be better evaluated with cervical spine MRI. MRI with and without IV contrast can provide additional information over MRI without IV contrast in the setting of malignancy or post- treatment syndromes, as it can improve delineation of tumor margins and/or fibrosis. US Neck US neck is typically not the first-line imaging test for evaluation of brachial plexopathy in the setting of a known malignancy or post-treatment syndrome, and is generally not useful as the primary imaging modality in this clinical scenario.
Plexopathy. In the post-treatment setting, MRI can help differentiate radiation plexopathy from neoplastic plexopathy [20,79,80]. Research is ongoing into new MRI sequences that might improve evaluation of neoplastic brachial plexopathy, but these are not routinely performed outside of a research setting. For example, Yuh et al [20] in a retrospective review of 23 patients who underwent brachial plexus MRI with diffusion-weighted imaging for evaluation of a mass-like or infiltrative lesion found that apparent diffusion coefficient values were significantly different between malignant tumors and postradiation changes or benign tumors. MRI with and without IV contrast can provide additional information over MRI without IV contrast in the setting of malignancy or post-treatment syndromes, as it can improve delineation of tumor margins and/or fibrosis [5,6,9,10,27]. MRI Cervical Spine There is no relevant literature to support the use of MRI of the cervical spine (without dedicated plexus imaging) for evaluation of brachial plexopathy in the setting of known malignancy or post-treatment syndrome. However, MRI cervical spine may be complementary in this clinical scenario because it can better assess for cervical spinal metastases with extraosseous extension of tumor into the neural foramina and epidural space that can compress the brachial plexus nerve roots or spinal cord. In the post-treatment setting, radiation injury or tumor recurrence involving the intradural nerve roots would also be better evaluated with cervical spine MRI. MRI with and without IV contrast can provide additional information over MRI without IV contrast in the setting of malignancy or post- treatment syndromes, as it can improve delineation of tumor margins and/or fibrosis. US Neck US neck is typically not the first-line imaging test for evaluation of brachial plexopathy in the setting of a known malignancy or post-treatment syndrome, and is generally not useful as the primary imaging modality in this clinical scenario.