Thoracic Outlet Syndrome: Diagnostic Accuracy of MRI - 13/11/19

Doi : 10.1016/j.otsr.2019.09.020

Alexandre Hardy ^a,^b,⁎ , Cécile Pougès ^c, Guillaume Wavreille ^d, Hélène Behal ^b,^e, Xavier Demondion ^b,^f,^g, Guillaume Lefebvre ^b,^f
^a Service de Chirurgie Orthopédique et Traumatologique, Hôpital Salengro, CHRU de Lille, rue Emile Laine, 59037, Lille, France
^b Université Lille-Hauts de France, 59000 Lille, France
^c Service de chirurgie Orthopédique et Traumatologique, Hôpital Saint Vincent de Paul, boulevard de Belfort, 59000 Lille, France
^d Clinique Lille Sud, 96, rue Gustave-Delory, 59810 Lesquin, France
^e Santé publique: épidémiologie et qualité des soins, Unité de Biostatistiques, CHRU de Lille, rue Emile Laine, 59037, Lille, France
^f Service d’Imagerie musculo-squelettique, Hôpital Salengro, CHRU de Lille, rue Emile Laine, 59037, Lille, France
^g Laboratoire d’Anatomie et d’Organogénèse, Faculté de Médecine, place de Verdun, 59000 Lille, France

^⁎Corresponding author at: Service de Chirurgie Orthopédique et Traumatologique, Hôpital Salengro, CHRU de Lille, rue Emile Laine, Lille, 59037, France.Service de Chirurgie Orthopédique et Traumatologique, Hôpital Salengro, CHRU de Lillerue Emile LaisneLille59037France

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Abstract

Background

Thoracic outlet syndrome (TOS) is challenging to diagnose, as the physical findings and investigations lack sensitivity and/or specificity. Magnetic resonance imaging (MRI) with dynamic manoeuvres can rule out a tumour and detect anatomical abnormalities potentially responsible for compression. The objective of this study was to assess the sensitivity and specificity of MRI for identifying anatomical structures responsible for compression in TOS, using intra-operative findings as the diagnostic reference standard.

Hypothesis

MRI is effective in diagnosing the source of compression in TOS, notably within the scalene triangle and at the pleural apex.

Methods

We retrospectively included 48 patients who underwent surgery for TOS after a work-up that included MRI (1.5-T, n=29 and 3-T, n=19). The MRI scans were reviewed for the study by a specialised radiologist who was unaware of the intra-operative findings. The sensitivity and specificity of MRI for diagnosing TOS were estimated using the intra-operative findings as the reference standard.

Results

MRI identified a structure potentially responsible for TOS in 34 (71%) patients; thus, the false-negative rate was 14/48 (29%). The sensitivity of MRI was 28% for compression at the suspensory ligament of the pleural dome, 81% for hypertrophy of the anterior scalene muscle, and 50% for an accessory scalene muscle. For diagnosing a cervical rib, MRI had 100% sensitivity and 100% specificity.

Conclusion

MRI can contribute to the diagnosis of TOS. Specificity is sufficiently high to provide guidance for planning the surgical procedure. Sensitivity, however, is too low for MRI to be useful as a screening test. MRI should be used in combination with the clinical assessment and other investigations to assist in the diagnosis of TOS.