Department of Radiology, Shandong Mental Health Center, Shandong, 250014, China.
Department of Radiology, Third Medical Centre of Chinese PLA General Hospital, Beijing, 100039, China.
BMC Med Imaging. 2021 Mar 17;21(1):51. doi: 10.1186/s12880-021-00582-8.
The visualization of the tibial nerve and its branches in the ankle canal is helpful for the diagnosis of local lesions and compression, and it is also useful for clinical observation and surgical planning. The aim of this study was to investigate the feasibility of three-dimensional dual-excitation balanced steady-state free precession sequence (3D-FIESTA-C) multiplanar reformation (MPR) display of the tibial nerve and its branches in the ankle canal.
The subjects were 20 healthy volunteers (40 ankles), aged 22-50 years, with no history of ankle joint disease. The 3D-FIESTA-C sequence was used in the 3.0 T magnetic resonance equipment for imaging. During scanning, each foot was at an angle of 90° to the tibia. The tibial nerve of the ankle canal and its branches were displayed and measured at the same level through MPR.
Most of the tibial nerve bifurcation points were located in the ankle canal (57.5%), few bifurcation points (42.5%) were located at the proximal end of the ankle canal, and none of them were found away from the distal end. The bifurcation between the medial plantar nerve and the lateral plantar nerve was on the line between the tip of the medial malleolus and the calcaneus, and it's angle ranged between 6° and 35°. In MPR images, the display rates of both the medial calcaneal nerve and the subcalcaneal nerve were 100%, and the starting point of the subcalcaneal nerve was always at the distal end of the starting point of the medial calcaneal nerve. In 55% of cases, there were more than two medial calcaneal nerve innervations.
The 3D-FIESTA-C MPR can display the morphological features and positions of the tibial nerve and its branches and the bifurcation point's projection position can be marked on the body surface. This method not only benefited the imaging diagnosis of the tibial nerve and branch-related lesions in the ankle canal, but it also provided a good imaging basis to plan a clinical operation of the ankle canal and avoid surgical injury.
在踝关节管内可视化胫神经及其分支有助于诊断局部病变和压迫，也有助于临床观察和手术规划。本研究旨在探讨三维双激发平衡稳态自由进动序列（3D-FIESTA-C）多平面重建（MPR）显示踝关节管内胫神经及其分支的可行性。
本研究纳入 20 名健康志愿者（40 侧踝关节），年龄 22-50 岁，均无踝关节疾病史。使用 3.0T 磁共振设备进行 3D-FIESTA-C 序列成像。扫描时，每只脚与胫骨成 90°角。在 MPR 上同一水平显示和测量踝关节管内胫神经及其分支。
大多数胫神经分叉点位于踝关节管内（57.5%），少数分叉点（42.5%）位于踝关节管近端，无分叉点位于踝关节管远端。内侧足底神经和外侧足底神经的分叉点位于内踝尖和跟骨之间的连线上，角度在 6°-35°之间。MPR 图像中，内侧跟骨神经和跗骨下神经的显示率均为 100%，跗骨下神经的起点始终位于内侧跟骨神经起点的远端。在 55%的情况下，有超过两条内侧跟骨神经支配。
3D-FIESTA-C MPR 可显示胫神经及其分支的形态特征和位置，可在体表标记分叉点的投影位置。该方法不仅有助于诊断踝关节管内胫神经及其分支相关病变的影像学表现，而且为踝关节管的临床手术规划提供了良好的影像学依据，避免了手术损伤。
