Evaluation of MR angiographic technique in the assessment of thoracic outlet syndrome

AIM: To evaluate two-dimensional time of flight (2D TOF) and three-dimensional contrast-enhanced magnetic resonance angiographic (3DCE MRA) techniques in the assessment of patients with suspected thoracic outlet syndrome (TOS) of vascular origin.
MATERIALS AND METHODS: Fifty-five consecutive examinations, in 51 patients with suspected TOS of vascular origin, were examined using either a 1 T or 1.5 T Siemens magnetic resonance imaging (MRI) unit, using either 2D TOF (n = 13) or 3DCE MRA (n = 42). Examinations were performed with the arms abducted (n = 27) or both abducted and adclucted (n = 28). The source images and MIPs were reviewed retrospectively and assessed for image quality and the presence of significant persistent stenosis or impingement (a >60% reduction in the diameter of the subclavian vessels at the thoracic outlet or evidence of post-stenotic dilatation). When significant impingement was identified, the images were reformatted with multiplanar reconstruction to determine the cause.
RESULTS: Images were sub-optimal in 53% 2D TOF and 10% 3DCE MRA examinations. 3DCE MRA offered vessel coverage from the aortic arch to the distal axilliary arteries, whereas, 2D TOF sequences gave more limited coverage. Eight patients were found to have significant impingement (n = 7) or stenosis (n = 1) of the subclavian artery attributable to TOS. 3DCE MRA also demonstrated other relevant significant stenoses not attributable to TOS (n = 5). All cases of impingement were either seen only, or more prominently, on sequences with the arms abducted. Reformatting the 3DCE MRA studies demonstrated the cause of impingement.
CONCLUSIONS: Both 2D TOF and 3DCE MRA may demonstrate TOS with significant arterial impingement. In comparison with 2D TOF sequences, 3DCE MRA offers extensive vessel coverage, is less prone to artefact and frequently demonstrates the underlying cause of TOS when studies are reformatted. Evidence of impingement should be sought from sequences performed with the arms abducted and venous phase sequences may show corroborative venous impingement. (C) 2004 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.