MRI Brachial Plexus — Dictation, Appropriateness, and Dose for Residents

What an MRI of the Brachial Plexus Covers and What Attendings Look For

An MRI of the brachial plexus is a high-yield, non-invasive study for evaluating the complex nerve network running from the cervical spine to the axilla. It’s the go-to for suspected plexopathy when the clinical picture is murky. Your attending isn’t just looking for a generic “no acute findings” read; they expect a systematic evaluation for specific, often subtle, pathologies that can dramatically alter patient management.

This study visualizes the entire course of the plexus, from the C5-T1 nerve roots exiting the spinal cord, through the trunks, divisions, and cords in the thoracic outlet, to the terminal branches in the axilla. It’s a complex anatomical region, and a structured approach is key to not missing anything.

When I’m on service, I expect the report to systematically address:

• Nerve Roots: Specifically looking for evidence of traumatic avulsion, like a pseudomeningocele.
• Plexus Itself: Assessing for diffuse or focal thickening, abnormal T2 signal, and enhancement, which can indicate inflammation, tumor, or radiation-induced changes.
• Surrounding Structures: The lung apex for a Pancoast tumor, the scalene muscles and clavicle for thoracic outlet compression, and the axilla for adenopathy.
• Musculature: Signs of denervation, such as edema (acute) or fatty atrophy (chronic), which help localize the level of injury.

Getting this right means catching the difference between a benign schwannoma and an infiltrative lymphoma, or distinguishing radiation fibrosis from tumor recurrence—distinctions that are critical for the referring oncologist or surgeon.

Radiology Report Template for MRI Brachial Plexus

This template provides a solid framework for a comprehensive report. You can adapt it for your institution’s macros in PowerScribe, Fluency, or other dictation software. The key is to be systematic, moving from the roots distally.

Technique

Multiplanar, multisequence MRI of the brachial plexus was performed without and with the administration of [AMOUNT] mL of [CONTRAST_NAME] macrocyclic gadolinium-based contrast. Sequences included coronal STIR and T1, sagittal oblique T1 and T2, high-resolution axial T2, and 3D high-resolution imaging of the cervical nerve roots.

(If applicable: Additional postural imaging was obtained with the arms in neutral and hyperabducted positions for evaluation of thoracic outlet syndrome.)

Findings

Cervical Spine and Nerve Roots: The visualized cervical spine is evaluated for disc disease, foraminal stenosis, and cord signal abnormality. The C5, C6, C7, C8, and T1 nerve roots are assessed. The ventral and dorsal rootlets are [intact/not intact]. No evidence of nerve root avulsion or pseudomeningocele is seen.

Trunks, Divisions, and Cords: The superior, middle, and inferior trunks, as well as the divisions and cords of the brachial plexus, are symmetric in size and signal intensity. There is no focal mass, thickening, or abnormal T2 signal to suggest plexitis, tumor, or compressive neuropathy. The perineural fat planes are preserved.

Thoracic Outlet: The costoclavicular space and interscalene triangle are patent. There is no compression of the brachial plexus between the clavicle and first rib or by the scalene muscles.

Surrounding Structures:
– Lung Apices: The lung apices are clear. No suspicious apical mass (e.g., Pancoast tumor) is identified.
– Axilla: No axillary lymphadenopathy is present.
– Musculature: The visualized musculature of the shoulder girdle and upper arm demonstrates normal bulk and signal intensity, without evidence of denervation edema or fatty atrophy.

Vessels: The subclavian artery and vein are patent and demonstrate normal courses.

Impression

1. Normal, non-contrasted MRI of the brachial plexus.

2. No evidence of nerve root avulsion, plexitis, or compressive mass lesion.

3. No suspicious apical lung mass or axillary adenopathy.

Free Template Sources for On-Call Use

Building your own templates is a rite of passage, but you don’t have to start from scratch. When you’re looking for a specific protocol or a rare finding, two great free repositories exist that are built and maintained by radiologists:

• RadReport.org: This is the RSNA-curated library. It’s comprehensive, peer-reviewed, and has structured templates for almost every common study you’ll encounter.
• Radiology Templates (AU): An excellent, straightforward resource maintained by Australian radiologists. It’s particularly good for clean, practical templates that are easy to adapt.

Bookmark them. They’re lifesavers when you get a study you haven’t seen in a while and want a reliable starting point.

The Next-Level Move: Free-Form Dictation to Structured Report

The reality of a busy call shift is that you identify the positive findings first. You see the pseudomeningocele at C7, the T2-bright mass encasing the superior trunk, or the muscle edema in the supraspinatus fossa. The challenge is translating those free-form thoughts into a perfectly structured report that your attending expects, without constantly toggling between your dictation window and a template document.

This is where AI-powered reporting tools can make a real difference. With GigHz Precision AI, you can dictate the positive findings naturally—”large pseudomeningocele at the left C7-T1 neural foramen consistent with nerve root avulsion”—and the software structures it into the appropriate section of a pre-loaded ACR or SIR-compliant template. It’s designed to streamline the process, ensuring key elements aren’t missed while letting you focus on the pathology. For studies that require it, the system also surfaces the relevant Clinical Decision Support (CDS) popups, like for LI-RADS or Bosniak classifications, guiding you to the right conclusion without having to look it up.

When Should You Order an MRI of the Brachial Plexus? ACR Appropriateness Criteria

Knowing when an MRI of the brachial plexus is the right first step is crucial. The American College of Radiology (ACR) provides evidence-based guidelines that are your best defense for ordering decisions.

For a patient presenting with brachial plexopathy (acute or chronic, nontraumatic) without a known malignancy, an MRI of the brachial plexus is rated “Usually Appropriate.” This is the first-line imaging test to evaluate for inflammatory, compressive, or other non-traumatic causes. Similarly, for traumatic brachial plexopathy (common in motorcycle accidents), MRI is also “Usually Appropriate” to directly visualize nerve injury, especially root avulsion.

In the setting of a known malignancy or post-treatment syndrome, MRI is again “Usually Appropriate” to differentiate between tumor recurrence and radiation-induced plexopathy, a critical distinction for therapy planning.

For suspected neurogenic thoracic outlet syndrome (TOS), an MRI of the brachial plexus is “Usually Appropriate” as the initial imaging study. It can directly visualize the compression of the plexus, often supplemented with dynamic imaging in neutral and hyperabducted arm positions. For venous or arterial TOS, other modalities like ultrasound or CTA/MRA may be preferred, but MRI remains key for the neurogenic component.

As an alternative, CT myelography can be used to assess for root avulsion when MRI is contraindicated, and high-resolution nerve ultrasound is a valuable adjunct for evaluating more distal nerve segments.

MRI Brachial Plexus Imaging Protocol — Sequences, Contrast, and Key Parameters

A high-quality brachial plexus MRI protocol is designed to provide both a wide overview and high-resolution detail of the nerves and surrounding tissues. The key is using fat-suppressed, fluid-sensitive sequences to make edematous or inflamed nerves stand out, combined with high-resolution 3D sequences to resolve the individual nerve rootlets.

The large field-of-view (FOV) coronal images are the workhorses, while the sagittal oblique planes are prescribed perpendicular to the plexus for a true cross-sectional view. Contrast is essential for evaluating tumors, inflammation, and differentiating scar from recurrence.

Common protocol pitfalls: A frequent mistake is using too small a field of view, which can cut off the distal plexus or the nerve roots. Another is insufficient fat suppression, which obscures nerve pathology on T2-weighted images. Finally, for thoracic outlet syndrome, failing to perform dynamic imaging with the arms abducted can lead to a false-negative study, as the compression may only be present in that position.

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All we ask in return is your feedback so we can keep improving the product for residents and fellows on the front lines.

To apply, just let us know these three things:

1. Your PGY year (e.g., PGY-2, PGY-4)
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The signup process is simple. No credit card, no long forms. Just reply with those three items, and we’ll get you set up. Ready to give it a try? Apply for the residents free-access program.

Free GigHz Tools That Pair With This Article

Three free tools that complement the material above:

• ACR Appropriateness Criteria Lookup — Type an indication or clinical scenario in plain language and get the imaging studies the ACR rates for it, with adult and pediatric radiation levels. Built directly from 297 ACR topics, 1,336 clinical variants, and 15,823 procedure ratings.
• GigHz Imaging Protocol Library — A searchable library of 131 imaging protocols with the physics specs surfaced and the matching ACR Appropriateness Criteria alongside. Plain-English narratives readable in 60 seconds, organized by modality.
• GigHz Radiation Dose Calculator — Pick the imaging studies a patient has had and see total dose in millisieverts (mSv) with comparisons to natural background radiation, transatlantic flights, and chest X-rays. Useful for shared decision-making.

Frequently Asked Questions

Is it HIPAA-compliant?

Yes. The platform is designed for de-identified workflows by default. No patient-identifying information is required to use the reporting assistant, ensuring compliance with HIPAA privacy rules.

Do I need my hospital’s IT department to set this up?

No. GigHz Precision AI is browser-based and requires no local software installation or special permissions from your IT department. It works on any modern computer, including the PACS workstation or your personal laptop/iPad in the call room.

Does this replace PowerScribe or other dictation software?

No, it works alongside it. You can dictate your findings as you normally would, then use the tool to structure those findings into a complete report. You can then copy and paste the final, structured text into your hospital’s official dictation system.

Can I use this on my phone or iPad?

Yes, the platform is fully responsive and works on mobile devices and tablets. This is perfect for reviewing a case or building a report shell from anywhere.

Can I customize the templates?

Yes. While the system comes pre-loaded with ACR and other society-standard templates, you have the ability to create, modify, and save your own custom templates to match your personal workflow or your institution’s specific requirements.

What happens after I finish my residency or fellowship?

Trainee accounts are intended for use during residency and fellowship. After you graduate, you can transition to a standard professional account to continue using the service in your practice.

Reviewed by Pouyan Golshani, MD, Interventional Radiologist — May 7, 2026