MR imaging of nontraumatic brachial plexopathies: frequency and spectrum of findings

Magnetic resonance imaging is the method of choice for evaluating patients with a nontraumatic brachial plexopathy. Although there is a wide range of disease processes that may cause a brachial plexopathy, radiation fibrosis, primary and metastatic lung cancer, and metastatic breast cancer account for almost three-fourths of the causes. Radiation fibrosis, the most common cause in our series, may occur several months to years after the completion of therapy. Findings of radiation fibrosis include (a) thickening and diffuse enhancement of the brachial plexus without a focal mass and (b) soft-tissue changes with low signal intensity on both T1- and T2-weighted images. Lung cancer arising in the lung apex may invade the lower portion of the brachial plexus. Many tumors may metastasize to the brachial plexus, causing a brachial plexopathy. Breast cancer is the most likely to metastasize because major lymphatic drainage routes for the breast course through the apex of the axilla.