Method to evaluate patients for thoracic outlet syndrome

Abstract

Methods to obtain three-dimensional models and images for diagnosis of Thoracic Outlet Syndrome are described.

1 . (canceled) 
     
     
         2 . A method of identifying thoracic outlet syndrome (TOS) by analyzing a series of images of a thoracic outlet of a human subject, wherein the series of images comprises a plurality of sets of magnetic resonance imaging (MRI) slices, a plurality of slices from a contrast-enhanced magnetic resonance angiogram (MRA), a plurality of slices from a magnetic resonance venogram (MRV), and three-dimensional models of an affected side(s) of the subject, the method comprising:
 determining, based on the plurality of sets of MRI slices including at least a first set of MRI slices and a second set of MRI slices, a presence or absence of stenosis;   determining, based on the plurality of slices from the MRA slices, the presence or degree of stenosis, external compression, or aneurysm, if any, in each of subclavian and axillary arteries by assessing vascular contrast enhancement, on both sides of a body of the subject,   determining, based on the plurality of slices from the MRV slices, the presence or degree of stenosis or external compression in each of subclavian, axillary, and brachiocephalic veins on both sides of the body of the subject by assessing vascular contrast enhancement, on both sides of the body of the subject; and   determining a presence or absence of TOS based on the plurality of sets of MRI slices, the MRA slices and the MRV slices, and an evaluation of the three-dimensional models, the three-dimensional models comprising a first three-dimensional model, a second three-dimensional model, and a third three-dimensional model;   wherein the first three-dimensional model of a brachial plexus on the affected side(s) is generated based on at least the first set of magnetic resonance imaging (MRI) slices obtained in each of three planes, in the absence of a contrast agent, with the subject in a supine position with both arms in a neutral position by the side of the body of the subject, wherein the first set of MRI slices are obtained by:
 obtaining a gradient echo T1, spin echo T1, or fast spin echo T2-weighted sequence that comprises sagittal slices that cover a scalene triangle, a costoclavicular space, and a retropectoralis spaces on the affected side(s); 
 obtaining another gradient echo T1, spin echo T1, or fast spin echo T2-weighted sequence that comprises axial slices that cover mid and lower cervical spinal portions, lower neck, the brachial plexus, supraclavicular space, superior mediastinum, and lung apex on the affected side(s); and 
 obtaining a Short Tau Inversion Recovery (STIR) sequence that comprises slices that cover a volume of the brachial plexus on the affected side(s); 
   wherein the second set of MRI slices is obtained in one or more of the three planes, in the absence of the contrast agent, with the subject in a supine position with both arms placed in abduction and external rotation, by imaging an upper chest and neck, and a supraclavicular fossa region on the affected side(s), wherein the second set of MRI slices is obtained by the gradient echo T1, spin echo T1, or fast spin echo T2-weighted sequence that comprises sagittal slices that cover the scalene triangle, the costoclavicular space and the retropectoralis space on the affected side(s);   wherein the second three-dimensional model of arteries on the affected side(s) is generated based on at least in part on the plurality of slices from the MRA, wherein the plurality of MRA slices images the subclavian and axillary arteries on both sides of the subject, wherein the plurality of MRA slices are obtained by administering a diluted contrast agent comprising gadolinium into a vein on a first side of the subject such that the contrast agent enters arteries on both sides of the subject and veins on both sides of the subject and obtaining the contrast-enhanced MRA, which images, in the subject, the contrast agent; and   wherein the third three-dimensional model of veins on the affected side(s) is generated based at least in part on the plurality of slices from the MRV, wherein the plurality of MRV slices images the subclavian, axillary, and brachiocephalic veins on both sides of the subject, wherein the plurality of MRV slices are obtained by administering the diluted contrast agent comprising gadolinium into the vein on the first side of the subject such that the contrast agent enters arteries on both sides of the subject and veins on both sides of the subject and obtaining the MRV, which images, in the subject, the contrast agent.   
     
     
         3 . The method of  claim 2 , wherein the contrast agent further comprises normal saline. 
     
     
         4 . The method of  claim 2 , wherein the arteries comprise upper extremity arteries and wherein the veins comprise upper extremity veins. 
     
     
         5 . The method of  claim 2 , wherein obtaining the first set of MRI slices comprises disposing a surface coil over the subject to cover the upper chest and neck and the supraclavicular fossa region on the affected sides. 
     
     
         6 . A method of identifying thoracic outlet syndrome (TOS) by analyzing a series of images of a thoracic outlet of a human subject, wherein the series of images comprises a plurality of sets of magnetic resonance imaging (MRI) slices, a plurality of slices from a contrast-enhanced magnetic resonance angiogram (MRA), a plurality of slices from a magnetic resonance venogram (MRV), and three-dimensional models of an affected side(s) of the subject, the method comprising:
 determining, based on the plurality of sets of MRI slices including at least a first set of MRI slices and a second set of MRI slices, a presence or absence of stenosis;   determining, based on the plurality of slices from the MRA slices, the presence or degree of stenosis, external compression, or aneurysm, if any, in each of subclavian and axillary arteries by assessing vascular contrast enhancement, on both sides of a body of the subject,   determining, based on the plurality of slices from the MRV slices, the presence or degree of stenosis or external compression in each of subclavian, axillary, and brachiocephalic veins on both sides of the body of the subject by assessing vascular contrast enhancement, on both sides of the body of the subject; and   determining a presence or absence of TOS based on the plurality of sets of MRI slices, the MRA slices and the MRV slices, and an evaluation of the three-dimensional models, the three-dimensional models comprising a first three-dimensional model, a second three-dimensional model, and a third three-dimensional model;   wherein the first three-dimensional model of a brachial plexus on the affected side(s) is generated based on a first set of magnetic resonance imaging (MRI) slices obtained in each of three planes, in the absence of a contrast agent, with a subject in a supine position with both arms in a neutral position by a side of a body of the subject, wherein the first set of MRI slices is obtained by:
 obtaining a gradient echo, spin echo, or fast spin echo sequence that comprises sagittal slices that cover the thoracic outlet on an affected side(s), 
 obtaining a gradient echo, spin echo, or fast spin echo sequence that comprises axial slices that cover the mid and lower cervical spine and lower neck, and the brachial plexus, supraclavicular space, superior mediastinum and lung apex on the affected side(s), and 
 obtaining a Short Tau Inversion Recovery (STIR) sequence that comprises slices that cover a volume of the brachial plexus on the affected side(s); 
   wherein the second set of MRI slices is obtained in one or more planes of the three planes, in the absence of the contrast agent, with the subject in a supine position with both arms placed in abduction and external rotation, by imaging the upper chest and neck, and the supraclavicular fossa region on the affected side(s), wherein the second set of MRI slices is obtained by the gradient echo, spin echo, or fast spin echo sequence that comprises sagittal slices that cover the thoracic outlet on the affected side(s);   wherein the second three-dimensional model of arteries on the affected side(s) is generated based on a plurality of slices from a contrast-enhanced magnetic resonance angiogram (MRA), wherein the plurality of MRA slices images the subclavian and axillary arteries on both sides of the subject, wherein the plurality of MRA slices are obtained by administering a diluted contrast agent comprising gadolinium into a vein on a first side of the subject such that the contrast agent enters arteries on both sides of the subject and veins on both sides of the subject and obtaining a contrast-enhanced MRA, which images, in the subject, the contrast agent; and   wherein the third three-dimensional model of veins on the affected side(s) is generated based at least in part on a plurality of slices from a magnetic resonance venogram (MRV), wherein the plurality of MRV slices images the subclavian, axillary, and brachiocephalic veins on both sides of the subject, wherein the plurality of MRV slices are obtained by administering the diluted contrast agent comprising gadolinium into the vein on the first side of the subject such that the contrast agent enters arteries on both sides of the subject and veins on both sides of the subject and obtaining the MRV, which images, in the subject, the contrast agent.   
     
     
         7 . The method of  claim 6 , wherein the contrast agent further comprises normal saline. 
     
     
         8 . The method of  claim 6 , wherein the arteries comprise upper extremity arteries and wherein the veins comprise upper extremity veins. 
     
     
         9 . The method of  claim 6 , wherein the first set of MRI slices is further obtained by disposing a surface coil over the subject to cover the upper chest and neck and the supraclavicular fossa region on the affected sides. 
     
     
         10 . The method of  claim 6 , wherein the thoracic outlet comprises a scalene triangle, a costoclavicular space, and a rectropectoralis space. 
     
     
         11 . A method of identifying thoracic outlet syndrome (TOS) by analyzing a series of images of a thoracic outlet of a human subject, wherein the series of images comprises a plurality of sets of magnetic resonance imaging (MRI) slices, a plurality of slices from a contrast-enhanced magnetic resonance angiogram (MRA), a plurality of slices from a magnetic resonance venogram (MRV), and three-dimensional models of an affected side(s) of the subject, the method comprising:
 determining, based on the plurality of sets of MRI slices including at least a first set of MRI slices and a second set of MRI slices, a presence or absence of stenosis;   determining, based on the plurality of slices from the MRA slices, the presence or degree of stenosis, external compression, or aneurysm, if any, in each of subclavian and axillary arteries by assessing vascular contrast enhancement, on both sides of a body of the subject,   determining, based on the plurality of slices from the MRV slices, the presence or degree of stenosis or external compression in each of subclavian, axillary, and brachiocephalic veins on both sides of the body of the subject by assessing vascular contrast enhancement, on both sides of the body of the subject; and   determining a presence or absence of TOS based on the plurality of sets of MRI slices, the MRA slices and the MRV slices, and an evaluation of the three-dimensional models, the three-dimensional models comprising a first three-dimensional model, a second three-dimensional model, and a third three-dimensional model;   wherein the first three-dimensional model of a brachial plexus on the affected side(s) is generated based on at least the first set of magnetic resonance imaging (MRI) slices obtained in each of three planes, in the absence of a contrast agent, with the subject in a supine position with both arms in a neutral position by the side of the body of the subject, wherein the first set of MRI slices are obtained by:
 obtaining a gradient echo T1, spin echo T1, or fast spin echo T2-weighted sequence that comprises sagittal slices that cover a scalene triangle, a costoclavicular space, and a retropectoralis spaces on the affected side(s); 
 obtaining another gradient echo T1, spin echo T1, or fast spin echo T2-weighted sequence that comprises axial slices that cover mid and lower cervical spinal portions, lower neck, the brachial plexus, supraclavicular space, superior mediastinum, and lung apex on the affected side(s); and 
 obtaining a Short Tau Inversion Recovery (STIR) sequence that comprises slices that cover a volume of the brachial plexus on the affected side(s); 
   wherein the second set of MRI slices is obtained in one or more of the three planes, in the absence of the contrast agent, with the subject in a supine position with both arms placed in abduction and external rotation, by imaging an upper chest and neck, and a supraclavicular fossa region on the affected side(s), wherein the second set of MRI slices is obtained by the gradient echo T1, spin echo T1, or fast spin echo T2-weighted sequence that comprises sagittal slices that cover the scalene triangle, the costoclavicular space and the retropectoralis space on the affected side(s);   wherein the second three-dimensional model of arteries on the affected side(s) is generated based on at least in part on the plurality of slices from the MRA, wherein the plurality of MRA slices images the subclavian and axillary arteries on both sides of the subject, wherein the plurality of MRA slices are obtained by administering a diluted contrast agent into a vein on a first side of the subject such that the contrast agent enters arteries on both sides of the subject and veins on both sides of the subject and obtaining the contrast-enhanced MRA, which images, in the subject, the contrast agent; and   wherein the third three-dimensional model of veins on the affected side(s) is generated based at least in part on the plurality of slices from the MRV, wherein the plurality of MRV slices images the subclavian, axillary, and brachiocephalic veins on both sides of the subject, wherein the plurality of MRV slices are obtained by administering the diluted contrast agent into the vein on the first side of the subject such that the contrast agent enters arteries on both sides of the subject and veins on both sides of the subject and obtaining the MRV, which images, in the subject, the contrast agent.   
     
     
         12 . The method of  claim 11 , wherein the contrast agent further comprises gadolinium and normal saline. 
     
     
         13 . The method of  claim 11 , wherein the arteries comprise upper extremity arteries and wherein the veins comprise upper extremity veins. 
     
     
         14 . The method of  claim 11 , wherein obtaining the first set of MRI slices comprises disposing a surface coil over the subject to cover the upper chest and neck and the supraclavicular fossa region on the affected sides.