High-resolution ultrasound of the supra- and infraclavicular levels of the brachial plexus including the axillary nerve: imaging anatomy based on multiplanar reconstructions and technical guide

Abstract

Purpose The diagnosis of peripheral nerve injuries remains challenging. Electromyography and nerve conduction studies do not allow precise localization of the lesion and differentiation between lesions in continuity and non-continuity in cases with complete axonotmesis. Improved ultrasound technology allows the examination of almost the entire peripheral nervous system. The complex sono-anatomy of the brachial plexus outside of the standard scanning planes makes it difficult to access this region.

Methods On the basis of the Visible Human Project of the National Institutes of Health (NIH), multiplanar reconstructions were created with the 3D Slicer open-source software in the various planes of the ultrasound cross-sections. The ultrasound examination itself and the guidance of the ultrasound probe in relation to the patient were recorded as video files and were synchronized through the audio channel. Subsequently, image matching was performed.

Results Multiplanar reconstructions facilitate visualization of anatomical regions which are challenging to access thereby enabling physicians to evaluate the course of the peripheral nerve of interest in dynamic conditions. Sonographically visible structures could be reproducibly identified in single-frame analysis.

Conclusion With precise knowledge of the ultrasound anatomy, the nerve structures of the brachial plexus can also be dynamically assessed almost in their entire course. An instructional video on ultrasound of the brachial plexus supplements this manuscript and has been published on Vimeo.com.

Zusammenfassung

Ziel Die Diagnose peripherer Nervenverletzungen bleibt eine Herausforderung. Elektromyografie und -neurografie erlauben keine präzise Lokalisation der Läsion und Abklärung der Nervenkontinuität in Fällen mit vollständiger Axonotmesis. Die verbesserte Ultraschalltechnologie ermöglicht die Untersuchung fast des gesamten peripheren Nervensystems. Die komplexe Sonoanatomie des Plexus brachialis (PB) außerhalb der Standard-Schnittbildebenen erschwert den Zugang zu dieser Region.

Material und Methode Basierend auf dem Visible Human Project des National Institutes of Health wurden mithilfe der Open-Source-Software „3DSlicer“ multiplanare Rekonstruktionen in den Ebenen der Ultraschall-Schnittbilder erstellt. Die Ultraschalluntersuchung selbst und die Führung der Ultraschallsonde in Bezug zum Patienten wurden als Videodateien aufgezeichnet und über den Audiokanal synchronisiert. Anschließend wurde ein schrittweiser Abgleich der Schnittbilder durchgeführt.

Ergebnisse Multiplanare Rekonstruktionen erleichtern die Visualisierung von anatomischen Regionen, die schwer zugänglich sind und ermöglichen es Ärzten, den Verlauf des peripheren Nervs von Interesse unter dynamischen Bedingungen zu beurteilen. Sonografisch sichtbare Strukturen konnten reproduzierbar in der Einzelbildanalyse identifiziert werden.

Schlussfolgerungen Mit präzisem Wissen über die Ultraschallanatomie können auch die Nervenstrukturen des PB fast über ihren gesamten Verlauf dynamisch beurteilt werden. Ein Lehrvideo zur Ultraschalluntersuchung des PB ergänzt dieses Manuskript und wurde auf Vimeo.com veröffentlicht.

Keywords

peripheral nerve injuries - brachial plexus - sonography - METHODS & TECHNIQUES - ultrasound - clinical decision-making

Publication History

Received: 19 December 2022

Accepted after revision: 04 October 2023

Article published online:
27 December 2023

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