腓骨短肌腱位置的MRI评估：正常腓骨肌腱个体的解剖变异，以提高识别率并防止误诊。

MRI evaluation of peroneus brevis tendon position: Anatomical variants in individuals with normal peroneal tendons to improve recognition and prevent misdiagnosis.

作者信息

Zych Rafał, Dziedzic Dawid, Bokwa-Dąbrowska Katarzyna, Mocanu Dan, Szaro Pawel

机构信息

Department of Clinical and Descriptive Anatomy, Medical University of Warsaw, Chałubińskiego St. 5, Warszawa 02-004, Poland.

Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Blå stråket St. 5, Gothenburg 413 46, Sweden; Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Göteborgsvägen St. 31, Gothenburg 431 80, Sweden.

出版信息

Ann Anat. 2025 Aug;261:152694. doi: 10.1016/j.aanat.2025.152694. Epub 2025 Jul 11.

DOI:10.1016/j.aanat.2025.152694

PMID:40651667

Abstract

BACKGROUND

An accurate assessment of the peroneal tendon position is essential in ankle MRI, yet classical anatomical descriptions may not reflect the full range of normal anatomical variation. This study aimed to classify anatomical variants in peroneus brevis position and assess associations with tendon shape, size, and the presence of the peroneus quartus muscle and low-lying peroneus brevis muscle.

METHODS

This observational cohort study included 230 ankle magnetic resonance examinations (3 T) with normal peroneal tendons. Peroneus brevis position relative to the peroneus longus was categorized into four types based on axial MRI: medial (no overlap), overlap with medial protrusion (extension beyond the medial margin of the longus), overlap with lateral protrusion (beyond the lateral margin), and overlap with both. Tendon shape was classified as general flat, flattened convex medially, flattened convex laterally, or oval. Associations between position and shape were tested using chi-square. Differences in cross-sectional area (mm²) and width (mm) across groups were assessed with analysis of variance and Tukey's post hoc test. A regression model identified predictors of tendon overlap.

RESULTS

The most common position was overlap with medial protrusion (72.0 %), followed by medial, lateral, and combined protrusions. Position was significantly associated with shape (p < 0.001); oval tendons were typically medial, while flattened tendons overlapped. Width and cross-sectional area differed significantly across positions (p = 0.0088), with the largest area in tendons protruding medially and laterally (16.9 mm²). Width correlated strongly with overlap (r = 0.79, p < 0.001) and was the strongest predictor in regression (β=0.51, p < 0.001). Peroneus quartus was independently associated with increased overlap (β=0.22, p = 0.03), while low-lying peroneus brevis muscle showed no significant effect.

CONCLUSION

Peroneus brevis position is highly variable and depends on its shape, width, and the presence of peroneus quartus. These variants are significantly related to tendon shape and width and may mimic peroneal instability on imaging.

摘要

背景

在踝关节磁共振成像（MRI）中，准确评估腓骨肌腱位置至关重要，但经典的解剖学描述可能无法反映正常解剖变异的全部范围。本研究旨在对腓骨短肌位置的解剖变异进行分类，并评估其与肌腱形状、大小以及第四腓骨肌和低位腓骨短肌存在情况的相关性。

方法

本观察性队列研究纳入了230例腓骨肌腱正常的踝关节磁共振检查（3T）。根据轴向MRI，将腓骨短肌相对于腓骨长肌的位置分为四种类型：内侧（无重叠）、内侧突出重叠（延伸至长肌内侧边缘之外）、外侧突出重叠（超出外侧边缘）以及双侧突出重叠。肌腱形状分为一般扁平、内侧扁平凸形、外侧扁平凸形或椭圆形。使用卡方检验来检验位置与形状之间的关联。通过方差分析和Tukey事后检验评估各组之间横截面积（mm²）和宽度（mm）的差异。回归模型确定了肌腱重叠的预测因素。

结果

最常见的位置是内侧突出重叠（72.0%），其次是内侧、外侧和双侧突出。位置与形状显著相关（p<0.001）；椭圆形肌腱通常位于内侧，而扁平肌腱存在重叠。不同位置的宽度和横截面积差异显著（p=0.0088），内侧和外侧突出的肌腱横截面积最大（16.9mm²）。宽度与重叠密切相关（r=0.79，p<0.001），并且是回归分析中最强的预测因素（β=0.51，p<0.001）。第四腓骨肌与重叠增加独立相关（β=0.22，p=0.03），而低位腓骨短肌未显示出显著影响。