Skeletal radiology · 2026
Zero echo time MRI for detecting osseous anomalies in neurogenic thoracic outlet syndrome.
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Lin Yenpo, Lowe Allison S, Ensle Falko, Igbinoba Zenas, Wang Shu-Han, Alschuler Daniel, Tan Ek T, Sneag Darryl B
Аннотация
OBJECTIVE: To evaluate the additive value of a zero echo time (ZTE) sequence to standard brachial plexus MR neurography (MRN) for detecting and characterizing osseous anomalies in patients with suspected neurogenic thoracic outlet syndrome (nTOS).
MATERIALS AND METHODS: In this retrospective, case-control study (January 2022-March 2025), unilateral brachial plexus MRN examinations with ZTE and reference imaging (radiographs and/or CT) were included. Two board-certified radiologists determined case status and osseous anomaly subtype (cervical rib, rib synostosis, or elongated C7 transverse process) on the reference imaging. Age- and sex-matched controls were randomly selected. Three musculoskeletal radiologists independently reviewed each examination in 3 rounds (MRN-only, ZTE-only, MRN + ZTE). Inter-reader agreement was assessed, and diagnostic performance was compared with reference standard.
RESULTS: Thirty examinations from 27 subjects (20 female; median age 31 years) were analyzed, including 15 case examinations (elongated C7 transverse process n = 7, cervical rib n = 4, rib synostosis n = 4) and 15 control examinations. Accuracy for osseous anomaly detection was highest in ZTE-only (0.90; sensitivity 0.80; specificity 1.00), followed by MRN + ZTE (0.87; 0.73; 1.00) and MRN-only (0.73; 0.53; 0.93). MRN + ZTE identified anomaly-related nerve impingement more frequently than MRN-only. MRN + ZTE showed the highest agreement for osseous anomaly detection and subtype (κ = 0.68 and 0.61), compared with MRN-only (κ = 0.53 and 0.56) and ZTE-only (κ = 0.59 and 0.54). Agreement for nerve impingement improved from fair with MRN-only (κ = 0.40) to substantial with MRN + ZTE (κ = 0.62).
CONCLUSION: ZTE improves detection of osseous anomalies in brachial plexus MRN and increases inter-reader agreement and diagnostic confidence, supporting its incorporation into MR protocols for nTOS evaluation.
MATERIALS AND METHODS: In this retrospective, case-control study (January 2022-March 2025), unilateral brachial plexus MRN examinations with ZTE and reference imaging (radiographs and/or CT) were included. Two board-certified radiologists determined case status and osseous anomaly subtype (cervical rib, rib synostosis, or elongated C7 transverse process) on the reference imaging. Age- and sex-matched controls were randomly selected. Three musculoskeletal radiologists independently reviewed each examination in 3 rounds (MRN-only, ZTE-only, MRN + ZTE). Inter-reader agreement was assessed, and diagnostic performance was compared with reference standard.
RESULTS: Thirty examinations from 27 subjects (20 female; median age 31 years) were analyzed, including 15 case examinations (elongated C7 transverse process n = 7, cervical rib n = 4, rib synostosis n = 4) and 15 control examinations. Accuracy for osseous anomaly detection was highest in ZTE-only (0.90; sensitivity 0.80; specificity 1.00), followed by MRN + ZTE (0.87; 0.73; 1.00) and MRN-only (0.73; 0.53; 0.93). MRN + ZTE identified anomaly-related nerve impingement more frequently than MRN-only. MRN + ZTE showed the highest agreement for osseous anomaly detection and subtype (κ = 0.68 and 0.61), compared with MRN-only (κ = 0.53 and 0.56) and ZTE-only (κ = 0.59 and 0.54). Agreement for nerve impingement improved from fair with MRN-only (κ = 0.40) to substantial with MRN + ZTE (κ = 0.62).
CONCLUSION: ZTE improves detection of osseous anomalies in brachial plexus MRN and increases inter-reader agreement and diagnostic confidence, supporting its incorporation into MR protocols for nTOS evaluation.