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Peroneal nerve: Normal anatomy and pathologic findings on routine MRI of the knee.

Van den Bergh FR, Vanhoenacker FM, De Smet E, Huysse W, Verstraete KL - Insights Imaging (2013)

Bottom Line: On a routine MR examination without dedicated MR-neurography sequences the peroneal nerve can readily be assessed.Axial T1-weighted sequences are especially helpful as they allow a good differentiation between the nerve and the surrounding fat.In the second part we discuss the different pathologic conditions: accidental and surgical trauma, and intraneural and extraneural compressive lesions. • Six anatomical features contribute to the vulnerability of the peroneal nerve around the knee. • MR signs of muscle denervation within the anterior compartment are important secondary signs for evaluation of the peroneal nerve. • The most common lesions of the peroneal nerve are traumatic or compressive. • Intraneural ganglia originate from the proximal tibiofibular joint. • Axial T1-weighted images are the best sequence to visualise the peroneal nerve on routine MRI.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, AZ Sint-Maarten Duffel-Mechelen, campus Duffel, Rooienberg 25, 2570, Duffel, Belgium.

ABSTRACT

Background: Peroneal nerve lesions are not common and are often exclusively assessed clinically and electromyographically.

Methods: On a routine MR examination without dedicated MR-neurography sequences the peroneal nerve can readily be assessed. Axial T1-weighted sequences are especially helpful as they allow a good differentiation between the nerve and the surrounding fat.

Results: The purpose of this article is to review the normal anatomy and pathologic conditions of the peroneal nerve around the knee.

Conclusion: In the first part the variable anatomy of the peroneal nerve around the knee will be emphasized, followed by a discussion of the clinical findings of peroneal neuropathy and general MR signs of denervation. Six anatomical features may predispose to peroneal neuropathy: paucity of epineural tissue, biceps femoris tunnel, bifurcation level, superficial course around the fibula, fibular tunnel and finally the additional nerve branches. In the second part we discuss the different pathologic conditions: accidental and surgical trauma, and intraneural and extraneural compressive lesions.

Teaching points: • Six anatomical features contribute to the vulnerability of the peroneal nerve around the knee. • MR signs of muscle denervation within the anterior compartment are important secondary signs for evaluation of the peroneal nerve. • The most common lesions of the peroneal nerve are traumatic or compressive. • Intraneural ganglia originate from the proximal tibiofibular joint. • Axial T1-weighted images are the best sequence to visualise the peroneal nerve on routine MRI.

No MeSH data available.


Related in: MedlinePlus

a-c Schwannoma of the left common peroneal nerve. Coronal T1-WI (a) showing a spindle shaped lesion (arrow) in the common peroneal nerve at the level of the lateral femoral condyle, with a signal that is isointense to the surrounding muscle. The peroneal nerve is seen entering proximally and exiting distally (arrowheads). A split-fat sign is visualised around the lesion. Axial fat-suppressed T2-WI (b) shows a homogeneous hyperintense signal (arrow). Axial fat-suppressed T1-WI after IV administration of gadolinium contrast (c) shows almost no enhancement (arrow)
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Fig12: a-c Schwannoma of the left common peroneal nerve. Coronal T1-WI (a) showing a spindle shaped lesion (arrow) in the common peroneal nerve at the level of the lateral femoral condyle, with a signal that is isointense to the surrounding muscle. The peroneal nerve is seen entering proximally and exiting distally (arrowheads). A split-fat sign is visualised around the lesion. Axial fat-suppressed T2-WI (b) shows a homogeneous hyperintense signal (arrow). Axial fat-suppressed T1-WI after IV administration of gadolinium contrast (c) shows almost no enhancement (arrow)

Mentions: Schwannomas and neurofibromas cannot be definitely differentiated on imaging (Fig. 12). Typical imaging findings are a fusiform shape, the nerve entering proximally and exiting distally and a split-fat sign, representing the normal fat around a neurovascular bundle. A well-defined margin and the presence of the split-fat sign suggest benignity [39]. Some features that can aid in the differentiation are described in Table 1 [40].Fig. 12


Peroneal nerve: Normal anatomy and pathologic findings on routine MRI of the knee.

Van den Bergh FR, Vanhoenacker FM, De Smet E, Huysse W, Verstraete KL - Insights Imaging (2013)

a-c Schwannoma of the left common peroneal nerve. Coronal T1-WI (a) showing a spindle shaped lesion (arrow) in the common peroneal nerve at the level of the lateral femoral condyle, with a signal that is isointense to the surrounding muscle. The peroneal nerve is seen entering proximally and exiting distally (arrowheads). A split-fat sign is visualised around the lesion. Axial fat-suppressed T2-WI (b) shows a homogeneous hyperintense signal (arrow). Axial fat-suppressed T1-WI after IV administration of gadolinium contrast (c) shows almost no enhancement (arrow)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3675257&req=5

Fig12: a-c Schwannoma of the left common peroneal nerve. Coronal T1-WI (a) showing a spindle shaped lesion (arrow) in the common peroneal nerve at the level of the lateral femoral condyle, with a signal that is isointense to the surrounding muscle. The peroneal nerve is seen entering proximally and exiting distally (arrowheads). A split-fat sign is visualised around the lesion. Axial fat-suppressed T2-WI (b) shows a homogeneous hyperintense signal (arrow). Axial fat-suppressed T1-WI after IV administration of gadolinium contrast (c) shows almost no enhancement (arrow)
Mentions: Schwannomas and neurofibromas cannot be definitely differentiated on imaging (Fig. 12). Typical imaging findings are a fusiform shape, the nerve entering proximally and exiting distally and a split-fat sign, representing the normal fat around a neurovascular bundle. A well-defined margin and the presence of the split-fat sign suggest benignity [39]. Some features that can aid in the differentiation are described in Table 1 [40].Fig. 12

Bottom Line: On a routine MR examination without dedicated MR-neurography sequences the peroneal nerve can readily be assessed.Axial T1-weighted sequences are especially helpful as they allow a good differentiation between the nerve and the surrounding fat.In the second part we discuss the different pathologic conditions: accidental and surgical trauma, and intraneural and extraneural compressive lesions. • Six anatomical features contribute to the vulnerability of the peroneal nerve around the knee. • MR signs of muscle denervation within the anterior compartment are important secondary signs for evaluation of the peroneal nerve. • The most common lesions of the peroneal nerve are traumatic or compressive. • Intraneural ganglia originate from the proximal tibiofibular joint. • Axial T1-weighted images are the best sequence to visualise the peroneal nerve on routine MRI.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, AZ Sint-Maarten Duffel-Mechelen, campus Duffel, Rooienberg 25, 2570, Duffel, Belgium.

ABSTRACT

Background: Peroneal nerve lesions are not common and are often exclusively assessed clinically and electromyographically.

Methods: On a routine MR examination without dedicated MR-neurography sequences the peroneal nerve can readily be assessed. Axial T1-weighted sequences are especially helpful as they allow a good differentiation between the nerve and the surrounding fat.

Results: The purpose of this article is to review the normal anatomy and pathologic conditions of the peroneal nerve around the knee.

Conclusion: In the first part the variable anatomy of the peroneal nerve around the knee will be emphasized, followed by a discussion of the clinical findings of peroneal neuropathy and general MR signs of denervation. Six anatomical features may predispose to peroneal neuropathy: paucity of epineural tissue, biceps femoris tunnel, bifurcation level, superficial course around the fibula, fibular tunnel and finally the additional nerve branches. In the second part we discuss the different pathologic conditions: accidental and surgical trauma, and intraneural and extraneural compressive lesions.

Teaching points: • Six anatomical features contribute to the vulnerability of the peroneal nerve around the knee. • MR signs of muscle denervation within the anterior compartment are important secondary signs for evaluation of the peroneal nerve. • The most common lesions of the peroneal nerve are traumatic or compressive. • Intraneural ganglia originate from the proximal tibiofibular joint. • Axial T1-weighted images are the best sequence to visualise the peroneal nerve on routine MRI.

No MeSH data available.


Related in: MedlinePlus