“Are All MRI’s for Thoracic Outlet Syndrome Created Equal?”

Join Dr. Scott Werden for a free, online and in depth discussion as he answers the question: “Are All MRI’s for Thoracic Outlet Syndrome Created Equal?” In clear language that patients can understand and relate to, Dr. Werden will explain the broad differences in the MRI techniques that are used to diagnose patients with Thoracic Outlet Syndrome (TOS).

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we're going to explain it in terms of what we've already learned about thoracic outlet syndrome remember that imaging functions along with the clinical judgment when your doctor sees you and he or she tries to determine do you have the disease and then secondly what would they need to know to plan treatment whether it's surgery or conservative therapy there's still a lot in our field of tos that's unknown about that and that's where we believe we contribute a huge amount of additional information with our specialized advanced unique nia vista imaging so let's talk about some of the issues the three topics i'll cover will be what is the current standard of tos imaging in this country in general number two if we had a perfect imaging test what would that show what information would that give us and number three how have we at vanguard specialty imaging moved from one closer to two which would be the perfect world that would help everybody get diagnosed and treated so let's talk about one what's the current standard of imaging for tos patients well as everybody knows i stay in touch with doctors and patients around the country and since i'm a little busybody i'm always asking questions always trying to learn and make things better so i get copies of reports that have been performed by radiologists around the country radiologists go through a lot of training there's a lot of awfully smart people i've met way smarter than me in radiology and yet there are certain forces that keep these reports not ideal or optimized so number one they're always short number two they're really not images or reports based on thoracic outlet syndrome they're based on the brachial plexus if you look at the header of a report it'll say mri of the right brachial plexus or mri of the left brachial plexus without contrast something like that and then the radiologist will generate four or five sentences and say it looks normal to me not only do i see this in the reports that i get from other radiologists which i review of course with prior images to see what information we already had or what changes occurred from then until now when we do imaging but i also hear this from the referring doctors and i have to say if radiologists don't pay attention they should there's a lot of referring doctors who talk to me and they even over the phone you can hear them rolling their eyes i order an mri and what do i get back the brachial plexus looks normal and that's it it's not useful to me well that comes about for a few reasons one is radiologists don't image this area too often most radiologists i know kind of shake their heads and want to get through it as quickly as possible it is a complex area and the more i've studied it the more i've realized how complex and variable it is in a typical normal person it's complex but there's all these known anatomic variations that we have to look out for and it changes depending on the patient's arm position and neck position it's complex so for radiologists who don't put a lot of time into learning it and it takes a lot of time they're just looking for something big they're looking for some abnormality like a mass or some rupture of a part of the brachial plexus but the second part is that tos thoracic outlet syndrome is not a disease of the brachial plexus it is a disease of the thoracic outlet which is extrinsic to the brachial plexus and extrinsic to the blood vessels so changes in the thoracic outlet dynamic changes in the arm extra muscles tight muscles these things will affect the brachial plexus but the disease does not arise from the brachial plexus and so an mri of the brachial plexus is not even focused on the correct underlying pathology and if a radiologist starts out this way he or she is going to unfortunately be led down the wrong path and not provide that useful information that the referring doctor needs to help make the diagnosis understand the underlying process and he'll make decisions based on those things now a lot of radiologists don't have a lot of experience with tos when i