Vascular thoracic outlet syndrome: protocol design and diagnostic value of contrast-enhanced 3D MR angiography and equilibrium phase imaging on 1.5- and 3-T MRI scanners

Abstract

Objective: The purpose of this article is to evaluate the efficiency and reproducibility of a contrast-enhanced 3D MR angiography (MRA) protocol, using the provocative arm position on 1.5- and 3-T MRI scanners, and to determine the frequency and distribution of vascular compression and vascular complications in the thoracic outlet.

Materials and methods: Seventy-eight consecutive patients with clinically suspected thoracic outlet syndrome (TOS) were included in the study. Two radiologists independently analyzed all eligible vessel segments, and interobserver agreement was determined using kappa statistics. The distribution of vascular compression with regard to the clinical presentation at referral was also analyzed.

Results: A venous component, which presented with mainly venous symptoms and findings, was confirmed in 85% of the subjects. An arterial component, which presented with clinical symptoms and findings of vascular TOS syndrome, was seen in 82% of the subjects. The vascular component of TOS, which presented with mainly neurogenic or indeterminate symptoms or findings, was excluded in 61% of the subjects.

Conclusion: Contrast-enhanced 3D MRA using provocative arm positioning allows excellent imaging of the arteries and veins on both sides and thus provides a noninvasive imaging alternative to digital subtraction angiography in patients with suspected vascular TOS. Contrast-enhanced 3D MRA is also an ideal imaging modality for postsurgical follow-up for identifying restenosis or residual vascular compression. However, all imaging studies, including the contrast-enhanced 3D MRA protocol described here, should be treated as complementary tests for the diagnosis of TOS.