Which imaging studies are indicated in the workup of brachial neuritis (BN)?

Updated: May 06, 2020
  • Author: Nigel L Ashworth, MBChB, MSc, FRCPC; Chief Editor: Milton J Klein, DO, MBA  more...
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Answer

Magnetic resonance imaging (MRI) or computed tomography (CT) myelogram scanning should be considered initially to rule out cervical radiculopathy (particularly C5/C6). MRI of the brachial plexus can help to rule out carcinomatous or granulomatous infiltration, if clinically indicated. [7, 8] Some of the newer MRI techniques, especially high-resolution MR neurography, can show abnormalities in the proximal root/plexus that may not be apparent with other investigations. [35]

A study by Sneag et al indicated that in patients with brachial neuritis, hourglass nerve constriction can be localized through identification of a bull’s-eye sign on MRI scans. [36]

A study by Lieba-Samal et al indicated that MRI and high-resolution ultrasonography (HRUS) can be useful in diagnosing brachial neuritis, with all clinically affected nerves/trunks of the study’s six brachial neuritis patients revealing segmental swelling on HRUS. In the five patients who underwent MRI, all clinically affected nerves displayed T2-weighted hyperintensity. [37]

A shoulder radiograph may be indicated to rule out specific shoulder pathologies. A chest radiograph is not usually part of the initial workup; however, it can be useful to rule out sarcoidosis or other granulomatous disease, as well as Pancoast tumor.


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