High spatial resolution magnetic resonance imaging of cystic adventitial disease of the popliteal artery  Ismaeel M. Maged, MD, Ulku C. Turba, MD, Ahmed.

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High spatial resolution magnetic resonance imaging of cystic adventitial disease of the popliteal artery  Ismaeel M. Maged, MD, Ulku C. Turba, MD, Ahmed M. Housseini, MD, John A. Kern, MD, Irving L. Kron, MD, Klaus D. Hagspiel, MD  Journal of Vascular Surgery  Volume 51, Issue 2, Pages 471-474 (February 2010) DOI: 10.1016/j.jvs.2009.08.079 Copyright © 2010 Terms and Conditions

Fig 1 A, An axial T2-weighted magnetic resonance image (MRI) of adventitial cystic disease in patient 2 shows thickening of the wall of the popliteal artery caused by multiple well-circumscribed high-signal intensity lesions (arrowheads) representing adventitial cysts. A stalk is seen connecting these cysts with the adjacent knee joint (arrow). B, Axial T2-weighted MRI slightly above the image in Panel A shows a high-signal intensity intra-articular cyst at the intercondylar notch of the femur (arrow) as well as a smaller periarterial lesion (arrowhead). C, Intraoperative photograph shows the mucinous material (arrow) after incision of the popliteal artery wall characteristic of adventitial cystic disease. D, Axial T2 weighted MRI of the same knee 6 months after cyst enucleation shows recurrent high-signal intensity foci representing adventitial cysts (arrowheads) within the popliteal arterial wall and beyond, resulting in an approximately 50% narrowing of the arterial lumen (asterisk). The connecting stalk between these cysts and cysts within the adjacent knee joint, which was not identified intraoperatively, is again noted (arrow). V, Popliteal vein. E, Sagittal T2-weighted MRI of the knee 6 months after cyst enucleation shows multiple high-signal intensity adventitial cysts arising from the wall of the popliteal artery (arrowheads) connected to intra-articular cysts behind the posterior cruciate ligament (asterisk) by the clearly identifiable stalk (arrows). Journal of Vascular Surgery 2010 51, 471-474DOI: (10.1016/j.jvs.2009.08.079) Copyright © 2010 Terms and Conditions

Fig 2 A, Axial T1-weighted magnetic resonance image (MRI) of patient 3, who had adventitial cystic disease of the left popliteal artery and lower extremity claudication, shows a homogeneous structure of slightly lower signal intensity than skeletal muscle, representing an adventitial cyst completely obliterating the lumen of the popliteal artery (asterisk) as well as cysts in the joint (white arrows), representing intra-articular cysts. The popliteal vein (black arrow) and two small contributing veins (black arrowheads) are muscle isointense on this sequence and immediately posterior and to the left of the occluded artery. B, Axial 3D postgadolinium volumetric interpolated breath-hold examination (VIBE) MRI at the same level as Panel A shows rim enhancement but no central enhancement of the adventitial cyst occluding the popliteal artery (asterisk) as well as the cysts inside the joint (short arrows). Note the patent popliteal vein (long arrow) and two small veins draining into it (arrowheads). C, Axial short tau inversion recovery (STIR) MRI at the same level as Panels A and B shows the hyperintense cyst completely obliterating the lumen of the popliteal artery (asterisk). This sequence also shows the popliteal vein (long arrow), two small contributing veins (arrowheads), and multiple well-circumscribed cysts inside the adjacent knee joint (short arrows). D, Sagittal STIR MR image shows the adventitial cyst (arrowhead) within the popliteal artery and the small stalk connecting it with the knee joint (arrow). The asterisk designates the popliteal vein. E, Intraoperative photograph shows the popliteal artery, which is distended by the cyst (between the red vessel loops) and the discharge of mucinous material (arrow) after incision of the arterial wall. Journal of Vascular Surgery 2010 51, 471-474DOI: (10.1016/j.jvs.2009.08.079) Copyright © 2010 Terms and Conditions