{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T11:04:00Z","timestamp":1784113440447,"version":"3.55.0"},"reference-count":14,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Anatomy"],"abstract":"ABSTRACT<\/jats:title>\n \n Thoracic outlet syndrome (TOS) is a complex condition caused by the compression of the neurovascular bundle within the thoracic outlet. This study aims to characterize the physiological degree of vascular compression on the asymptomatic side in patients with unilateral TOS using dynamic MRI, establish normative reference ranges for vascular narrowing in stress position, and evaluate the influence of body mass index (BMI) on compression severity. In this retrospective study, 114 patients were screened and 57 patients with clinically diagnosed unilateral TOS were included (mean age 35.5 13.5\u2009years; 72% female). The asymptomatic side was required to remain symptom\u2010free for at least 6\u2009months following MRI to ensure that the asymptomatic side represented a true physiological baseline. Subclavian artery and vein compression and costoclavicular distance (CCD) were measured in neutral and stress positions. Intra\u2010observer reliability was assessed with a 6\u2010month washout period. BMI was categorized according to the World Health Organization criteria. In the stress position, median venous compression on the asymptomatic side was 64.3% (IQR 52.5\u201374.5), with 75% of patients exhibiting >\u200950% stenosis. CCD decreased significantly in the stress position (\n p<\/jats:italic>\n \u2009<\u20090.001) and differed significantly across BMI groups (\n p<\/jats:italic>\n \u2009<\u20090.001), with the greatest reduction observed in the obese group. Arterial compression also differed significantly across BMI groups (\n p<\/jats:italic>\n \u2009=\u20090.004), with the overweight group demonstrating a greater degree of compression compared with the combined normal and underweight group and the obese group (both\n p<\/jats:italic>\n \u2009=\u20090.015). No significant differences in venous compression were observed across BMI groups (\n p<\/jats:italic>\n \u2009=\u20090.245). Intra\u2010observer reliability was excellent, with Intraclass Correlation Coefficients of 0.88 for vascular stenosis and 0.91 for CCD. Significant venous compression is a common physiological finding in asymptomatic individuals in the stress position. These results suggest that imaging evidence of narrowing should not be used as the sole criterion for the diagnosis of TOS. BMI influences arterial compression and costoclavicular narrowing, highlighting the importance of considering patient\u2010specific factors when interpreting dynamic imaging. Establishing standardized reference ranges for dynamic imaging and accounting for clinical context such as BMI may improve diagnostic accuracy and reduce overdiagnosis.\n <\/jats:p>","DOI":"10.1002\/ca.70194","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T10:10:58Z","timestamp":1784110258000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Magnetic Resonance Imaging Investigation Into the Dynamic Changes of the Thoracic Outlet: Normal Reference Range of Thoracic Outlet Vascular Compression in Patients With Unilateral Thoracic Outlet Syndrome"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2307-7014","authenticated-orcid":false,"given":"Seo\u2010Ho","family":"Cho","sequence":"first","affiliation":[{"name":"Biomedical Research Imaging Center University of North Carolina at Chapel Hill Chapel Hill North Carolina USA"},{"name":"General Medicine Semmelweis University Budapest Hungary"},{"name":"Department of Dermatology, Venereology and Dermatooncology Semmelweis University Budapest Hungary"},{"name":"Department of Physiology Semmelweis University Budapest Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6288-3556","authenticated-orcid":false,"given":"Sheng\u2010Che","family":"Hung","sequence":"additional","affiliation":[{"name":"Biomedical Research Imaging Center University of North Carolina at Chapel Hill Chapel Hill North Carolina USA"},{"name":"Division of Neuroradiology, Department of Radiology University of North Carolina School of Medicine Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1007\/s00256-012-1485-3","article-title":"MRI Findings in Thoracic Outlet Syndrome","volume":"41","author":"Aralasmak A.","year":"2012","journal-title":"Skeletal Radiology"},{"key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1016\/j.avsg.2014.05.003","article-title":"Physiologic Variations in Venous and Arterial Hemodynamics in Response to Postural Changes at the Thoracic Outlet in Normal Volunteers","volume":"28","author":"Chen H.","year":"2014","journal-title":"Annals of Vascular Surgery"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1148\/radiol.2272012111","article-title":"Thoracic Outlet: Assessment With MR Imaging in Asymptomatic and Symptomatic Populations","volume":"227","author":"Demondion X.","year":"2003","journal-title":"Radiology"},{"key":"e_1_2_9_5_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0268842","article-title":"Combined Nerve and Vascular Ultrasound in Thoracic Outlet Syndrome: A Sensitive Method in Identifying the Site of Neurovascular Compression","volume":"17","author":"Dollinger P.","year":"2022","journal-title":"PLoS One"},{"key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.2214\/AJR.11.6417","article-title":"Vascular Thoracic Outlet Syndrome: Protocol Design and Diagnostic Value of Contrast\u2010Enhanced 3D MR Angiography and Equilibrium Phase Imaging on 1.5\u2010 and 3\u2010T MRI Scanners","volume":"198","author":"Ersoy H.","year":"2012","journal-title":"AJR. American Journal of Roentgenology"},{"issue":"2","key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.jcct.2017.11.008","article-title":"Dynamic CT Angiography for the Diagnosis of Patients With Thoracic Outlet Syndrome: Correlation With Patient Symptoms","volume":"12","author":"Gillet R.","year":"2018","journal-title":"Journal of Cardiovascular Computed Tomography"},{"key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"e23","DOI":"10.1016\/j.jvs.2016.04.039","article-title":"Reporting Standards of the Society for Vascular Surgery for Thoracic Outlet Syndrome","volume":"64","author":"Illig K. A.","year":"2016","journal-title":"Journal of Vascular Surgery"},{"key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s40122-019-0124-2","article-title":"Thoracic Outlet Syndrome: A Comprehensive Review of Pathophysiology, Diagnosis, and Treatment","volume":"8","author":"Jones M. R.","year":"2019","journal-title":"Pain and Therapy"},{"key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"623","DOI":"10.2214\/ajr.158.3.1739007","article-title":"Thoracic Outlet Syndrome: Evaluation of the Subclavian Vessels by Color Duplex Sonography","volume":"158","author":"Longley D. G.","year":"1992","journal-title":"AJR. American Journal of Roentgenology"},{"key":"e_1_2_9_11_1","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1016\/S0741-5214(97)70090-9","article-title":"Helical Computed Tomography of the Normal Thoracic Outlet","volume":"26","author":"Matsumura J. S.","year":"1997","journal-title":"Journal of Vascular Surgery"},{"key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.jacr.2015.01.016","article-title":"ACR Appropriateness Criteria Imaging in the Diagnosis of Thoracic Outlet Syndrome","volume":"12","author":"Moriarty J. M.","year":"2015","journal-title":"Journal of the American College of Radiology"},{"key":"e_1_2_9_13_1","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1148\/rg.2016150221","article-title":"Imaging of the Patient With Thoracic Outlet Syndrome","volume":"36","author":"Raptis C. A.","year":"2016","journal-title":"Radiographics"},{"key":"e_1_2_9_14_1","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/j.ejvs.2025.07.019","article-title":"Quantitative Computed Tomography and Magnetic Resonance Assessment of Vascular Compression in the Thoracic Outlet","volume":"70","author":"Schropp L.","year":"2025","journal-title":"European Journal of Vascular and Endovascular Surgery"},{"key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"S323","DOI":"10.1016\/j.jacr.2020.01.029","article-title":"ACR Appropriateness Criteria Thoracic Outlet Syndrome","volume":"17","author":"Zurkiya O.","year":"2020","journal-title":"Journal of the American College of Radiology"}],"container-title":["Clinical Anatomy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ca.70194","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ca.70194","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ca.70194","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T10:11:00Z","timestamp":1784110260000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ca.70194"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":14,"alternative-id":["10.1002\/ca.70194"],"URL":"https:\/\/doi.org\/10.1002\/ca.70194","archive":["Portico"],"relation":{},"ISSN":["0897-3806","1098-2353"],"issn-type":[{"value":"0897-3806","type":"print"},{"value":"1098-2353","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]},"assertion":[{"value":"2026-04-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ca.70194"}}