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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: Axial T1-weighted sequences are especially helpful as they allow a good differentiation between the nerve and the surrounding fat.The purpose of this article is to review the normal anatomy and pathologic conditions of the peroneal nerve around the knee.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

Large osteochondroma. Plain radiographs. Anteroposterior (a) and lateral view (b) demonstrate a large sessile osteochondroma (thick arrow) at the lateral aspect of the right tibia. There is obvious scalloping (arrow) and slight posterior displacement of the fibula, in keeping with a slow-growing lesion. Coronal fat-suppressed T2-WI (c) shows a hyperintense cartilage cap with partially mineralised hypointense cartilage and an intralesional cystic component (arrow). The maximum cartilage thickness is 16 mm. Axial T1-WI (d) shows the posterior displacement of the common peroneal nerve with a preserved fascicular structure (thick arrow)
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Fig15: Large osteochondroma. Plain radiographs. Anteroposterior (a) and lateral view (b) demonstrate a large sessile osteochondroma (thick arrow) at the lateral aspect of the right tibia. There is obvious scalloping (arrow) and slight posterior displacement of the fibula, in keeping with a slow-growing lesion. Coronal fat-suppressed T2-WI (c) shows a hyperintense cartilage cap with partially mineralised hypointense cartilage and an intralesional cystic component (arrow). The maximum cartilage thickness is 16 mm. Axial T1-WI (d) shows the posterior displacement of the common peroneal nerve with a preserved fascicular structure (thick arrow)

Mentions: On imaging a sessile and a pedunculated type can be differentiated. Bony structures can be evaluated on conventional X-rays, but MR imaging demonstrates a better extent of cortical and medullary continuity between the cartilaginous exostosis and the parent bone (Fig. 15). In cases of neurologic compromise the cartilaginous exostosis may exert a mass effect in the expected nerve location, but the nerve itself may be too small to discern. Signs of denervation in the dependent muscles strongly suggest neural compression or entrapment.Fig. 15


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)

Large osteochondroma. Plain radiographs. Anteroposterior (a) and lateral view (b) demonstrate a large sessile osteochondroma (thick arrow) at the lateral aspect of the right tibia. There is obvious scalloping (arrow) and slight posterior displacement of the fibula, in keeping with a slow-growing lesion. Coronal fat-suppressed T2-WI (c) shows a hyperintense cartilage cap with partially mineralised hypointense cartilage and an intralesional cystic component (arrow). The maximum cartilage thickness is 16 mm. Axial T1-WI (d) shows the posterior displacement of the common peroneal nerve with a preserved fascicular structure (thick arrow)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3675257&req=5

Fig15: Large osteochondroma. Plain radiographs. Anteroposterior (a) and lateral view (b) demonstrate a large sessile osteochondroma (thick arrow) at the lateral aspect of the right tibia. There is obvious scalloping (arrow) and slight posterior displacement of the fibula, in keeping with a slow-growing lesion. Coronal fat-suppressed T2-WI (c) shows a hyperintense cartilage cap with partially mineralised hypointense cartilage and an intralesional cystic component (arrow). The maximum cartilage thickness is 16 mm. Axial T1-WI (d) shows the posterior displacement of the common peroneal nerve with a preserved fascicular structure (thick arrow)
Mentions: On imaging a sessile and a pedunculated type can be differentiated. Bony structures can be evaluated on conventional X-rays, but MR imaging demonstrates a better extent of cortical and medullary continuity between the cartilaginous exostosis and the parent bone (Fig. 15). In cases of neurologic compromise the cartilaginous exostosis may exert a mass effect in the expected nerve location, but the nerve itself may be too small to discern. Signs of denervation in the dependent muscles strongly suggest neural compression or entrapment.Fig. 15

Bottom Line: Axial T1-weighted sequences are especially helpful as they allow a good differentiation between the nerve and the surrounding fat.The purpose of this article is to review the normal anatomy and pathologic conditions of the peroneal nerve around the knee.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