MR imaging of venous malformations: sciatic nerve infiltration patterns and involved muscle groups

Constantin Goldann,Walther A Wohlgemuth,Maximilian Helm,Simone Hammer,Richard Brill,Alexander Gussew,Jonas Rosendahl,Moritz Wildgruber,Claudia Fellner,Wibke Uller,Andreas Deistung

doi:10.1038/s41598-020-71595-6

Constantin Goldann, Walther A Wohlgemuth + Show 9 more

Open Access

https://doi.org/10.1038/s41598-020-71595-6

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Abstract

The aim of this retrospective cross-sectional study was to provide an MRI-based examination framework of venous malformations (VMs) infiltrating the sciatic nerve and determine the frequency of nerve infiltration patterns and muscle involvement in correlation to the patients’ quality of life. Pelvic and lower limb MR images of 378 patients with vascular malformations were examined retrospectively. Pain levels and restriction of motion were evaluated with a questionnaire. Cross-sectional areas of affected nerves were compared at standardized anatomical landmarks. Intraneural infiltration patterns and involvement of muscles surrounding the sciatic nerve were documented. Sciatic nerve infiltration occurred in 23/299 patients (7.7%) with VM. In all cases (23/23; 100%), gluteal or hamstring muscles surrounding the nerve were affected by the VM. Infiltrated nerves were enlarged and showed signal alterations (T2-hyperintensity) compared to the unaffected side. Enlarged nerve cross-sectional areas were associated with elevated pain levels. Three nerve infiltration patterns were observed: subepineurial (12/23; 52.2%), subparaneurial (6/23; 26.1%) and combined (5/23; 21.7%) infiltration. This study provides a clinically relevant assessment for sciatic nerve infiltration patterns and muscle involvement of VMs, while suggesting that VMs in gluteal and hamstring muscles require closer investigation of the sciatic nerve by the radiologist.

Highlights

The aim of this retrospective cross-sectional study was to provide an magnetic resonance imaging (MRI)-based examination framework of venous malformations (VMs) infiltrating the sciatic nerve and determine the frequency of nerve infiltration patterns and muscle involvement in correlation to the patients’ quality of life
Among eight patients with simple VMs, one individual was diagnosed with PTEN-Hamartoma-Tumor syndrome and another one with a Cutaneomucosal Venous Malformation (VMCM)
Among 46 individuals, they found 6 patients (13%) with the gluteal muscles and 9 patients (19%) with the hamstring muscles involved in simple VMs

Summary

Introduction

The aim of this retrospective cross-sectional study was to provide an MRI-based examination framework of venous malformations (VMs) infiltrating the sciatic nerve and determine the frequency of nerve infiltration patterns and muscle involvement in correlation to the patients’ quality of life. Pelvic and lower limb MR images of 378 patients with vascular malformations were examined retrospectively. This study provides a clinically relevant assessment for sciatic nerve infiltration patterns and muscle involvement of VMs, while suggesting that VMs in gluteal and hamstring muscles require closer investigation of the sciatic nerve by the radiologist. Vascular anomalies of the lower limb are an uncommon diagnosis, which begins with an early onset in childhood or adolescence. Venous malformations (VMs) represent a large group within vascular malformations[6], especially in the extremities: In a study of 5,621 patients, 36.8% of all vascular anomalies were venous malformations. 48.3% of venous and 63.3% of combined venous-lymphatic malformations occurred in the e xtremities[7]

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