Efficacy of Three-Dimensional Contrast-Enhanced Magnetic Resonance Angiography (3D CE-MRA) in the Diagnosis of Thoracic Outlet Syndrome

Year 2011, Volume: 2011 Issue: 3, 279 - 285, 01.03.2011

Ercüment Ünlü Derya Demirbağ Kabayel Ferda Özdemir Bekir Çağlı Sedat A. Tuncel

https://doi.org/10.5174/tutfd.2010.03817.1

Abstract

Objective: The purpose of this study is to evaluate the effect of various upper extremity positions (adduction-abduction) on vascular structures in contrast-enhanced three-dimensional MR angiographic studies performed in patients with thoracic outlet syndrome. Materials and Methods: Twenty-two consecutive patients with clinical symptoms of neurovascular thoracic outlet syndrome were examined by 1.0 T MR unit. Examinations were studied by three-dimensional contrast-enhanced MR angiography with the arms positioned in abduction and adduction in the same patients. Results: In twenty-one of 44 subclavian arteries, impingement or stenosis with different degrees were found. Majority of lesions were localized in the costoclavicular region. Venous phase sequences of contrast-enhanced MR angiography showed compression of the subclavian vein in the 17 areas. Conclusion: Thoracic outlet syndrome remains controversial in both diagnosis and treatment, particulary in patients with no muscle atrophy, hand ischemia findings or venous stasis symptoms. Three-dimensional contrast-enhanced MR angiography is noninvasive and requires neither ionizing radiation nor administration of iodinated contrast material- and may be used to diagnose early compression findings and stenosis of the subclavian vessels.

Keywords

Thoracic outlet syndrome, contrast-enhanced, three dimensional, magnetic resonance angiography, adduction, abduction

Efficacy of Three-Dimensional Contrast-Enhanced Magnetic Resonance Angiography (3D CE-MRA) in the Diagnosis of Thoracic Outlet Syndrome

Abstract

References

• Roos DB, Owens JC. Thoracic outlet syndrome. Arch Surg 1966;93:71-4. [CrossRef]
• Novak CB, Mackinnon SE. Thoracic outlet syndrome. Orthop Clin North Am 1996;27:747-62.
• Demondion X, Bacqueville E, Paul C, Duquesnoy B, Hachulla E, Cotten A. Thoracic outlet: assessment with MR imaging in asymp- tomatic and symptomatic populations. Radiology 2003;227:461- 8. [CrossRef]
• Wilbourn AJ. The thoracic outlet syndrome is overdiagnosed. Arch Neurol 1990;47:328-30.
• Davidovic LB, Kostic DM, Jakovljevic NS, Kuzmanovic IL, Simic TM. Vascular thoracic outlet syndrome. World J Surg 2003;27:545-50. [CrossRef]
• Roos DB. The thoracic outlet syndrome is underrated. Arch Neu- rol 1990;47:327-30.
• Huang JH, Zager EL. Thoracic outlet syndrome. Neurosurgery 2004;55:897-903. [CrossRef]
• Mackinnon SE, Novak CB. Thoracic outlet syndrome. Curr Probl Surg 2002;39:1070-145. [CrossRef]
• Matsumura JS, Rilling WS, Pearce WH, Nemcek AA Jr, Vogelzang RL, Yao JS. Helical computed tomography of the normal thoracic outlet. J Vasc Surg 1997;26:776-83. [CrossRef]
• Panegyres PK, Moore N, Gibson R, Rushworth G, Donaghy M. Thoracic outlet syndromes and magnetic resonance imaging. Brain 1993;116:823-41. [CrossRef]
• Tateishi A. Diagnosis and management of thoracic outlet syn- drome. Nippon Seikeigeka Gakkai Zasshi 1980;54:817-27.
• Ohkawa Y, Isoda H, Hasegawa S, Furuya Y, Takahashi M, Kaneko M. MR angiography of thoracic outlet syndrome. J Comput As- sist Tomogr 1992;16:475-7. [CrossRef]
• Seror P. Frequency of neurogenic thoracic outlet syndrome in pa- tients with definite carpal tunnel syndrome: an electrophysiologi- cal evaluation in 100 women. Clin Neurophysiol 2005;116:259-63. [CrossRef]
• Ide J, Kataoka Y, Yamaga M, Kitamura T, Takagi K. Compression and stretching of the brachial plexus in thoracic outlet syndrome: correlation between neuroradiographic findings and symptoms and signs produced by provocation manoeuvres. J Hand Surg Br 2003;28:218-23. [CrossRef]
• Longley DG, Yedlicka JW, Molina EJ, Schwabacher S, Hunter DW, Letourneau JG. Thoracic outlet syndrome: evaluation of the subclavian vessels by color duplex sonography. AJR Am J Roent- genol 1992;158:623-30. [CrossRef]
• Wadhwani R, Chaubal N, Sukthankar R, Shroff M, Agarwala S. Color Doppler and duplex sonography in 5 patients with thoracic outlet syndrome. J Ultrasound Med 2001;20:795-801. [CrossRef]
• Remy-Jardin M, Doyen J, Remy J, Artaud D, Fribourg M, Du- hamel A. Functional anatomy of the thoracic outlet: evaluation with spiral CT. Radiology 1997;205:843-51. [CrossRef]
• Remy-Jardin M, Remy J, Masson P, Bonnel F, Debatselier P, Vinck- ier L. CT angiography of thoracic outlet syndrome: evaluation of imaging protocols for the detection of arterial stenosis. J Com- put Assist Tomogr 2000;24:349-61. [CrossRef]
• Demondion X, Boutry N, Drizenko A, Paul C, Francke JP, Cotten A. Thoracic outlet: anatomic correlation with MR imaging. AJR Am J Roentgenol 2000;175:417-22. [CrossRef]
• van Es HW. MRI of the brachial plexus. Eur Radiol 2001;11:325-36. [CrossRef]
• Yanaka K, Asakawa H, Matsumaru Y, Kujiraoka Y, Nose T. Diagno- sis of vascular compression at the thoracic outlet using magnetic resonance angiography. Eur Neurol 2004;51:122-3. [CrossRef]
• Hagspiel KD, Spinosa DJ, Angle JF, Matsumoto AH. Diagnosis of vascular compression at the thoracic outlet using gadolinium-en- hanced high-resolution ultrafast MR angiography in abduction and adduction. Cardiovasc Intervent Radiol 2000;23:152-4. [CrossRef]
• Dymarkowski S, Bosmans H, Marchal G, Bogaert J. Three-dimen- sional MR angiography in the evaluation of thoracic outlet syn- drome. AJR Am J Roentgenol 1999;173:1005-8.
• Charon JP, Milne W, Sheppard DG, Houston JG. Evaluation of MR angiographic technique in the assessment of thoracic outlet syndrome. Clin Radiol 2004;59:588-95. [CrossRef]
• Cosottini M, Zampa V, Petruzzi P, Ortori S, Cioni R, Bartolozzi C. Contrast-enhanced three-dimensional MR angiography in the as- sessment of subclavian artery diseases. Eur Radiol 2000;10:1737-44. [CrossRef]
• Lang EK. Arteriography of thoracic outlet syndrome. In: Baum S, editor. Abrams angiography: vascular and interventional radiol- ogy. Boston: Little, Brown Medical Division; 1997. p. 995-1010.
• Kadir S. Arteriography of the upper extremities. In: Kadir S, edi- tor. Diagnostic angiography. Philadelphia: WB Saunders; 1986. p. 172-206.
• Degeorges R, Reynaud C, Becquemin JP. Thoracic outlet syn- drome surgery: long-term functional results. Ann Vasc Surg 2004;18:558-65. [CrossRef]
• Connors JJ 3rd, Sacks D, Furlan AJ, Selman WR, Russell EJ, Stieg PE, et al. Training, competency, and credentialing standards for diagnostic cervicocerebral angiography, carotid stenting, and cerebrovascular intervention: a joint statement from the American Academy of Neurology, American Association of Neurological Sur- geons, American Society of Interventional and Therapeutic Radiol- ogy, American Society of Neuroradiology, Congress of Neurologi- cal Surgeons, AANS/CNS Cerebrovascular Section, and Society of Interventional Radiology. Radiology 2005;234:26-34. [CrossRef]
• Haire WD, Lynch TG, Lund GB, Lieberman RP, Edney JA. Limi- tations of magnetic resonance imaging and ultrasound-directed (duplex) scanning in the diagnosis of subclavian vein thrombosis. J Vasc Surg 1991;13:391-7. [CrossRef]
• Prince MR. Gadolinium-enhanced MR aortography. Radiology 1994;191:155-64.
• Yang CW, Carr JC, Futterer SF, Morasch MD, Yang BP, Shors SM, et al. Contrast-enhanced MR angiography of the carotid and verte- brobasilar circulations. AJNR Am J Neuroradiol 2005;26:2095-101.