Transcript Popliteal Lab

Axial
Coronal
These are T1 weighted MRI images through the lower
thigh, note the coronal reference image and the
corresponding axial image
These are the quadriceps
Can you identify the muscle group
muscles, what 4 muscles make up
marked by the arrows?
this group and what is the only
Vastus medialis, lateralis and intermedius one of this groups that crosses 2
and the rectus femoris (rectus crosses
joints?
knee & hip joints)
What is the structure in the
center of the muscle? (dark on
outside bright in the center)
This is the femur, so why
is it dark on the outside
and bright on the inside?
Cortical bone, black signal, is very
densely packed and generates almost no
signal on MRI. The marrow space is filled
with fat and marrow producing elements
and is similar signal to the rest of the fat
on MRI images.
Add mag
N
Hamstrings
What is this vascular structure in the
medial aspect of the thigh?
Femoral artery
What muscle overlies the
femoral artery in the thigh?
Sartorius Muscle
What nerve lies between the
adductor magnus and the
hamstrings?
Sciatic nerve
This axial slice is a little lower
down. Can you name the
vascular structures posterior
to the femur?
These are the popliteal
artery and vein.
What are the nerves just lateral
and posterior to the vessels?
Tibial nerve (solid arrow)
Common peroneal nerve (dashed arrow)
Why does the femur have
less black (cortex) and more
medullary space (marrow
fat) down close to the knee
joint?
This is because we have left the
diaphysis and are now in the
metaphysis where there is more
marrow and cortex is thinner.
Look at the
cortical
thickness
Let’s name some
muscles. Can you point
out the vastus medialis?
Sartorius
Semimembranosis
Semitendinosis, just
a tendon at this level
Gracilis, it is just a tendon here
Biceps femoris
These are some more inferior
images of the knee, other side
(left) from the previous patient.
Can you follow the popliteal
artery and vein and note their
relationship to the nerves (tibial
and peroneal together at this
level).
A
V
N
Can you identify the bone
anterior to the femur.
This is the patella.
Note that the peroneal
nerve is starting to head
lateral at this level
Note how the muscles change
around the knee. The
semitendinosis and the gracilis
are just tendons (black dots) at
this level.
Semitendinosis
Gracilis
Look at the superficial
peroneal nerve at the level.
Where is it heading?
Why don’t we see any bones on
this image?
Because we are at the level
of the knee joint
We are now below the level of
the knee joint. What bone are
we looking at?
This is the tibia. Where is
the fibula?
B
What is this black structure
attaching to the tibial tubercle?
This is the patellar tendon.
Do you see the fibula
now?
What are the muscles you see
in the upper calf posteriorly?
Medial and lateral
gastocnemius muscles.
This is the solues
muscle
Popliteus
On this CT angiogram can you identify the
popliteal artery, take-off of the anterior tibial
artery, peroneal artery and posterior tibial
artery?
Popliteal arteries
Anterior tibial arteries
Peroneal arteries
Posterior tibial arteries
This is a patient with complete
disruption of the distal superficial
femoral artery/upper popliteal artery.
You can see how it is reconsitiuted
(through collaterals) at the level of the
knee joint.
Disrupted
Reconstituted