Skip to main content

Advertisement

SpringerLink
Log in

Quantification of popliteal artery narrowing with QISS MRA during active ankle plantarflexion in healthy, asymptomatic volunteers and its potential application in the diagnosis of popliteal artery entrapment syndrome (PAES)

  • Technical Report
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

To assess the degree of narrowing of the popliteal artery during active ankle plantar flexion in healthy volunteers using a non-contrast quiescent-interval single-shot (QISS) magnetic resonance angiography (MRA) technique.

Materials and methods

Following IRB approval, 10 healthy volunteers were recruited and following informed consent underwent QISS MRA of the lower extremity at rest and during ankle plantarflexion. Two pediatric musculoskeletal radiologists independently reviewed MR images in random order and recorded a number of subjective and objective anatomic variables including branch pattern, proximity of vessel to bony structures, gastrocnemius bulk, and presence of accessory muscle. Arterial narrowing with plantarflexion was recorded by a subjective assessment of 3D reconstructions (negligible or non-negligible) and objectively by measuring the narrowest diameter during plantarflexion and at rest. Agreement between reader scores was assessed using the concordance correlation coefficient (CCC) for continuous variables, and kappa and the proportion of agreement for categorical variables.

Results

Mean reduction in arterial diameter during plantar flexion was 17.1% (min 1.9%, max 64.1%, SD 16.7%) for reader 1 and 17.2% (min 1.7%, max 50.0%, SD 14.3%.) for reader 2 with high agreement between readers: CCC = 0.92 and CI = 0.82, 0.96. Arterial narrowing was described subjectively as “non-negligible” in 7/20 legs by reader 1 and 5/20 legs by reader 2 with proportion of agreement = 0.90, CI (0.77, 1.00).

Conclusion

We observed a wide range of popliteal arterial narrowing with plantarflexion in asymptomatic volunteers. Larger studies, for which QISS is well suited, may be invaluable for distinguishing physiologic from pathologic arterial narrowing in patients with suspected popliteal artery entrapment syndrome (PAES).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Stuart TP. Note on a variation in the course of the popliteal artery. J Anat Physiol. 1879;13(Pt 2):162.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Love JW, Whelan TJ. Popliteal artery entrapment syndrome. Am J Surg. 1965;109(5):620–4.

    Article  CAS  Google Scholar 

  3. Rignault DP, Pailler JL, Lunel F. The “functional” popliteal entrapment syndrome. Int Angiol. 1985;4(3):341–3.

    CAS  PubMed  Google Scholar 

  4. di Marzo L, Cavallaro A. Popliteal vascular entrapment. World J Surg. 2005;29(Suppl 1):S43–5.

    Article  Google Scholar 

  5. Turnipseed WD. Functional popliteal artery entrapment syndrome: a poorly understood and often missed diagnosis that is frequently mistreated. J Vasc Surg. 2009;49(5):1189–95.

    Article  Google Scholar 

  6. Wady H, Badar Z, Farooq Z, Shaw P, Kobayashi K. Avoiding the trap of misdiagnosis: valuable teaching points derived from a case of longstanding popliteal artery entrapment syndrome. Case Rep Med. 2018;2018:3214561.

    Article  Google Scholar 

  7. Sinha S, Houghton J, Holt PJ, Thompson MM, Loftus IM, Hinchliffe RJ. Popliteal entrapment syndrome. J Vasc Surg. 2012;55(1):252–62.e30.

    Article  Google Scholar 

  8. Kumar R, Warren P, Mannava K. Popliteal artery entrapment syndrome presenting with critical limb ischemia in an adolescent. J Pediatr. 2020;217:215-.e1.

    Article  Google Scholar 

  9. Tsilogianni Z, Grapatsas K, Papanikolaou Z, Kokkini-Paschou A, Tsantilas A, Tsiligiris V, et al. Popliteal artery entrapment syndrome: a common cause of a rare clinical entity--critical leg ischemia in the young. Mil Med. 2014;179(1):e124–6.

    Article  Google Scholar 

  10. Sellers W, Obmann M, Nikam S, Song B, Mariner D. Popliteal artery entrapment syndrome presenting as acute limb ischemia in pregnancy. J Vasc Surg Cases Innov Tech. 2017;3(4):232–5.

    Article  Google Scholar 

  11. Shahi N, Arosemena M, Kwon J, Abai B, Salvatore D, DiMuzio P. Functional popliteal artery entrapment syndrome: a review of diagnosis and management. Ann Vasc Surg. 2019;59:259–67.

    Article  Google Scholar 

  12. Offerman EJ, Hodnett PA, Edelman RR, Koktzoglou I. Nonenhanced methods for lower-extremity MRA: a phantom study examining the effects of stenosis and pathologic flow waveforms at 1.5T. J Magn Reson Imaging. 2011;33(2):401–8.

    Article  Google Scholar 

  13. Edelman RR, Carr M, Koktzoglou I. Advances in non-contrast quiescent-interval slice-selective (QISS) magnetic resonance angiography. Clin Radiol. 2019;74(1):29–36.

    Article  CAS  Google Scholar 

  14. Edelman RR, Sheehan JJ, Dunkle E, Schindler N, Carr J, Koktzoglou I. Quiescent-interval single-shot unenhanced magnetic resonance angiography of peripheral vascular disease: technical considerations and clinical feasibility. Magn Reson Med. 2010;63(4):951–8.

    Article  Google Scholar 

  15. Klasen J, Blondin D, Schmitt P, Bi X, Sansone R, Wittsack HJ, et al. Nonenhanced ECG-gated quiescent-interval single-shot MRA (QISS-MRA) of the lower extremities: comparison with contrast-enhanced MRA. Clin Radiol. 2012;67(5):441–6.

    Article  CAS  Google Scholar 

  16. Altaha MA, Jaskolka JD, Tan K, Rick M, Schmitt P, Menezes RJ, et al. Non-contrast-enhanced MR angiography in critical limb ischemia: performance of quiescent-interval single-shot (QISS) and TSE-based subtraction techniques. Eur Radiol. 2017;27(3):1218–26.

    Article  Google Scholar 

  17. Arendt CT, Leithner D, Lenga L, Wichmann JL, Albrecht MH, Czwikla R, et al. Multi-observer comparison study between unenhanced quiescent-interval single-shot magnetic resonance angiography and invasive carbon dioxide angiography in patients with peripheral arterial disease and chronic renal insufficiency. Eur J Radiol. 2018;108:140–6.

    Article  Google Scholar 

  18. Hodnett PA, Koktzoglou I, Davarpanah AH, Scanlon TG, Collins JD, Sheehan JJ, et al. Evaluation of peripheral arterial disease with nonenhanced quiescent-interval single-shot MR angiography. Radiology. 2011;260(1):282–93.

    Article  Google Scholar 

  19. Koktzoglou I, Huang R, Ong AL, Aouad PJ, Aherne EA, Edelman RR. Feasibility of a sub-3-minute imaging strategy for ungated quiescent interval slice-selective MRA of the extracranial carotid arteries using radial k-space sampling and deep learning-based image processing. Magn Reson Med. 2020;84(2):825–37.

    Article  Google Scholar 

  20. Edelman RR, Silvers RI, Thakrar KH, Metzl MD, Nazari J, Giri S, et al. Nonenhanced MR angiography of the pulmonary arteries using single-shot radial quiescent-interval slice-selective (QISS): a technical feasibility study. J Cardiovasc Magn Reson. 2017;19(1):48.

    Article  Google Scholar 

  21. Shen D, Edelman RR, Robinson JD, Haji-Valizadeh H, Messina M, Giri S, et al. Single-shot coronary quiescent-interval slice-selective magnetic resonance angiography using compressed sensing: a feasibility study in patients with congenital heart disease. J Comput Assist Tomogr. 2018;42(5):739–46.

    Article  Google Scholar 

  22. Okur A, Kantarci M, Karaca L, Yildiz S, Sade R, Pirimoglu B, et al. Non-contrast-enhanced imaging of haemodialysis fistulas using quiescent-interval single-shot (QISS) MRA: a feasibility study. Clin Radiol. 2016;71(3):244–9.

    Article  CAS  Google Scholar 

  23. Kim D, Orron DE, Skillman JJ. Surgical significance of popliteal arterial variants: a unified angiographic classification. Ann Surg. 1989;210(6).

  24. Bidgood WD Jr, Horii SC. Introduction to the ACR-NEMA DICOM standard. Radiographics. 1992;12(2):345–55.

    Article  Google Scholar 

  25. Lin LI. A concordance correlation coefficient to evaluate reproducibility. Biometrics. 1989;45(1):255–68.

    Article  CAS  Google Scholar 

  26. Fliess J. Statistical methods for rates and proportions. New York; 1981.

  27. Agresti A. Categorical data analysis. 3rd ed. Hoboken: Wiley; 2013.

    Google Scholar 

  28. Uebersax JS. Diversity of decision-making models and the measurement of interrater agreement. Psychol Bull. 1987;101(1):140.

    Article  Google Scholar 

  29. SAS Institute Inc. SAS/STAT® 14.1 User Guide. Cary: SAS Institute Inc; 2015.

    Google Scholar 

  30. Pillai J, Levien LJ, Haagensen M, Candy G, Cluver MD, Veller MG. Assessment of the medial head of the gastrocnemius muscle in functional compression of the popliteal artery. J Vasc Surg. 2008;48(5):1189–96.

    Article  Google Scholar 

  31. de Almeida MJ, Bonetti Yoshida W, Habberman D, Medeiros EM, Giannini M, Ribeiro de Melo N. Extrinsic compression of popliteal artery in asymptomatic athlete and non-athlete individuals. A comparative study using duplex scan (color duplex sonography). Int Angiol. 2004;23(3):218–29.

    PubMed  Google Scholar 

  32. Gourgiotis S, Aggelakas J, Salemis N, Elias C, Georgiou C. Diagnosis and surgical approach of popliteal artery entrapment syndrome: a retrospective study. Vasc Health Risk Manag. 2008;4(1):83–8.

    Article  Google Scholar 

  33. Akkersdijk WL, de Ruyter JW, Lapham R, Mali W, Eikelboom BC. Colour duplex ultrasonographic imaging and provocation of popliteal artery compression. Eur J Vasc Endovasc Surg. 1995;10(3):342–5.

    Article  CAS  Google Scholar 

  34. Hoffmann U, Vetter J, Rainoni L, Leu AJ, Bollinger A. Popliteal artery compression and force of active plantar flexion in young healthy volunteers. J Vasc Surg. 1997;26(2):281–7.

    Article  CAS  Google Scholar 

  35. Chernoff DM, Walker AT, Khorasani R, Polak JF, Jolesz FA. Asymptomatic functional popliteal artery entrapment: demonstration at MR imaging. Radiology. 1995;195(1):176–80.

    Article  CAS  Google Scholar 

  36. Hodnett PA, Ward EV, Davarpanah AH, Scanlon TG, Collins JD, Glielmi CB, et al. Peripheral arterial disease in a symptomatic diabetic population: prospective comparison of rapid unenhanced MR angiography (MRA) with contrast-enhanced MRA. AJR Am J Roentgenol. 2011;197(6):1466–73.

    Article  Google Scholar 

  37. Hansmann J, Morelli JN, Michaely HJ, Riester T, Budjan J, Schoenberg SO, et al. Nonenhanced ECG-gated quiescent-interval single shot MRA: image quality and stenosis assessment at 3 tesla compared with contrast-enhanced MRA and digital subtraction angiography. J Magn Reson Imaging. 2014;39(6):1486–93.

    Article  Google Scholar 

  38. Varga-Szemes A, Wichmann JL, Schoepf UJ, Suranyi P, De Cecco CN, Muscogiuri G, et al. Accuracy of noncontrast quiescent-interval single-shot lower extremity MR angiography versus CT angiography for diagnosis of peripheral artery disease: comparison with digital subtraction angiography. JACC Cardiovasc Imaging. 2017;10(10 Pt A):1116–24.

    Article  Google Scholar 

  39. Keller S, Yamamura J, Sedlacik J, Wang Z, Gebert P, Starekova J, et al. Diffusion tensor imaging combined with T2 mapping to quantify changes in the skeletal muscle associated with training and endurance exercise in competitive triathletes. Eur Radiol. 2020;30(5):2830–42.

    Article  CAS  Google Scholar 

  40. Mathew RC, Kramer CM. Recent advances in magnetic resonance imaging for peripheral artery disease. Vasc Med. 2018;23(2):143–52.

    Article  Google Scholar 

  41. Ledermann HP, Heidecker HG, Schulte AC, Thalhammer C, Aschwanden M, Jaeger KA, et al. Calf muscles imaged at BOLD MR: correlation with TcPO2 and flowmetry measurements during ischemia and reactive hyperemia--initial experience. Radiology. 2006;241(2):477–84.

    Article  Google Scholar 

  42. Filli L, Boss A, Wurnig MC, Kenkel D, Andreisek G, Guggenberger R. Dynamic intravoxel incoherent motion imaging of skeletal muscle at rest and after exercise. NMR Biomed. 2015;28(2):240–6.

    Article  Google Scholar 

Download references

Acknowledgements

The authors wish to extend their gratitude to James Connors RT(MR) and MRI Quality Improvement Coordinator at Boston Children’s Hospital with his assistance in this project.

Author information

Authors and Affiliations

  1. Department of Radiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Micheál A. Breen, Patrick Johnston & Sarah D. Bixby

  2. Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA, USA

    Mahad M. Hassan

  3. Department of Surgery, Boston Children’s Hospital, Boston, MA, USA

    Joseph Upton

Authors
  1. Micheál A. Breen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mahad M. Hassan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patrick Johnston
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joseph Upton
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sarah D. Bixby
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Micheál A. Breen.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Breen, M.A., Hassan, M.M., Johnston, P. et al. Quantification of popliteal artery narrowing with QISS MRA during active ankle plantarflexion in healthy, asymptomatic volunteers and its potential application in the diagnosis of popliteal artery entrapment syndrome (PAES). Skeletal Radiol 50, 2091–2102 (2021). https://doi.org/10.1007/s00256-021-03751-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-021-03751-6

Keywords

Search

Navigation