ACR Appropriateness Criteria® Plexopathy: 2021 Update

Neurological, Expert Panel on; Imaging, Musculoskeletal; Boulter, Daniel; Job, Joici; Shah, Lubdha M.; Wessell, Daniel E.; Lenchik, Leon; Parsons, Matthew S.; Agarwal, Vikas; Appel, Marc; Burns, Judah; Hutchins, Troy A.; Kendi, Ayse T.; Khan, Majid; Liebeskind, David S; Moritani, Toshio; Ortiz, A. Orlando; Shah, Vinil; Singh, Simranjit; Than, Khoi D.; Timpone, Vincent M.; Beaman, Francesca D.; Corey, Amanda S.

doi:10.1016/j.jacr.2021.08.014

Cited by 6 publications

(9 citation statements)

References 88 publications

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“…Electromyography is important not only to establish the level of neurological impairment but also to detect findings supportive of the diagnosis, as we see here with postganglionic pattern and myokymia which is very specific to RILP. Imaging studies are also warranted, and MRI is superior to CT scan in this setting [8,12,16,19]. There are no pathognomonic MRI findings for RILP, but the appearance of smooth longitudinal thickening of fibers with longitudinal thin enhancement is typical of radiation neuritis [19,20].…”

Section: Figure 3: Gadolinium-enhanced T1-weighted Coronal Image Of P...mentioning

confidence: 99%

“…Imaging studies are also warranted, and MRI is superior to CT scan in this setting [8,12,16,19]. There are no pathognomonic MRI findings for RILP, but the appearance of smooth longitudinal thickening of fibers with longitudinal thin enhancement is typical of radiation neuritis [19,20]. Metastases have patchy and nodular aspects [12,16,19].…”

Section: Figure 3: Gadolinium-enhanced T1-weighted Coronal Image Of P...mentioning

confidence: 99%

“…Spontaneous consecutive discharges with slow irregular firing frequencies, known as myokymia are very specific for RILP, but they do not exclude concomitant causes [1,6,17]. Investigation should include pelvic, lumbar, and sacral MRI with enhanced contrast to assess the neuraxis and radicular roots and exclude other concurrent causes [13,16,19,20]. PET scan with fluorodeoxyglucose enhancement can be used as an alternative to MRI, or if its findings were inconclusive [8,12,19].…”

Section: Introductionmentioning

confidence: 99%

“…Investigation should include pelvic, lumbar, and sacral MRI with enhanced contrast to assess the neuraxis and radicular roots and exclude other concurrent causes [13,16,19,20]. PET scan with fluorodeoxyglucose enhancement can be used as an alternative to MRI, or if its findings were inconclusive [8,12,19].…”

Section: Introductionmentioning

confidence: 99%

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Radiation-Induced Lumbosacral Plexopathy

Almeida¹,

Faustino²,

Esteves³

et al. 2023

Cureus

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Lumbosacral plexopathy (LSP) encompasses a group of disorders affecting post-ganglionic fibers derived from the L1-S4 roots. The differential diagnosis is challenging and includes other neuropathies of medullary, radicular, or peripheral origin. Defining the etiology is equally crucial, as LSP management relies on its cause. A thorough clinical history should address potential neoplastic disease (new-onset, progression, or relapse), diabetes mellitus, lumbar or pelvic trauma, and previous exposure to radiation. This is the case of a 78-year-old male, with a history of prostatic adenocarcinoma, treated with image-guided radiation therapy and hormone therapy five years before, with no evidence of relapse on follow-up. The patient presented with bilateral weakness, numbness, and paresthesia of lower limbs, gradually progressing over a three-month period, and followed by an acute worsening with inability to stand or walk. He also referred to distal mild edema, episodic hematuria, and urinary incontinence. Physical examination revealed paraparesis affecting proximal and distal leg muscles, along with bilateral hypoesthesia, impaired deep tendon reflexes, and proprioception below knee level. Pelvic, dorsal, and lumbosacral MRI excluded neoplastic lesions but identified somatic fracture of L5 without medullary or conus medullaris compromise. These findings did not explain the clinical picture. Further neurophysiologic studies characterized sensory-motor deficits as post-ganglionic, with specific spontaneous discharges of the muscle fibers, known as myokymia. These findings were consistent with radiation-induced LSP and were supported by MRI. Radiation-induced cystitis was also documented in pelvic MRI and urethral cystoscopy. This case highlights the clinical picture and differential diagnosis of radiation-induced LSP. Despite more typical symptoms and course, a neoplastic origin should always be carefully investigated and excluded. Radiation protocol should be carefully accessed, and its complications should not be overlooked, as they might cause severe morbidity.

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Section: Figure 3: Gadolinium-enhanced T1-weighted Coronal Image Of P...mentioning

confidence: 99%

Section: Figure 3: Gadolinium-enhanced T1-weighted Coronal Image Of P...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Radiation-Induced Lumbosacral Plexopathy

Almeida¹,

Faustino²,

Esteves³

et al. 2023

Cureus

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“…Guidelines of the American College of Radiology describe the role of contrast in BP MRN and different clinical conditions under which it may be useful and appropriate 29 . T1-weighted fat-suppressed sequences are recommended if there is clinical concern for neoplastic disease, suspicion of inflammatory or demyelinating neuropathies, or infection 30,31 .…”

Section: Technical Considerationsmentioning

confidence: 99%

Brachial Plexus Magnetic Resonance Neurography

et al. 2022

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Magnetic resonance neurography of the brachial plexus (BP) is challenging owing to its complex anatomy and technical obstacles around this anatomic region. Magnetic resonance techniques to improve image quality center around increasing nerve-to-background contrast ratio and mitigating imaging artifacts. General considerations include unilateral imaging of the BP at 3.0 T, appropriate selection and placement of surface coils, and optimization of pulse sequences. Technical considerations to improve nerve conspicuity include fat, vascular, and respiratory artifact suppression techniques; metal artifact reduction techniques; and 3-dimensional sequences. Specific optimization of these techniques for BP magnetic resonance neurography greatly improves image quality and diagnostic confidence to help guide nonoperative and operative management.

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