Visualizing nerve fibers surrounding a brachial plexus tumor using MR diffusion tensor imaging

A 25-year-old man developed a growing neck mass, and percutaneous biopsy yielded diagnosis of schwannoma. The patient underwent magnetic resonance (MR) neurography, including diffusion tensor imaging performed with RESOLVE at 3 tesla (Skyra; Siemens, Malvern, PA). Postprocessing and 3-dimensional tractography were performed in DSI studio (dsi-studio.labsolver.org).1 MR neurography confirmed a mass arising from the right C4 nerve (figure, A). Tractography localized a potential window for surgical approach in the surrounding nerve fibers (figure, B and C). Intraoperative electrophysiologic mapping and microscopy findings (figure, D-F) precisely confirmed the imaging findings. Diffusion tensor imaging and tractography may be valuable in the preoperative workup of peripheral nerve tumors.2,3