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--- brachial_plexus [2025/06/25 19:37] – created scott
+++ brachial_plexus [2025/06/25 21:18] (current) – scott
@@ Line 1: / Line 1: @@
 ======Brachial Plexus MRI======
-=====Scan Coverage and Planning=====
+=====Anatomy=====
+The brachial plexus exam can be more difficult than a standard brain or spine exam, as there is more complex anatomy, different positioning requirements, and different scanning challenges.  A good sense of the anatomy is crucial to proper coverage and slice orientation.
+The brachial plexuses are bundles of nerves that originate from about C4/5 to T2/3 and extends into the forelimbs on both sides. When there is an injury or lesion in the brachial plexus, a patient may present with muscle atrophy or forelimb lameness without an orthopedic cause. Below are MIPs of the brachial plexus nerves in 3 planes. Keep in mind that the nerves extend deeper into the forelimb than visualized on these sequences, so the required coverage will be larger.
+{{::nervestir_sag_mip.gif?}}  {{::nerve_stir_ax_mip.gif?}}  {{::nerve_stir_dor_mip.gif?}}
+=====Scan Coverage and Planning=====
 ====Sagittal Plane====
-On the axial and dorsal scout imaging, plan the slices parallel to the center of the spinal cord. On the sagittal scout image, center the FOV on C4/5.
+For brachial plexus scout images, add more slices on all planes to cover sternum to spine dorsally, shoulder to shoulder sagittal, and C3 to T3 axially. On the axial and dorsal scout imaging, plan the slices parallel to the center of the spinal cord. On the sagittal scout image, center the FOV on C6/7.
-For each patient, the FOV should be re-sized to include the Cerebellum to include the T3 vertebral body. On the dorsal scout image, add enough slices to cover the entire vertebral body out to the transverse processes. **Be sure to use an ODD number of slices. This will ensure that the center slice is in true midline.**
+For each patient, the FOV should be re-sized to include at least C4/5 to include the T3/4. On the dorsal scout image, add enough slices to cover out to the humeral head on both sides unless specifically doing a unilateral study. **Be sure to use an ODD number of slices. This will ensure that the center slice is in true midline through the spinal cord.**
-{{:library:cspinedorscoutplan.png?500|}} {{:cspinestir.png?500|}}
+{{::bpluexus_plan.png?600|}}
 ====Axial Plane====
-There are two common variations for planning axial slices in the cervical spine, parallel to the intervertebral disc or perpendicular to the spinal cord. Both variations will yield diagnostic images, so be sure to **check clinician preference**.
-In the image below, axial slices prescribed parallel to the disc are in __orange__, and slices prescribed perpendicular to the cord are in __yellow__. Center the FOV in the middle of the intervertebral disc and check dorsal images to ensure that the slices are not tilted tot he left or right. If patient positioning is suboptimal, it may be necessary to rotate the slices to match any side-to-side curve of the neck. If axial slices are being prescribed caudally toward C5/C6/C7, check axial and dorsal images to ensure wrap won't occur.
+Axial coverage for the brachial plexus should cover from typically C4/5 to T3/4 to ensure that the entire plexus is covered. Angling parallel to the intervertebral disc will generally display the nerves exiting the foramen more clearly. The FOV should be centered at the inferior aspect at the vertebrae and large enough to include the mid shaft of the humerus on both sides.
 {{:cspineaxplan.png?500|}}