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Magnetic resonance imaging of the brachial plexus in patients with multifocal motor neuropathy

From the Departments of Radiology (Drs. Van Es, Witkamp, Ramos, and Feldberg), Neurology (Drs. Van den Berg, Notermans, and Wokke), and Clinical Neurophysiology (Dr. Franssen), University Hospital Utrecht, the Netherlands.

We studied whether magnetic resonance (MR) imaging of the brachial plexus is useful to distinguish multifocal motor neuropathy (MMN) from lower motor neuron disease (LMND) and whether abnormalities resemble those of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). We compared MR images of the brachial plexus of nine patients with MMN with scans from five patients with CIDP, eight patients with LMND, and 174 controls. In two patients with MMN, and in three patients with CIDP, the MR images showed an increased signal intensity on the T₂-weighted images of the brachial plexus. Two other patients with MMN demonstrated a more focal, increased signal intensity on the T₂-weighted images, occurring in one patient only in the axilla, and in the other patient in the axilla and in the ventral rami of the roots. MR images of the brachial plexus of eight patients with LMND were normal. The distribution of the MR imaging abnormalities corresponded with the distribution of symptoms of the patients: asymmetrical in MMN and symmetrical in CIDP. These findings demonstrate that MR imaging abnormalities of the brachial plexus in patients with MMN resemble those seen in CIDP and may be useful to distinguish MMN from LMND.

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