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1.5T Peripheral nerve study, lower legs - Istanbul, Turkey

ExamCard
Baskan, Ozdil, M.D. Istanbul, Sonomed Imaging Center Turkey

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ExamCard purpose

This ExamCard, for release 11.1.2.1, has been created to specifically view nerves of the lower legs. It is one of a series of ExamCards that have been created by the Sonomed Imaging Center to generate high resolution images in both the longitudinal and cross sectional planes of major peripheral nerves.

ExamCard overview

 

The ExamCard is used in combination with the Quadrature Knee/Foot coil (scans 1-9) and the Microscopy 47mm coil (scans 10-16). Scans 2-4 are used for localization.

For instructions on the use of the 3-points Planscan technique please refer to the Application Guide Volume 3.

 

Note: help text found in the ExamCard may not reflect the latest optimizations.

Clinical case

A 29-year-old female presented with bilateral drop foot after a weight loss of 35 kg, in a period of 6 months, due to following a strict diet. The patient underwent a bilateral knee examination with each knee being scanned on seperate occasions.

Images of the right knee:

Axial T1W TSE Performed with the Quadrature Knee/Foot coil.<br>
Slice thickness 3 mm.Axial ProSet Performed with the Quadrature Knee/Foot coil.<br>
Slice thickness 2 mm.
Axial T1W TSE
Axial ProSet
Performed with the Quadrature Knee/Foot coil.
Slice thickness 3 mm.
Performed with the Quadrature Knee/Foot coil.
Slice thickness 2 mm.
Axial T2W TSE SPIR Performed with the Quadrature Knee/Foot coil.<br>
Slice thickness 3 mm.
Axial T2W TSE SPIR
Performed with the Quadrature Knee/Foot coil.
Slice thickness 3 mm.
Sagittal/oblique ProSet Performed with the Microscopy 47 mm coil and the 3PPS technique.<br>
Acquired slice thickness 2 mm overcontiguous<br>
Reconstructed slice thickness 1 mm.Sagittal/oblique T2W TSE SPIR Performed with the Microscopy 47 mm coil and the 3PPS technique.<br>
Slice thickness 1.5 mm.
Sagittal/oblique ProSet
Sagittal/oblique T2W TSE SPIR
Performed with the Microscopy 47 mm coil and the 3PPS technique.
Acquired slice thickness 2 mm overcontiguous
Reconstructed slice thickness 1 mm.
Performed with the Microscopy 47 mm coil and the 3PPS technique.
Slice thickness 1.5 mm.
Note: Click on the images to enlarge them.

 

In the right knee the motor strength was measured to be 3/5.

 

The axial T2W TSE SPIR images show the peroneal nerve to have an abnormal hyperintense signal from the fibular head to the fibular tunnel (green arrows). However the proximal segment of the peroneal nerve is normal (white arrows). In the anterior tibialis muscle an increased signal is detected, which is secondary to the denervation (red arrows).

 

The sagittal/oblique ProSet images demonstrate a normal proximal segment of the peroneal nerve (red arrow). However from the fibular head to the fibular tunnel the peroneal nerve shows an abnormal hyperintense signal (white arrows).

 

The sagittal/oblique T2W TSE SPIR images also demonstrate an abnormal hyperintense signal of the peroneal nerve from the fibular head to the fibular tunnel (white arrows), as well as an increased signal in the anterior tibialis muscle, which is secondary to the denervation (green arrows).

Images of the left knee:

Axial T1W TSE Performed with the Quadrature Knee/Foot coil.<br>
Slice thickness 3 mm<br>Axial ProSet Performed with the Quadrature Knee/Foot coil.<br>
Slice thickness 2 mm<br>
Axial T1W TSE
Axial ProSet
Performed with the Quadrature Knee/Foot coil.
Slice thickness 3 mm
Performed with the Quadrature Knee/Foot coil.
Slice thickness 2 mm
Coronal/oblique T1W TSE Performed with the Quadrature Knee/Foot coil using the 3PPS technique.<br>
Slice thickness 2 mm.<br>Coronal/oblique ProSet Performed with the Quadrature Knee/Foot coil using the 3PPS technique.<br>
Slice thickness 2 mm.
Coronal/oblique T1W TSE
Coronal/oblique ProSet
Performed with the Quadrature Knee/Foot coil using the 3PPS technique.
Slice thickness 2 mm.
Performed with the Quadrature Knee/Foot coil using the 3PPS technique.
Slice thickness 2 mm.
Axial T2W TSE SPIR Performed with the Quadrature Knee/Foot coil.<br>
Slice thickness 3 mm
Axial T2W TSE SPIR
Performed with the Quadrature Knee/Foot coil.
Slice thickness 3 mm
Coronal/oblique T2W TSE Performed with the Microscopy 47 mm coil and the 3PPS technique.<br>
Slice thickness 1 mm.Coronal/oblique ProSet Performed with the Microscopy 47 mm coil and the 3PPS technique.<br>
Slice thickness 1 mm.
Coronal/oblique T2W TSE
Coronal/oblique ProSet
Performed with the Microscopy 47 mm coil and the 3PPS technique.
Slice thickness 1 mm.
Performed with the Microscopy 47 mm coil and the 3PPS technique.
Slice thickness 1 mm.
Note: Click on the images to enlarge them.

 

On the images the green arrows indicate the peroneal nerve. The axial T2W TSE SPIR images of the left knee demonstrate a minimal, but abnormal, increased signal in the peroneal nerve from the fibular head to the fibular tunnel (green arrows). The abnormal segment is also shorter when compared with the right knee. However there are no abnormal signals detected in the muscles.

Conclusion:

It was concluded from the MRI studies that the patient was suffering from bilateral peroneal compartment syndrome.

 

 

Related information:



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ExamCard
Intera 1.5T
Release 11
Explorer / Nova Dual, Master / Nova, Omni / Stellar, Power / Pulsar
Neuro, Peripheral nerves
 

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