The brachial plexus: normal anatomy, pathology, and MR imaging.

The brachial plexus is the most technically and anatomically challenging area of the peripheral nervous system for diagnostic imaging. Marked improvements in spatial and contrast resolution of plexus images have resulted from the use of phased-array technology and newer MR pulse sequence designs. This article presents case material incorporating these improvements and discusses the primary factors that continue to limit MR image quality, such as inhomogenous fat suppression, motion artifacts, and small vessels that mimic or obscure plexus components, and potential solutions and imaging alternatives. Brachial plexus anatomy and its appearance on multiplanar MR images are reviewed. The morphologic features and MR signal characteristics that have been found useful in distinguishing between normal and abnormal plexus components,and in detecting neuropathic lesions, are addressed in the context of clinical indications for plexus imaging as follows: mass involving the plexus, traumatic injury, entrapment syndrome, posttreatment evaluation, and miscellaneous conditions.