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Symptomatic Brachial Plexopathy following Treatment for Breast Cancer: Utility of MR Imaging with Surface-Coil Techniques¹

¹ From the Department of Diagnostic Radiology, Royal Marsden National Health Service Trust, Downs Rd, Sutton, Surrey SM2 5PT, England. From the 1997 RSNA scientific assembly. Received September 17, 1998; revision requested November 23; final revision received June 28, 1999; accepted August 2. Address reprint requests to A.D.M.

PURPOSE: To investigate the clinical utility and diagnostic accuracy of magnetic resonance (MR) imaging in patients with symptomatic brachial plexopathy following treatment for breast cancer.

MATERIALS AND METHODS: Fifty patients with symptoms of brachial plexopathy (principally pain, weakness, and paresthesia) who had received treatment for breast cancer, which included surgery, radiation therapy, and cytotoxic chemotherapy, underwent MR imaging at 1.5 T. MR imaging was performed by using a body coil, which was supplemented with surface-coil imaging of the cervical spine and shoulder-coil imaging of the brachial plexus. At review, two observers attempted to discriminate between tumor recurrence and nonmalignant causes of symptoms. The diagnosis was verified with histologic analysis or a follow-up of at least 12 months.

RESULTS: Of 27 patients demonstrated to have tumor recurrence, 26 were correctly identified by using MR imaging; the recurrence was directly related to the brachial plexus in 17. During the follow-up, 21 patients remained free of recurrence, 20 of whom were determined to have a nonmalignant cause of symptoms. Two of the 50 patients were excluded from the analysis. The MR criteria used for detection of tumor yielded a sensitivity of 96%, specificity of 95%, positive predictive value of 96%, and negative predictive value of 95%.

CONCLUSION: MR imaging is reliable and accurate in the diagnosis of symptomatic brachial plexopathy following breast cancer therapy.

Index terms: Brachial plexus, 31.339 • Brachial plexus, MR, 31.121411, 31.121413, 31.30 • Breast neoplasms, therapy, 00.30, 07.30, 09.30 • Magnetic resonance (MR), coil arrays, 00.121411