Normal Brachial Plexus versus Graft

This case study is a comparison between two different patients to show the appearance of a normal brachial plexus versus a graft. The MR Neurography images provide clear insight into the differences that can be seen when neurographic imaging and image refinement techniques are employed.


MR Neurography: Normal Brachial Plexus
The first MR Neurography case depicts the brachial plexus as well as all associated nerve elements.

As you can see, they are entirely normal in appearance.

There is no abnormality in course caliber or image intensity of any element.

Specifically, there is no entrapment, no nerve image hyperintensity, no distortion in the course of any nerve element.


MR Neurography: Failed Graft
In this MR Neurography case, the musculocutaneous anastomosis is directly below the coracoid approximately 2.3 cm below the external cortex of the inferior portion of the coracoid.

The anastomosis shows some indentation. Proximal to this the musculocutaneous element shows marked hyperintensity. This progresses for nearly 4 cm proximally.

This would be consistent with proximal edema, which either reflects inhibition of endoneural fluid flow due to truncation at the graft site, or more proximal edema.

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