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Nonobstetric traumatic brachial plexus injuries can result in significant morbidity and chronic disability if not managed in a timely manner. Functional arm recovery is possible, but it requires a multidisciplinary approach toward the diagnosis and management of such injuries.This article provides an overview of the clinical, electrophysiology, and diagnostic imaging knowledge needed for accurate imaging interpretation and to participate in multidisciplinary discussions aimed at expediting optimal patient management.

The purpose of this article is to evaluate the significance of subspecialty second-opinion consultations for CT and MRI examinations in musculoskeletal (MSK) radiology.All 3165 MSK CT and MRI examinations referred to one academic institution for second-opinion consultation during a 24-month period were reviewed by three MSK-trained radiologists. Outside and inside reports were compared by two independent MSK radiology fellows using a previously published 5-point scale. Clinically important differences (categories 4 and 5) were defined as those likely to change patient management. Statistical comparisons of rates were performed using a chi-square test with Bonferroni corrections. Interobserver reliability was reported using linear weighted kappa statistics and the percentage of agreement.Of all second-opinion examinations, 73.5% (2326/3165) had an outside report available for comparison and inclusion in this study. There were 610 of 2326 (26.2%) examinations with clinically important differences. The rate of clinically important discrepant readings was even higher in oncologic cases (36.3%; 331/911). When the final diagnosis was determined from pathology reports performed after internal interpretation, the second-opinion consultation was noted to be correct in 82.0% (334/407) of examinations with category 4 or 5 discrepancies. There was very good agreement (κ = 0.93) in scoring the discrepancies between second-opinion consultants.The subspecialty second-opinion consultation was more accurate than outside reports in 82.0% of examinations when pathologic confirmation was made. A moderate rate (26.2%) of discrepant interpretations was noted between outside and inside MSK imaging examinations, especially in tumor cases (36.3%). Most discrepancies were in interpreting rather than detecting abnormalities.

OBJECTIVE. In this article, we will review the normal anatomy and imaging features of various neuromuscular abnormalities related to suprascapular neuropathy. CONCLUSION. Suprascapular neuropathy can be difficult to distinguish from rotator cuff pathology, plexopathy, and radiculopathy. Electrodiagnostic studies are considered the reference standard for diagnosis; however, high-resolution 3-T MR neurography (MRN) can play an important role. MRN enables direct visualization of the nerve and simultaneous assessment of the cervical spine, brachial plexus, and rotator cuff.

OBJECTIVE. A wide spectrum of space-occupying soft-tissue lesions may be discovered on MRI studies, either as incidental findings or as palpable or symptomatic masses. Characterization of a lesion as benign or indeterminate is the most important step toward optimal treatment and avoidance of unnecessary biopsy or surgical intervention. CONCLUSION. The systemic MRI interpretation approach presented in this article enables the identification of cases in which sarcoma can be excluded.

OBJECTIVE. Diabetes is the most common cause of neuropathy. Focal diabetic neuropathy, although less common than entrapment neuropathy, clinically mimics entrapment neuropathy. This article depicts the spectrum of MR abnormalities in diabetic subjects— from abnormal T2 hyperintensity and fascicular enlargement in the acute and subacute stages to atrophic-appearing fascicles with intraepineurial fat deposition in the chronic stage—on high-resolution high-field (3-T) MRI. CONCLUSION. A spectrum of imaging abnormalities is observed in diabetic neuropathy. It is important for radiologists to understand the pathophysiology and recognize high-resolution MR appearances of these lesions and of related entities in the differential diagnosis for appropriate diagnosis and patient treatment.

OBJECTIVE. The femoral nerve is subject to a variety of diseases that may affect the nerve anywhere from the nerve roots to the distal branches. High-resolution 3-T MR neurography (MRN) is being increasingly used for peripheral nerve evaluation because it complements information gained from electrodiagnostic testing. CONCLUSION. There are scattered case reports describing femoral nerve diseases using MRI. This article comprehensively reviews different pathologic abnormalities involving the femoral nerve and illustrates their MRN features with case examples.

OBJECTIVE: MR neurography (MRN) has increasingly been used in clinical practice for the evaluation of peripheral nerve disease. This article reviews the historic perspective of MRN, the current imaging trends of this modality, and the future directions and applications that have shown potential for improved imaging and diagnostic capabilities. CONCLUSION: MRN has come a long way in the past 2 decades. Excellent depiction of 3D nerve anatomy and pathology is currently possible. Further technical developments in diffusion-based nerve and muscle imaging, whole-body MRN, and nerve-specific MR contrast agents will likely play a major role in advancing this novel field and understanding peripheral neuromuscular diseases in the years to come.

Nonelderly patients presenting with knee pain often have patellofemoral maltracking or impingement abnormalities. There is a relative paucity of literature on the incidence and significance of impingement-related edema of the superolateral aspect of Hoffa's (infrapatellar) fat pad in these cases. Our study was designed to systematically evaluate the correlation of superolateral Hoffa's fat pad edema with various anatomic parameters of trochlear morphology and patellar alignment.We evaluated 50 knee MRI examinations in 47 patients for the presence of edema in superolateral Hoffa's fat pad and associated anatomic abnormalities of the patellofemoral joint.Of the 50 examinations, 25 (50%) showed superolateral Hoffa's fat pad edema, and statistically significant differences were seen between those with and without edema with respect to sex (6/22 men vs 19/28 women) and patellar tendon patellar-length ratio (1.3 ± 0.16 and 1.1 ± 0.12 for those with and without edema, respectively).The findings in our study suggest that edema in superolateral Hoffa's fat pad may be an important indicator of underlying patellofemoral maltracking or impingement in younger, symptomatic patients.