Method to evaluate patients for thoracic outlet syndrome

1. A method to evaluate a human subject for the presence or absence of thoracic outlet syndrome (TOS) which method comprises:

a) obtaining a first set of magnetic resonance imaging (MRI) slices in each of three planes, in the absence of contrast agent, with the subject in a supine position with both arms in a neutral position by the side of the body, using a surface coil placed to cover the upper chest and neck, and the supraclavicular fossa region on an affected side(s),

wherein the obtaining the first set comprises obtaining a gradient echo T1, spin echo T1, or fast spin echo T2-weighted sequence that comprises sagittal slices that cover the scalene triangle, costoclavicular space, and retropectoralis space on the affected side(s),

wherein the obtaining the first set further comprises obtaining a gradient echo T1, spin echo T1, or fast spin echo T2-weighted 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

wherein the obtaining the first set further comprises obtaining a Short Tau Inversion Recovery (STIR) sequence that comprises coronal slices that cover the volume of the brachial plexus on the affected side(s);

b) obtaining a second set of MRI slices in one or more planes, in the absence of contrast agent, with the subject in a supine position with both arms placed in abduction and external rotation, using the surface coil placed to cover the upper chest and neck, and the supraclavicular fossa region on the affected side(s),

wherein the obtaining the second set comprises obtaining a gradient echo T1, spin echo T1, or fast spin echo T2-weighted sequence that comprises sagittal slices that cover the scalene triangle, costoclavicular space, and retropectoralis space on the affected side(s); followed by

administering a diluted contrast agent comprising 50% gadolinium into a vein on a first side of the subject such that the contrast agent enters arteries of the subject;

obtaining a contrast-enhanced magnetic resonance angiogram (MRA) and a magnetic resonance venogram (MRV), each of which image, in the subject, the contrast agent delivered by the administering, the MRA comprising coronal slices imaging the subclavian and axillary arteries on both sides of the subject, the MRV comprising coronal slices imaging the subclavian, axillary, and brachiocephalic veins on both sides of the subject;

c) composing the slices from the STIR sequence into a composite volume, and editing the composite volume to create a three-dimensional model of the brachial plexus on the affected side(s);

d) composing the slices from the MRA into a composite volume, and editing the composite volume to create a three-dimensional model of the arteries on the affected side(s);

e) composing the slices from the MRV into a composite volume, and editing the composite volume to create a three-dimensional model of the veins on the affected side(s);

f) determining a degree of stenosis, if any, in each of the subclavian and the axillary arteries and each of the subclavian, the axillary, and the brachiocephalic veins on both sides of the subject by assessing vascular contrast enhancement, on the both sides, produced by the contrast agent delivered by the administering of the contrast agent into the vein on the first side; and

determining the presence or absence of TOS based on an evaluation of the first and second sets and the three-dimensional models of c) and d).

2. The method of claim 1 , wherein the obtaining the second set further comprises obtaining a gradient echo T1, spin echo T1, or fast spin echo T2-weighted 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).