MR imaging and MR angiography in popliteal artery entrapment syndrome

Abstract

Popliteal artery entrapment (PAE) syndrome is an uncommon congenital anomaly seen in young adults causing ischemic symptoms in the lower extremities. It is the result of various types of anomalous relationships between the popliteal artery and the neighboring muscular structures. The purpose of this study was to define the role of MR imaging combined with MR angiography in the diagnosis of PAE cases. Four cases with segmental occlusion and medial displacement of popliteal artery in digital subtraction angiography (DSA) examinations were diagnosed as PAE syndrome by MR imaging and MR angiography. The DSA and MRA images are compared. All of the cases showed various degrees of abnormal intercondylar insertion of the medial head of the gastrocnemius muscle. The MR images showed detailed anatomy of the region revealing the cause of the arterial entrapment. Subclassification of the cases were done and fat tissue filling the normal localization of the muscle was evaluated. The DSA and MRA images demonstrated the length and localization of the occluded segment and collateral vascular developments equally. It is concluded that angiographic evaluation alone in PAE syndrome might result in overlooking the underlying cause of the arterial occlusion, which in turn leads to unsuccessful therapy procedures such as balloon angioplasty. Magnetic resonance imaging combined with MR angiography demonstrates both the vascular anatomy and the variations in the muscular structures in the popliteal fossa successfully, and this combination seems to be the most effective way of evaluating young adults with ischemic symptoms suggesting PAE syndrome.

Popliteal artery entrapment syndrome

“…Magnetic resonance imaging is reported as the diagnostic method of choice when there is clinical evidence or duplex Doppler imaging suggestive of PAES. 6 Recurrent external compression of the popliteal artery leads to mechanical damage to the vessel wall. This damage occurs in three distinct histological stages.…”

Vascular Arterial Compression Syndromes

“…CT angiography may reveal stenosis of the popliteal artery and, more importantly, may delineate the anatomy of adjacent structures in the popliteal fossa [43]. MRI most accurately enables the evaluation of popliteal fossa anatomy and entrapment of vessel without the need for an iodinated contrast agent or radiation exposure [44]. Transverse T1-weighted MRI sequences typically demonstrate deviation of the popliteal artery and the abnormal local anatomy of the popliteal fossa.…”

Arteries and Nerves

“…MR imaging combined with MR angiography is the ideal imaging method for diagnosing arterial compression. It enables to locate the arterial stenosis as well as the anatomical relations between the artery and the adjacent muscle [ 26 ]. It has been demonstrated that stress MR imaging can improve the diagnosis of popliteal entrapment syndrome [ 27 ].…”