Materials and methods

This scoping review applied Arksey and O′Malley’s framework for scoping reviews, as modified by Levac et al. [18], [19] (see ¹). We adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines [20].

Search strategy

The search strategy was developed through discussion amongst the authors and consultation with an information specialist (university librarian). A search of PubMed, Cochrane, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science were searched from database inception through 10/05/2023. Boolean searches were performed with terms appertaining to “Brachial Plexus Injury” and “Magnetic Resonance Imaging”. No time limits were applied, and databases were searched for articles in English that focused on human subjects from inception to the date the search was performed (10/5/2023). These databases only host published articles, and do not contain any protected health information. Therefore, this study was exempt from IRB approval.

Study selection

After the database searches were completed, duplicates were removed and the remaining articles were independently screened by five reviewers (B.M., R.S., B.P., S.M., and D.R.S.). The review team performed the title, abstract and full-text level selection according to the inclusion and exclusion criteria listed below. All disagreements within the review team were resolved by three of the senior authors (A.C., A.M. and PS). Only original articles were included in this study. Inclusion criteria involved studies describing MRI protocols for the diagnosis of TEBPI. To identify these conditions, the studies had to include brachial plexus conditions caused by an external injury or entrapment that did not involve organic causes such as inflammation or tumors. MRI findings in inflammatory brachial plexus neuropathy are typically absent or discrete. Tumors on the other hand, were excluded because MRI protocols for tumor evaluation differ significantly from those for trauma. Tumor protocols prioritize contrast-enhanced sequences to visualize tumor morphology and its relationship to the brachial plexus, whereas trauma protocols emphasize MR neurography and typically do not involve contrast; this review aims to evaluate sequences specifically optimized for traumatic indications. Thus, the exclusion criteria included studies that do not focus on mechanical brachial injuries such as trauma or entrapment, or studies that do not use MRI as an imaging modality. These excluded studies were categorized as either “wrong study design”, “wrong intervention”, “wrong indication”, or “wrong patient population” in our selection process. Studies that included MRI in addition to other imaging modalities such as computed tomography (CT) or ultrasound were included. Studies concentrating on MRI imaging of the sequelae of brachial plexus injury, as well as those involving cadaveric models, were excluded. For example, one article that discussed neonatal brachial plexus injury but primarily focused on glenohumeral dysplasia was ultimately excluded during our selection process. Additionally, papers that were reviews, case reports, textbooks, letters to the editors, or written in a non-English language were also excluded from the study.

Data extraction

Data extraction strategy was developed by P.S. in consultation with the other authors. Extraction was performed similarly to study selection with two reviewers collecting data independently and any disagreements resolved in consultation with P.S. Data extraction was performed by B.M., R.S. and D.R.S. Data included publication date, magnetic field strength, patient age, two-dimensional (2D) fat-suppression techniques, three-dimensional (3D) MRI sequences used for brachial plexus imaging, and advanced MRI techniques. The 2D fat-suppression techniques included Dixon, short tau inversion recovery (STIR), chemical shift selective fat saturation (CHESS/Fat-Sat), spectral-spatial resonance frequency (SSRF), principle of selective excitation technique (Pro-SET), water excitation technique (WET), spectral presaturation with inversion recovery (SPIR), and spectral adiabatic inversion recovery (SPAIR). The 3D sequences included STIR with Sampling Perfection with Application-optimized Contrasts using different flip-angle Evolution (STIR SPACE), T2-weighted STIR SPACE, 3D STIR, 3D T2-weighted STIR, and Fast Imaging Employing Steady-state Acquisition (FIESTA). A complete extraction table summarizing these variables across all included studies is available in ¹. Although not fat suppression techniques themselves, these advanced imaging methods frequently incorporate fat suppression to enhance neural contrast and mitigate artifacts. Given their expanding role in brachial plexus imaging, we opted to extract data on these techniques to assess their utilization in conjunction with fat suppression and their integration into clinical and research workflows.

Footnotes

1. Supplementary data associated with this article can be found in the online version at doi:10.1016/j.ejro.2026.100809. ↩ ↩²