Recht Michael P, Grooff Paul, Ilaslan Hakan, Recht Hannah S, Sferra James, Donley Brian G
Division of Radiology, A-21, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195, USA.
AJR Am J Roentgenol. 2007 Sep;189(3):W123-7. doi: 10.2214/AJR.07.2229.
Entrapment of the first branch of the lateral plantar nerve is a well-recognized but diagnostically elusive cause of heel pain. The MR finding of selective atrophy of the abductor digiti quinti (ADQ) muscle has been reported as a marker of such entrapment. We performed a prospective study of consecutive patients undergoing foot and ankle MRI to determine the prevalence of ADQ atrophy and to examine the clinical symptoms of patients found to have ADQ atrophy.
A prospective study of all patients referred for ankle and foot MRI examinations was performed. Six hundred two patients were included in the study: 387 females and 215 males. All images were evaluated for the presence of selective fatty atrophy of the ADQ muscle. The clinical notes on all patients with findings of ADQ atrophy were analyzed for descriptions of symptoms leading to the MR examination, the presence of symptoms that might be related to nerve entrapment, and the influence on clinical management related to the MR finding of ADQ atrophy.
Thirty-eight of the 602 patients had selective fatty atrophy of the ADQ, 29 females and nine males. Only one patient had a clinical diagnosis of possible nerve entrapment before MR examination. MRI findings of ADQ atrophy altered clinical management in only one patient.
Selective fatty atrophy of the ADQ is not a rare finding on MR examination of the foot and ankle, being seen in 6.3% of all studies and in 7.5% of all studies in females. The clinical relevance of selective ADQ atrophy seen on MRI is uncertain.
足底外侧神经第一分支卡压是一种已被充分认识但诊断困难的足跟痛病因。已有报道称，趾短屈肌（ADQ）选择性萎缩的磁共振成像（MR）表现是这种卡压的一个标志。我们对连续接受足踝部MRI检查的患者进行了一项前瞻性研究，以确定ADQ萎缩的患病率，并检查发现有ADQ萎缩的患者的临床症状。
对所有转诊进行踝部和足部MRI检查的患者进行前瞻性研究。602例患者纳入研究，其中女性387例，男性215例。所有图像均评估ADQ肌是否存在选择性脂肪萎缩。分析所有有ADQ萎缩表现患者的临床记录，以了解导致进行MR检查的症状描述、可能与神经卡压相关的症状的存在情况，以及ADQ萎缩的MR表现对临床管理的影响。
602例患者中有38例存在ADQ选择性脂肪萎缩，其中女性29例，男性9例。只有1例患者在MR检查前有可能神经卡压的临床诊断。ADQ萎缩的MRI表现仅改变了1例患者的临床管理。
ADQ选择性脂肪萎缩在足踝部MR检查中并非罕见发现，在所有研究中占6.3%，在女性所有研究中占7.5%。MRI上所见ADQ选择性萎缩的临床相关性尚不确定。
