{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T18:54:27Z","timestamp":1783018467589,"version":"3.54.6"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Objective<\/jats:title>\n The objective of this scoping review is to systematically map the extent and nature of the literature on the use of imaging for assessing cervicothoracic junction anatomical variation in patients with neurogenic thoracic outlet syndrome.<\/jats:p>\n <\/jats:sec>\n \n Introduction<\/jats:title>\n Neurogenic thoracic outlet syndrome is a complex, disputed diagnosis that lacks a definitive gold-standard test, despite being the most common thoracic outlet syndrome subtype. Imaging is essential for identifying anatomical variations, such as cervical ribs, and excluding competing diagnoses. This review aims to clarify how imaging modalities are utilized to describe, classify, and assess these anatomical variations, and how these findings are explicitly linked to diagnosis or management.<\/jats:p>\n <\/jats:sec>\n \n Selection criteria<\/jats:title>\n This review will consider studies that include patients with neurogenic thoracic outlet syndrome and evaluate the role of imaging in assessing anatomical variations at the cervicothoracic junction. All study designs, including reviews, quantitative, and descriptive studies, will be considered. This review will exclude studies where the primary focus is the diagnosis of arterial or venous thoracic outlet syndrome using vascular imaging modalities.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The search strategy will employ a three-step process, developed in consultation with a medical librarian, utilizing a final comprehensive search across multiple major databases (e.g., MEDLINE, CINAHL, Embase, Scopus) and gray literature sources. Studies published in the English language and from database inception will be included. Following screening by two independent reviewers, data will be extracted, synthesized descriptively, and presented in tabular and narrative format to map the identified evidence.<\/jats:p>\n <\/jats:sec>\n \n Review Registration<\/jats:title>\n \n Open Science Framework\n https:\/\/osf.io\/hybg2<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0352667","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T17:47:00Z","timestamp":1783014420000},"page":"e0352667","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Imaging of cervicothoracic junction anatomical variation in neurogenic thoracic outlet syndrome: A scoping review protocol"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2350-5322","authenticated-orcid":true,"given":"Hugo O.H.","family":"Beaumont","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2210-4874","authenticated-orcid":true,"given":"George","family":"Slade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazel","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom J.","family":"Quick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"pone.0352667.ref001","volume-title":"Thoracic Outlet Syndrome","author":"J Kaplan","year":"2025"},{"issue":"11","key":"pone.0352667.ref002","doi-asserted-by":"crossref","DOI":"10.1016\/j.jse.2022.06.026","article-title":"Thoracic outlet syndrome: a review","volume":"31","author":"EJ Panther","year":"2022","journal-title":"J Shoulder Elbow Surg"},{"issue":"4","key":"pone.0352667.ref003","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1016\/j.jvs.2019.12.037","article-title":"Differences in quality of life outcomes after paraclavicular decompression for thoracic outlet syndrome","volume":"72","author":"Z Al Rstum","year":"2020","journal-title":"J Vasc Surg"},{"key":"pone.0352667.ref004","first-page":"19861","article-title":"Exostosis of the left transverse process of the seventh cervical vertebra, surrounded by blood vessels and nerves; successful removal","volume":"1","author":"H Coote","year":"1861","journal-title":"Lancet"},{"issue":"8","key":"pone.0352667.ref005","article-title":"Consensus recommendations for neurogenic thoracic outlet syndrome from the INTOS Workgroup","volume":"12","author":"H Chim","year":"2024","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"1","key":"pone.0352667.ref006","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":"MR Jones","year":"2019","journal-title":"Pain Ther"},{"issue":"3","key":"pone.0352667.ref007","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.jvs.2007.04.050","article-title":"Diagnosis of thoracic outlet syndrome","volume":"46","author":"RJ Sanders","year":"2007","journal-title":"J Vasc Surg"},{"key":"pone.0352667.ref008","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.aanat.2016.03.011","article-title":"Anatomical variations in the brachial plexus roots: implications for diagnosis of neurogenic thoracic outlet syndrome","volume":"206","author":"V Leonhard","year":"2016","journal-title":"Ann Anat"},{"key":"pone.0352667.ref009","doi-asserted-by":"crossref","DOI":"10.1016\/j.otsm.2021.150806","article-title":"Thoracic Outlet Syndrome","volume":"29","author":"GJ Pearl","year":"2021","journal-title":"Operative Techniques in Sports Medicine"},{"issue":"6","key":"pone.0352667.ref010","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1002\/mus.23235","article-title":"The thoracic outlet syndromes","volume":"45","author":"MA Ferrante","year":"2012","journal-title":"Muscle Nerve"},{"key":"pone.0352667.ref011","doi-asserted-by":"crossref","first-page":"3085","DOI":"10.2147\/JPR.S282578","article-title":"Evaluation and Management of Neurogenic Thoracic Outlet Syndrome with an Overview of Surgical Approaches: A Comprehensive Review","volume":"14","author":"C Lim","year":"2021","journal-title":"J Pain Res"},{"key":"pone.0352667.ref012","article-title":"Diagnostic accuracy of scalene and pectoralis minor muscle blocks for thoracic outlet syndrome: A systematic review and meta-analysis","author":"KH Nagarsheth","year":"2025","journal-title":"The American SurgeonTM"},{"issue":"9","key":"pone.0352667.ref013","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.3390\/diagnostics13091625","article-title":"General Overview and Diagnostic (Imaging) Techniques for Neurogenic Thoracic Outlet Syndrome","volume":"13","author":"SBJ Teijink","year":"2023","journal-title":"Diagnostics (Basel)"},{"key":"pone.0352667.ref014","first-page":"673020","article-title":"Early versus Late Surgical Treatment for Neurogenic Thoracic Outlet Syndrome","volume":"2013","author":"JY Al-Hashel","year":"2013","journal-title":"ISRN Neurol"},{"key":"pone.0352667.ref015","doi-asserted-by":"crossref","DOI":"10.1016\/j.wneu.2017.11.148","article-title":"Cervical Rib Prevalence and its Association with Thoracic Outlet Syndrome: A Meta-Analysis of 141 Studies with Surgical Considerations","volume":"110","author":"BM Henry","year":"2018","journal-title":"World Neurosurg"},{"issue":"1","key":"pone.0352667.ref016","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1067\/mva.2002.123750","article-title":"Management of cervical ribs and anomalous first ribs causing neurogenic thoracic outlet syndrome","volume":"36","author":"RJ Sanders","year":"2002","journal-title":"J Vasc Surg"},{"key":"pone.0352667.ref017","doi-asserted-by":"crossref","first-page":"19","DOI":"10.5758\/vsi.240011","article-title":"Predisposing Anatomy for Thoracic Outlet Syndrome and Functional Outcomes after Supraclavicular Thoracic Outlet Decompression in Athletes","volume":"40","author":"D Jiang","year":"2024","journal-title":"Vasc Specialist Int"},{"issue":"4","key":"pone.0352667.ref018","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1016\/j.avsg.2013.08.014","article-title":"Relevance of bone anomalies in patients with thoracic outlet syndrome","volume":"28","author":"AE Weber","year":"2014","journal-title":"Ann Vasc Surg"},{"issue":"8","key":"pone.0352667.ref019","doi-asserted-by":"crossref","DOI":"10.3171\/CASE23474","article-title":"Minimally invasive resection of a prominent transverse process in neurogenic thoracic outlet syndrome: new application for a primarily spinal approach. 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