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Predictive Value Of MRI-Based Interscalene Measurements On Resolution Of Symptoms In Neurogenic Thoracic Outlet Syndrome
Meryl Pearl D. Franco, BS, Joshua K. DeYoung, BS, Aneeq S. Chaudhry, BA, Kazimir Bagdady, BS, Courtney Li, BS, Matthew D. Ramsey, MD, Gregory A. Dumanian, MD, Jason H. Ko, MD, Lindsay E. Janes, MD.
Northwestern University, Chicago, IL, USA.
Purpose: Neurogenic thoracic outlet syndrome (nTOS) comprises approximately 90% of TOS cases and lacks definitive, objective diagnostic criteria. This study aims to investigate the utility of specific MRI measurements of thoracic outlet in predicting resolution of nTOS symptoms following decompression surgery.
Methods: A retrospective review of patients undergoing nTOS decompression surgery between 2017 and 2024 was performed. Preoperative MRIs were used to measure interscalene angle, anterior scalene width, and interscalene space volume. Pre- and post-operative symptoms were collected and analyzed against these anatomical measurements.
Results: Forty nTOS patients (24 females, 16 males, average age 42 ± 14 years) were included. Table 1 provides average interscalene measurements on MRI. No preoperative MRI measurement was a statistically significant predictor of postoperative symptom resolution for the cohort as a whole. A non-significant trend suggested smaller interscalene angles were associated with better outcomes. Notably, a median split analysis based on interscalene volume revealed two anatomically distinct subgroups, demonstrated by a large effect size (Cohen’s d > 3.0). This indicates substantial baseline anatomical differences within the nTOS population.
Conclusions: While static MRI measurements did not directly predict postoperative success in this cohort, they effectively stratified patients into distinct anatomical groups based on interscalene volume. Larger, adequately powered studies are needed to determine the predictive significance of the trend observed with the scalene angle.
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