 Thank you everyone. I will be presenting on MR Neurography approach to Traumatic Brachial Plexus Pathology. MR Neurography is a non-vasive imaging technique for dedicated assessment of peripheral nerves. Thin-section high resolution sequences are performed that are dedicated to optimally increase the complexity of nerve tissue signals. Being able to view the nerves help the physician to localize the site of nerve injury and diagnose the underlying etiology. They are typically high-tituated sequences along the high signal nerve to stand out from the darker fat suppressed background of tissue. MR Neurography can image nerves anywhere in the body. It is most commonly used in the diagnosis of abnormalities of the brachial plexus, lumbosacral plexus, thoracic outlet and the shating nerves. Now coming on to the imaging of the brachial plexus. Brachial pyxopathy is traumatic and non-traumatic often present with vague symptoms. Clinical examination and electrophysiological studies are useful but they may not localize the lesion accurately. MR Neurography, with its multi-generated imaging capability and soft tissue contrast resolution plays an important role in evaluation of the abnormal brachial plexus. The aims and objectives are to study the normal brachial plexus anatomy to evaluate the role of MR Neurography in diagnosis and characterization of traumatic brachial plexus lesion. Imaging technique. Patients are imaged in the supine position with arms at the sides using both cervical and body coils. A combination of various sequences in different planes is used for optimal assessment of the plexus. These comprise both 2D and 3D sequences like axial T1, axial T2 fat suppress, coronal T1, stress sequences space, sagittal stress and sagittal 3D T2 space sequences. Scan area extends from C3 to T3 level. The T1 weighted images dilate the anatomy. The T2 weighted images reveal the signal abnormalities within the brachial plexus. Sture images provide uniform and reliable fat suppression. IV gadolinium is administered in patients with tumor or mass lesion and is generally not administered in patients with traumatic brachial plexus lesions. In patients with traumatic injury, in addition to the previous described protocols, sagittal T2 weighted images are obtained through the cervical spines followed by axial T2 weighted images from C4 to T2 lesion levels. In addition, a 3D gradient eco sequence, GRE, 3D GRE sequence with thin slices obtained to look for the nerve root of the organ. Coming on to the normal anatomy. An artificial assessment of the brachial plexus starts with evaluating the spine, spinal cord and the roots of the spinal nerves. Within the canal, the ventral and dorsal nerve roots exit the spinal cord laterally. The ventral root carries the motor fibres, while the dorsal root carries the sensory fibres. The ventral and dorsal roots course into the neural foramine where they merge to form the spinal nerve. Disturbing the neural foramine, the spinal nerves divide into the ventral and dorsal remi. The brachial plexus is formed as a ventral remi or the spinal nerves of the C5 to T1. The ventral remi are also known as the roots of the brachial plexus. Now, this is the coronal T2 star image showing the roots of the brachial plexus. We can identify the T1 nerve root by its passing inferior to the first rib. The C8 nerve root passes above it. Above it is the C7, C6 and the C5 nerve root. The roots of the brachial plexus course between the anterior and middle scaling muscle adjacent to the subclavian artery. The C5 and C6 combine to form the upper trunk, C7 continue as the middle trunk, and the C8 and T1 join to form the lower trunk. At the lateral-bottom scaling triangle, each trunk is divided into anterior-posture division. The medial cord is formed as prolongation of the anterior division. The lateral cord is formed by the anterior division of the middle and upper trunk, and all the posterior divisions form the posterior cord. The medial and lateral cords course anterior to the subclavian artery, and posterior cord passes posterior to it. The cords run posterior to these pectoralis minor muscle and subsequently give them the terminal branches. The roots and the trunks are supraclavicular in location, while division are retoclavicular, and the cords are infraclavicular. The roots extend from the neural foramin to the edge of the scaling triangle. From the edge of the scaling triangle, we have the trunks. From scaling triangle to mid-clavicle level, we have the divisions. From the mid-clavicular segment to the anterior cord occurred process, we have the cords, and after that, we have the branches. This is a gyraltituated image showing the anterior and the middle scaling muscle with the trunks of the brachial plexus and the subclavian artery. Now, coming on to the pathologies. The traumatic pathologies can be divided into stretch injuries, which are neuropraxia, pseudo-meningo shields, and the root emergence. The common cause of brachial plexus injuries are road traffic accidents and birth palsy. The two most common clinical syndromes are upper brachial plexus palsy, that is, the earth's palsy, and the lower brachial plexus, that is, the clumpkey's palsy. The upper C5 to C7 routes are more susceptible to post-ganglionic injury, whereas the lower C8 T1 routes more commonly manifest with pre-ganglionic injury. Pre-ganglionic injury A pre-ganglionic injury usually consists of an evulsion of the nerve root from the spinal cord. A diagnosis of root evulsion is important because it directly affects treatment and pertains to a worsened prognosis. MRI may show discontinuities of the ventral or dorsal nerve root from the spinal cord as a direct sign of root evulsion. Pseudomaningocies These are formed due to extravisation of CSF fluid through tear of the perineural sheet. They are seen on T2 weighted images as fluid signal intensity lesion at the site of nerve root evulsion. Other sites of pre-ganglionic injury include the spinal cord edema near the level of the root evulsion. Now these are oblique sagittal and axial T2 weighted images which reveal the pseudo meningo seals at site of left C7 and C8 nerve root evulsion. Post-ganglionic injury Chromatic brachial pyxopathies may manifest as a focal caliber change of the nerve trunk, loss of fascicular architecture, nerve trunk, or fascicular discontinuity. Neuromore formation, perineural scarring, or nerve signal intensity abnormality at MRI. Neuropaxic injuries are seen at T2 hyperintense signal in the root, strengths, or cords with or without enlargement. Nerve rupture are seen at discontinuity in the neural structure. Associated findings of denervation edema in the muscle may also be seen. Now this is a coronal ster image which reveals swollen hyperintense divisions and cords of left trawicle plexus, suggesting of a post-ganglionic neurotaxic injury. Again, another coronal ster and sagittal T2 weighted images showing the nerve rupture with fluid collection around the retracted nerve, suggesting of a post-ganglionic injury. Sagittal T1 and star images showing post-ganglionic injury with fibrosis, encasing the cords of left brachial plexus. There is also denervation edema in the supran and interferospinalis muscles seen as ill-defined hyperintense signal on ster images. Brachial plexus injury may be associated with injuries subclavian artery due to their anatomical proximity to each other. Also, post-traumatic pseudoanalysis of subclavian artery may present with delayed brachial plexus paralysis due to compression of the brachial plexus. Now, these are coronal T1 and ster images which reveals post-traumatic pseudoanalysis of right subclavian artery causing compression of adhesin tribrachial plexus. The pre-ganglionic and post-ganglionic lesions. The pre-ganglionic lesions are generally aversion of the nerve roots at their origin and post-ganglionic lesions may be lesions in continuity or nerve rupture. Pre-ganglionic lesions are usually treated with nerve transfer to restore function of the denervation edema muscles. Post-ganglionic lesions in continuity without disruption of nerve fibers have good prognosis and recover spontaneously with conservative management. Post-ganglionic lesions with disruption of nerve fibers are treated with surgical repair that is nerve grafting with good results. Conclusion. To summarize, knowledge of the anatomy and proper planning of the scan are essential for complete evaluation of brachial plexus. Various traumatic pathologies affecting it can be optimally evaluated by MR neurology. Now these are the differences. Thank you.