The role of computed tomography and magnetic resonance imaging in surgical planning for thoracic outlet syndrome: the experience of a single third level reference center for peripheral nerve surgery

ABSTRACT

Objective

Anatomical abnormalities in the thoracic outlet syndrome are very frequent, but radiological images are not always reliable. Therefore, the different features and abilities of CT angiogram and brachial plexus MRI to detect anatomical abnormalities have been investigated.

Methods

All radiological and surgical records of patients operated for thoracic outlet syndrome between January 2011 and December 2018 were retrospectively analyzed. Considering the CT angiogram and/or brachial plexus MRI reports of the preoperative period, the performance of these investigations was evaluated by calculating the precision (P), sensitivity (Recall) and Hamming loss (L).

Results

From a total of 107 patients screened, 84 were eligible for study inclusion. Out of these, 46 had surgical abnormalities (group 1), while 38 did not (group 2). Among them, 30 patients have performed CT angiogram (subgroup A), 32 brachial plexus MRI (subgroup B) and 22 both (subgroup C). The best result is obtained when both diagnostic examinations are performed (subgroup C: P = 0.62; recall = 0.52; L = 0.038).

Conclusions

Prescribing both investigations in selected patients increases the probability of finding anatomic anomalies and facilitates preoperative planning. However, as the radiological images are not completely exhaustive, the surgeon should always actively search and remove any potential source of compression on the nervous vascular bundle along the thoracic outlet.

KEYWORDS:

• Thoracic outlet syndrome
• brachial plexus
• neurovascular compression
• neurolysis
• neuroimaging

Acknowledgments

The authors wish to thank Guido Staffa for his constant help and all his brilliant teaching in the fascinating yet complex field of peripheral nerve surgery throughout his remarkable career.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The authors declare that data supporting the findings of this study are available within the article.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/01616412.2023.2177809

Additional information

Funding

The authors reported there is no funding associated with the work featured in this article.