Journal List > Investig Magn Reson Imaging > v.24(1) > 1144484

Lee, Choo, Lee, Jung, Kim, Baek, Heo, and Gwak: Assessment of the Location of the Peroneus Longus Tendon in the Cuboid Groove Using 3D Isotropic Fast Spin-Echo MRI

Abstract

Purpose:

To investigate normal location of the peroneus longus tendon (PL) in the cuboid groove by evaluating it between ankles with no significant abnormality (asymptomatic group) and those with retromalleolar PL dislocation (dislocation group) using three-dimensional isotropic fast spin-echo (3D-FSE) magnetic resonance imaging (MRI) of the ankle.

Materials and Methods:

Thirty-six and 32 3D-FSE ankle MRI were assigned to the asymptomatic group and the dislocation group, respectively. Using multiplanar reformatted 3D-FSE, qualitative PL location (i.e., outside, overlying, and inside in relation to the cuboid groove), quantitative PL location (i.e., distance between the proximal margins of PL and cuboid groove), and cuboid groove size were measured in lateral, middle, and medial levels of the cuboid groove.

Results:

In the asymptomatic group, 64%, 42%, and 11%, respectively, had the outside or overlying-located PL in lateral, middle, and medial levels of the cuboid groove and the quantitative location gradually decreased from lateral to medial level. Qualitative and quantitative PL locations were not significantly different between the asymptomatic group and dislocation group. Cuboid groove size showed significant negative correlation with quantitative PL location in both groups.

Conclusion:

Outside- or overlying-located PL in lateral and middle levels of the cuboid groove would be a normal finding, regardless of PL status at the retromalleolar level.

REFERENCES

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Fig. 1.
Differentiation of the three levels of the cuboid groove. The peroneus longus tendon (PL) location and cuboid groove size are evaluated on the oblique sagittal images of the lateral, middle, and medial levels of the cuboid groove. On the oblique axial image, the three yellow-dotted lines indicate the lateral, middle, and medial levels of the cuboid groove. 1st MT = 1st metatarsal; LAT = lateral; MED = medial; MID = middle
imri-24-21f1.tif
Fig. 2.
Mimetic diagram of the categorization for the qualitative location of the PL . (a) The images show an inside-located type, wherein the whole cross-sectional area of the PL is inside the cuboid groove. (b) The images show an overlying-located type, wherein some part of cross-sectional area of the PL is outside the groove. (c) The images show an outside-located type, wherein the entire cross-sectional area of the PL is outside the groove.
imri-24-21f2.tif
Fig. 3.
Measurement for the quantitative location of the PL. On the oblique sagittal plane, the distance (double-headed arrow) between the proximal margin of cross-sectional area of the PL (orange solid line) and the proximal border of the cuboid groove (orange dotted line) is measured.
imri-24-21f3.tif
Fig. 4.
Measurement for the width and depth of the cuboid groove. (a) The cuboid groove width (double-headed arrow) indicates the distance between the most inferior contour of the cuboid tuberosity and the anterior edge of the cuboid. (b) Its depth indicates the distance between the deepest point of the cuboid groove and the imaginary line, crossing the most inferior contour of the cuboid tuberosity and the anterior edge of the cuboid.
imri-24-21f4.tif
Fig. 5.
Bar graph showing PL location in the asymptomatic group and the dislocation group. The proportions of ankles with the inside-located PL increase as the PL goes through the cuboid groove from the lateral to medial level in the asymptomatic group and the dislocation group, but there is no statistically significant difference.
imri-24-21f5.tif
Fig. 6.
An age 19 male with PL dislocation from the retromalleolar fossa. (a) On the axial T2-weighted spin-echo image, the PL (arrow) is anterolateral aspect of the lateral malleolus (arrow). (b-d) On the oblique sagittal reformatted 3D-FSE, the PL (arrow) is ‘inside-located’ in the lateral (b), middle (c) and medial levels of the cuboid groove (d).
imri-24-21f6.tif
Fig. 7.
An age 19 female with PL dislocation from the retromalleolar fossa. (a) On the axial T2-weighted spin-echo image, the PL (arrow) is dislocated from the retromalleolar fossa (arrow). (b-d) The oblique sagittal reformatted 3D-FSE demonstrates the outside-located PL (arrows) at the lateral level of cuboid groove (b), which is glided entirely into the cuboid groove in its middle and medial levels (c, d).
imri-24-21f7.tif
Table 1.
Parameters of Three-Dimensional Fast Spin Echo MRI of the Ankle
  Achieva Skyra
TR/TE (msec) 1300/32 1100/54
Matrix size 300 × 300 300 × 300
Echo train length 65 75
Field of view (mm) 150 150
Average number 2 1
Slice thickness/gap (mm) 1/0.5 0.5/0.5
Parallel imaging factor 2 × 2 2 × 1
Imaging time 7 min 24 sec 7 min 21 sec

TE = echo time; TR = repetition time

Table 2.
Quantitative Peroneus Longus Tendon Location
Cuboid groove level Asymptomatic group Dislocation group P-value
Lateral level 6.55 (0.00~12.9) 3.80 (0.00~15.9) 0.152
Middle level 0 (-1.44~11.7) 0 (-5.26~4.90) 0.306
Medial level 0 (-3.79~3.20) 0 (-3.70~4.30) 0.722
P-value < 0.001 < 0.001  

Unit: millimeter (mm)

Data are median (range)

Table 3.
Width and Depth of Cuboid Groove
Cuboid groove level Width of cuboid groove Depth of cuboid groove
Asymptomatic group Dislocation group P-value Asymptomatic group Dislocation group P-value
Lateral level 6.94 (1.89~12.30) 8.62 (4.08~13.30) 0.117 2.78 (1.61~5.66) 3.10 (1.71~6.28) 0.543
Middle level 8.20 (4.48~11.60) 9.46 (5.70~12.50) 0.158 3.22 (1.51~4.54) 3.04 (1.20~4.96) 0.274
Medial level 8.40 (5.09~12.30) 9.00 (6.40~12.30) 0.180 2.58 (1.89~4.92) 2.90 (1.80~5.60) 0.975
P-value 0.084 0.747   0.226 0.32  

Unit: millimeter (mm)

Table 4.
Relationship between Peroneus Longus Tendon Location and Cuboid Groove Size
Cuboid groove level Width of cuboid groove Depth of cuboid groove
Asymptomatic group Dislocation group Asymptomatic group Dislocation group
Lateral level Coefficient −0.807 −0.644 −0.458 −0.555
  P-value < 0.001 < 0.001 0.005 0.001
Middle level Coefficient −0.455 −0.419 −0.500 −0.409
  P-value 0.005 0.017 0.002 0.020
Medial level Coefficient −0.471 −0.415 −0.259 −0.065
  P-value 0.004 0.018 0.128 0.724
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