Normal MR Imaging

A n a t o m y o f th e
Thigh and Leg
Saifuddin Vohra, DO, George Arnold, MD,
Shashin Doshi, MD, David Marcantonio, MD*

KEYWORDS
 Anatomy  Thigh  Leg  MR imaging  Pitfalls

Developing a solid understanding of basic mag- T1W sequences provide excellent depiction of
netic resonance imaging (MR imaging) principles anatomic detail, bone marrow signal alteration, fat
and musculoskeletal imaging protocols, as well within mass lesions, identification of subacute
as the appearance of normal imaging anatomy, is blood products, and presence of enhancing tissue
crucial to interpret musculoskeletal MR imaging after gadolinium contrast administration. T2W
examinations at a diagnostic level. This knowledge sequences identify tissues with increased water
can then be applied to one’s understanding of content that can be seen in the setting of a broad
pathology commonly encountered in the area of range of pathology, including neoplastic, infec-
interest. Careful attention should be focused on tious, inflammatory, and traumatic processes.
awareness of commonly encountered anatomic Acquisition of T2W sequences is performed using
variants and diagnostic pitfalls to improve diag- the fast spin-echo (FSE) technique to reduce scan
nostic accuracy and avoid misinterpretation. time and minimize susceptibility artifact from field
In this article, focus is placed on depicting normal inhomogeneity. Frequency selective fat suppres-
anatomy at representative levels throughout the sion is used on T2W sequences to accentuate
thigh and leg, describing and providing rationale pathologic abnormalities. STIR sequences allow
for routine imaging protocols, and discussing for a more sensitive evaluation of soft tissue and
frequently encountered anatomical variants and bone marrow edema, and offer more reliable
imaging pitfalls. This will serve as a basic founda- uniform fat suppression; however, currently, in
tion for accurate evaluation of the many pathologic many institutions, FSE T2W and STIR sequences
processes that may involve the thigh and leg. are used similarly.1 Intravenous gadolinium con-
MR imaging of a healthy volunteer was per- trast administration allows differentiation of cystic
formed on a 3T MR imaging unit (Siemens, versus solid masses, and detection of hyperemic
Erlangen, Germany). Select axial T1-weighted tissues related to viable tumor as opposed to
(T1W) images are displayed to depict anatomical necrosis, and phlegmonous/inflammatory tissue
structures to best advantage, and allow the reader as opposed to abscess formation.1 The axial plane
to conceptualize relevant anatomy while empha- of imaging is preferred for a compartmental
sizing compartmental organization. approach to evaluation and in assessing the neuro-
vascular structures, muscles, and fascial layers.
PROTOCOLS The coronal plane provides a general overview of
the region of interest, and the sagittal plane aids
Routine thigh and leg MR imaging protocols at our in better depicting the cranial-caudal extent of
institution include a combination of T1W, T2W, and muscle disease and myotendinous junction
short tau inversion recovery (STIR) sequences. involvement.1,2 The field strength, coil (volume
[Link]

The authors having nothing to disclose.

Division of Musculoskeletal Radiology, Department of Diagnostic Radiology-Imaging Center, William
Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI 48073, USA
* Corresponding author.
E-mail address: [Link]@[Link]

Magn Reson Imaging Clin N Am 19 (2011) 621–636

doi:10.1016/[Link].2011.05.011
1064-9689/11/$ – see front matter Ó 2011 Elsevier Inc. All rights reserved.
622 Vohra et al

surface phased array), slice thickness, field of view, IMAGING ANATOMY

matrix size, and other select imaging parameters Thigh
are optimized with the goal of increasing the
The thigh is best described in terms of compart-
signal-to-noise ratio and decreasing scan time,
mental anatomy, and is composed of anterior,
thereby decreasing motion artifact. Patient-
posterior, and medial (adductor) compartments.
specific factors including body habitus and ability
In terms of spread of pathologic processes, such
to cooperate, desired region of coverage, and pres-
as tumor and infection, other delineated compart-
ence of metallic hardware or foreign bodies must
ments include the skin and subcutaneous fat,
also be considered.
bone bounded by periosteum and cortex, and
Specifically, our routine protocol for both the
parosteal space (between the bone and overlying
thigh and leg (Table 1) includes an axial T2W
soft tissues).3 The thigh extends from the superior
sequence with fat saturation, at least 2 planes of
margin of the subtrochanteric region through the
T1W sequences without fat saturation, and coronal
distal femoral metadiaphysis. Each compartment
and sagittal STIR sequences. If gadolinium contrast
is composed of muscles, neurovascular structures,
is indicated, at minimum, precontrast and postcon-
and intermuscular fascia. Muscles are of interme-
trast fat-suppressed axial T1W sequences are
diate signal intensity to fat on T1W and T2W FSE
obtained. At least one additional postcontrast fat-
sequences.1 Peripheral nerves are round or oval
suppressed T1W sequence is acquired, either in
and have a fascicular appearance, best depicted
the sagittal or coronal orientation; however, both
on T2W sequences. They are isointense to muscle
are preferable. Ultimately, the final imaging protocol
on T1W sequences with intermixed increased
is tailored to patient-specific factors with the
signal intensity similar to fat. On T2W sequences,
desired intention of obtaining the best image quality
they are isointense to slightly hyperintense relative
to answer the clinical question.

Table 1
Thigh (femur) and leg (tibia/fibula) routine imaging protocols: flex surface coil set up: Patient placed
feet first, supine, with leg at the center of the bore of the magnet. Area of interest/concern bracketed
with vitamin E capsules. 3T MR imaging unit (Siemens, Erlangen, Germany)

Thigh
Sequence Fat Saturation FOV, cm Matrix Slice Thickness/Gap, mm TR/TI, ms TE, ms
Coronal T1 N 40 256  256 5/2.5 750 9.5
Axial T1 N 20 256  256 4/2.0 750 9.6
Sagittal T1 N 40 256  256 5/2.5 750 9.5
Axial T2 Y 20 256  256 4/1.2 5250 81
Coronal STIR N/A 40 184  384 3/0.9 7380/210 27
Sagittal STIR N/A 40 184  384 3/0.9 7380/210 27
a
Axial T1 Pre. Y 20 256  256 4/2.0 750 9.6
Leg
Sequence Fat Saturation FOV, cm Matrix Slick Thickness/Gap, mm TR/TI, ms TE, ms
Coronal T1 N 35 256  256 5/1.5 750 9.5
Axial T1 N 20 256  256 5/1.5 750 9.6
Sagittal T1 N 40 256  256 5/2.5 750 9.5
Axial T2 Y 20 256  256 5/1.5 5250 81
Coronal STIR N/A 35 184  384 3/0.9 7380/210 27
Sagittal STIR N/A 40 184  384 3/0.9 7380/210 27
a
Axial T1 Pre. Y 20 256  256 5/1.5 750 9.6

Abbreviations: FOV, field of view; N, no; N/A, not applicable; STIR, short tau inversion recovery; Y, yes.
a
Optional, if intravenous contrast is indicated. Post–gadolinium contrast T1W sequences are obtained in at least 2
orthogonal planes with fat suppression.
 Normal MR Imaging Anatomy of the Thigh and Leg 623

to muscle.1 In general, arteries should be hypoin- tendon along the proximal medial tibia after
tense to muscle on all sequences.1 Veins have vari- curving anteriorly around the posteromedial
able signal intensity on T1W and T2W sequences. femoral condyle. The pectineus muscle is trian-
The iliotibial tract, tensor muscle of fascia lata, gular in shape and originates at the superior pubic
quadriceps femoris (vastus medialis, vastus latera- ramus along with the adductor longus muscle
lis, vastus intermedius, and rectus femoris), and more medially. It inserts onto the pectineal line of
sartorius muscles are located within the anterior the femoral shaft, whereas the adductor longus
compartment. The sartorius muscle is long, thin, muscle inserts onto the middle third of the linea as-
and bandlike, originating from the anterior superior pera. The adductor brevis muscle is also triangular
iliac spine, obliquely coursing over the proximal in shape, and originates from the inferior pubic
thigh along the inner margin of the quadriceps ramus and inserts along the upper third of the linea
muscles, and extending to the posteromedial aspera. The adductor magnus muscle, the largest
aspect of the knee. Its tendon extends anteriorly of the adductor muscle group, originates along the
and attaches to the anteromedial surface of the inferior pubic ramus and ischial tuberosity, and
proximal tibia superficial to the gracilis and semite- inserts along the entire linea aspera as well as
ndinosus tendons. Together, these 3 tendons the adductor tubercle of the distal femur. The
comprise the pes anserinus tendon complex. The obturator externus muscle, the deepest of the
rectus femoris muscle originates from the anterior muscles in the medial compartment, originates
inferior iliac spine as 2 tendons: the straight and re- from the anterior two-thirds of the obturator
flected heads. The vastus lateralis muscle arises foramen (formed by the lateral surface of the is-
from the anterior superior aspect of the femoral chiopubic ramus) and inserts into the trochanteric
shaft and the lateral facet of the linea aspera; the fossa of the proximal femur. The neurovascular
vastus medialis muscle originates from the intertro- bundle, including the saphenous nerve, is located
chanteric line and medial aspect of linea aspera; in this compartment.5
the vastus intermedius muscle arises between
these 2 muscles and subjacent to the rectus femo-
Leg
ris muscle, along the anterior aspect of the femoral
shaft. Differentiation of these muscles is some- The leg extends from the proximal tibial metaphy-
times difficult as they may be partially fused at their sis through the distal metaphysis. The soft tissues
origins and insertions. Distally, these 4 muscles are similarly organized in a compartmental fashion,
form the quadriceps tendon, which contains the and are supported by the tibia and fibula. The
patella, the largest sesamoid in the body.4 lower leg is composed of 4 compartments: ante-
The posterior compartment contains the semi- rior, superficial posterior, deep posterior, and
membranosus, semitendinosus, and long and lateral. The interosseous membrane separates
short heads of the biceps femoris muscles. The the anterior and deep posterior compartments.
major innervation of the lower extremity, the sciatic The transverse septum separates the superficial
nerve, is also located in this compartment. The and deep posterior compartments.
semitendinosus and long head of the biceps femo- The anterior compartment contains the tibialis
ris muscles originate from a common tendon along anterior, extensor digitorum longus, and extensor
the medial facet and distal margin of the ischial hallucis longus muscles, and the anterior neuro-
tuberosity. The semitendinosus muscle, fusiform vascular bundle, including the anterior tibial artery
in shape, is more tendinous distally, and inserts and vein, and deep peroneal nerve. The tibialis
along the medial aspect of the proximal tibia anterior muscle originates from the lateral surface
deep to the sartorius tendon. The short head of of the tibia and neighboring interosseous
the biceps femoris muscle originates from the linea membrane in the upper leg, and extends distally
aspera in the mid to distal thigh and joins the long over the anterior tibia to insert upon the dorsal
head of the biceps femoris muscle to insert on aspect of the first metatarsal. The extensor digito-
the fibular head laterally. The semimembranosus rum longus muscle originates from the anterior
tendon arises from the lateral facet of the ischial surface of the interosseous membrane and fibula,
tuberosity and has a broad insertion along the courses inferiorly along the anterior tibia, and gives
proximal posteromedial tibia. rise to tendons that insert upon the distal
The medial compartment contains the adductor phalanges of the second through fifth toes. The
brevis, longus, and magnus muscles as well as peroneus tertius muscle, when variably present,
gracilis, pectineus, and obturator externus muscu- is closely associated with the extensor digitorum
lature. The gracilis muscle is the most superficial longus muscle, coursing in the same synovial
and medial, and originates from the inferior ischio- sheath; however, its tendon attaches to the dorsal
pubic ramus and inserts deep to the sartorius aspect of the base of the fifth metatarsal.4 The
624 Vohra et al

extensor hallucis longus muscle originates from compartments by intermuscular septa. The pero-
the distal aspect of the fibula and interosseous neus longus muscle arises from the upper half of
membrane, and extends distally across the ankle the lateral surface of the fibula and adjacent struc-
and foot to insert upon the distal phalanx of the tures, descends lateral and then posterior to the
first toe. At the level of the ankle, the tendons in peroneus brevis muscle, and inserts along the
this compartment are stabilized by the superior plantar surface of the base of the first metatarsal.4,5
and inferior extensor retinacula. It lies posterior to the lateral malleolus and lateral to
The deep posterior compartment contains the the calcaneus at these respective levels. Along the
popliteus, tibialis posterior, flexor digitorum, and plantar surface of the foot, the tendon courses
flexor hallucis longus muscles, as well as the adjacent to the cuboid (cuboid tunnel) and tarso-
posterior tibial and peroneal arteries and the metatarsal articulations. The peroneus brevis
posterior tibial nerve. The popliteus muscle origi- muscle originates from the middle one-third of
nates from the lateral femoral condyle and inserts the lateral aspect of the fibula and inserts upon
upon the popliteal line of the tibia. The flexor digi- the dorsolateral aspect of the base of the fifth
torum longus muscle originates from the popliteal metatarsal. Both peroneal tendons are stabilized
line and posterior aspect of the tibia. Its tendon by the superior and inferior peroneal retinacula.
passes posterior and around the medial malleolus, Anatomic variants occur most commonly within
and gives rise to 4 tendinous slips that insert upon the mid to distal leg, and with less frequency within
the bases of the distal phalanges of the second the thigh. Accessory muscles comprise most of the
through fourth toes. The flexor hallucis longus variant anatomy. The peroneus tertius, a common
muscle originates from the distal two-thirds of anatomic variant located within the anterior com-
the fibula, and its tendon courses around the partment, originates from the anterior aspect of
medial malleolus, posterior to the flexor digitorum the distal fibula and extensor digitorum longus
longus tendon, and between the medial and lateral muscle as discussed previously. Accessory soleus
tubercles of the posterior process of the talus to musculature is most commonly unilateral, and
insert upon the distal phalynx of the first toe. The arises from the fibula, soleal line of the tibia, and
tibialis posterior muscle originates from the lateral anterior aspect of the soleus. There are 5 types
aspect of the tibia and adjacent interosseous related to insertion location.6 The peroneus quartus
membrane. It courses around the medial malleo- muscle is located within the lateral compartment. It
lus, anterior to the flexor digitorum longus tendon, originates from and is situated medial and posterior
and has a broad insertion upon multiple structures to the peroneus brevis and longus musculature.
along the plantar surface of the foot, predomi- Several types exist and are further classified based
nantly inserting upon the navicular and, to a lesser on their insertions. The peroneus calcaneus inter-
degree, the cuneiform bones. nus muscle is a rare anatomic variant that is usually
The plantaris, soleus, and medial and lateral asymptomatic; however, it has been clinically asso-
heads of the gastrocnemius muscles, along with ciated with posterior ankle impingement and flexor
the sural nerve, are located within the superficial hallucis longus tenosynovitis. Flexor digitorum ac-
posterior compartment. The medial and lateral cessorius longus is an uncommon variant that has
heads of the gastrocnemius musculature originate been associated with tarsal tunnel syndrome.6
from immediately superior to the medial and lateral Variations, including accessory slips and anoma-
femoral condyles, respectively, and insert upon the lous origins of the gastrocnemius and popliteus
deep aspect of the Achilles tendon at mid leg. The musculature, some of which may lead to popliteal
soleus muscle originates from the tibia and fibula, artery entrapment syndrome depending on their
deep to the gastrocnemius musculature, and effect upon the underlying popliteal vasculature,
inserts upon the deep aspect of the Achilles tendon are also not infrequently encountered. An un-
at a variable level. The plantaris muscle belly is common accessory popliteus shares a common
short and originates from the distal lateral linea as- origin with the lateral head of the gastrocnemius
pera in close association with the lateral head of and courses inferomedially within the deep popliteal
gastrocnemius muscle. Its long tendon courses fossa, situated anterior to the popliteal vessels. It
inferiorly between the soleus muscle and the inserts onto the posteromedial joint capsule of the
medial head of gastrocnemius muscle, and inserts knee, and may potentially have a compressive effect
upon the posterior superior aspect of the calcaneus upon the overlying popliteal neurovascular bundle.
along the medial margin of the Achilles tendon. Tensor fasciae suralis, a very rare accessory
The lateral compartment contains the peroneus muscle, can arise from any hamstring muscle;
longus and peroneus brevis muscles as well however, it most commonly originates from the
as the common and superficial peroneal nerves. distal semitendinosus muscle. It can insert onto
It is separated from the anterior and posterior the medial head of the gastrocnemius, posterior
 Normal MR Imaging Anatomy of the Thigh and Leg 625

fascia of the leg, or onto the superficial aspect of awareness of diagnostic pitfalls are crucial to
the Achilles tendon by means of a long, thin accurately detect disease, communicate relevant
tendon. Tensor fasciae suralis is superficial within findings, and plan and perform musculoskeletal in-
the popliteal fossa, situated lateral to the semi- terventional procedures. See the Appendix for
membranosus and semitendinosus muscles and illustrative figures.
medial to the biceps femoris muscle.
ACKNOWLEDGMENTS
SUMMARY
Mike Tenzer, MD, our healthy imaging volun-
Familiarity with normal MR imaging anatomy, teer, provided many of the images used in this
commonly encountered anatomic variants, and section.

APPENDIX

Fig. 1. Axial T1W image. Upper thigh. Compartmental muscle anatomy. Add., Adductor; a., artery; Glut Max.,
gluteus maximus; m., muscle; n., nerve; Obt. Ext./Int., obturator externus/internus; Smb, semimembranosus; t.,
tendon; Tens., tensor; v., vein; V., vastus.

Key Points

 The biceps femoris long head muscle originates from the medial facet of the ischial tuberosity and
the semitendinosus muscle originates from the medial facet and distal margin. They originate as
a conjoint tendon posteromedially, whereas the semimembranosus muscle arises from the lateral
facet more anteriorly.
 In the proximal thigh, the anterior and medial compartments are divided by the iliopsoas muscle
(which inserts upon the lesser trochanter) and neurovascular bundle. The posterior and anterior
compartments are separated by the gluteus maximus muscle.
 The vastus intermedius muscle arises along the anterolateral femur deep to the vastus lateralis muscle.
 The sciatic nerve is immediately lateral to the common hamstring tendon origin along the ischial
tuberosity, and deep to the gluteus maximus muscle.
 The adductor longus, brevis, and magnus (not seen) muscles, maintain this relationship from anterior
to posterior until the adductor brevis muscle inserts upon the upper aspect of the linea aspera and the
distal pectineal line.
626 Vohra et al

Fig. 2. Axial T1W image. Upper thigh. Compartmental muscle anatomy. Add., Adductor; a., artery; BF LH, biceps
femoris long head; Interm., intermedius; Long., longus; m., muscle; n., nerve; Smb, semimembranosus; Smt, sem-
itendinosus; t., tendon; v., vein; V., vastus.

Key Points

 Most medially the gracilis muscle is seen, which originates from the inferior pubic ramus.
 The deep (profunda) femoral artery and vein are the major femoral branch vessels positioned
between the vastus medialis muscle and the adductor magnus muscle.
 The sciatic nerve is adjacent to the posterior aspect of the adductor magnus muscle, deep to the
gluteus maximus muscle.
 Normal MR Imaging Anatomy of the Thigh and Leg 627

Fig. 3. Axial T1W image. Mid thigh. Compartmental muscle anatomy. Add., Adductor; a., artery; BF LH, biceps
femoris long head; Lat. Intmsclr. Sptm., lateral intermuscular septum; m., muscle; n., nerve; Smb, semimembrano-
sus; Smt, semitendinosus; t., tendon; v., vein; V., vastus.

Key Points
 The sciatic nerve is adjacent to the posterior aspect of the adductor magnus muscle.
 The gracilis muscle is seen most medially.
628 Vohra et al

Fig. 4. Axial T1W image. Mid thigh. Compartmental muscle anatomy. Add., Adductor; a., artery; BF LH, biceps
femoris long head; Lat. Intmsclr. Sptm., lateral intermuscular septum; m., muscle; n., nerve; Smb., semimembra-
nosus; Smt., semitendinosus; v., vein; V., vastus.

Key Points

 The femoral artery and vein are within the adductor canal of Hunter (floor formed by the adductor
longus muscle).
 The sciatic nerve is interposed between the adductor magnus muscle and the biceps femoris long
head muscle.
 The anterior and posterior compartments are separated by the lateral intermuscular septum.
 The semitendinosus, semimembranosus, and biceps femoris long head are entirely muscular at this
level, and have flipped medial-lateral orientation relative to their origin.
 Normal MR Imaging Anatomy of the Thigh and Leg 629

Fig. 5. Axial T1W image. Lower thigh. Compartmental muscle anatomy. Add., Adductor; a., artery; BF SH, LH,
biceps femoris short head, long head; m., muscle; n., nerve; Smb, semimembranosus; Smt, semitendinosus; v.,
vein; V., vastus.

Key Points

 A small portion of the adductor magnus muscle remains.

 The femoral artery and vein become the popliteal vessels below this level after exiting the adductor
canal of Hunter via the adductor hiatus.
 The sciatic nerve is between the adductor magnus muscle and biceps femoris long head muscle.
630 Vohra et al

Fig. 6. Axial T1W image. Lower thigh. Compartmental muscle anatomy. BF SH, LH, biceps femoris short head,
long head; Comm. Peron., common peroneal; F, femur; Fem., femoris; Interm., intermedius; m., muscle; n., nerve;
Smb, semimembranosus; Smt, semitendinosus; t., tendon; V., vastus.

Key Points

 The sciatic nerve has divided into the common peroneal nerve and the tibial nerve.
 The adductor magnus muscle is no longer well seen.
 The gracilis muscle is immediately posterior to the sartorius muscle.
 Normal MR Imaging Anatomy of the Thigh and Leg 631

Fig. 7. Axial T1W image. Upper leg. Compartmental muscle anatomy. a., artery; Ant. Tib., anterior tibial; Ext. Dig.
Long, extensor digitorum longus; Memb., membrane; M.H./L.H. Gastroc., gastrocnemius, medial and lateral
heads; m., muscle; Peron. Longus, peroneus longus; Peron., peroneal; Post. Tib, posterior tibialis; Tib. Ant., tibialis
anterior; Tib. Post., tibialis posterior.

Key Points

 The anterior compartment is separated from the deep posterior compartment by the interosseous
membrane.
 The peroneus brevis muscle is not seen at this level.
 The peroneal artery and posterior tibial artery are situated between the deep and superficial poste-
rior compartments.
 The plantaris tendon (not well seen) courses between the soleus muscle and medial head of gastroc-
nemius muscle at this level.
 The common peroneal nerve has not yet bifurcated into its superficial (lateral compartment) and
deep (anterior compartment) branches.
632 Vohra et al

Fig. 8. Axial T1W image. Upper leg. Compartmental muscle anatomy. a., artery; Ant. Tib., anterior tibial; DPN,
deep peroneal nerve; Ext. Dig. Long., extensor digitorum longus; Ext. Hal. Long., extensor hallucis longus;
Flex. Dig. Long, flexor digitorum longus; M.H./L.H. Gastroc., gastrocnemius, medial and lateral heads; m., muscle;
n., nerve; Peron. Longus., Brv., peroneus longus, brevis; Peron., peroneal; Post. Tib, posterior tibialis; Tib. Ant.,
tibialis anterior; Tib. Post., tibialis posterior; Tib., tibial.

Key Points

 The posterior tibial artery and the tibial nerve maintain a constant relationship in this region.
 The plantaris tendon is flattened and not clearly defined.
 The medial head gastrocnemius muscle extends more inferiorly than the lateral head gastrocnemius
muscle creating asymmetry in the posterior calf.
 The intermuscular septa are not as well seen as in the thigh.
 Normal MR Imaging Anatomy of the Thigh and Leg 633

Fig. 9. Axial T1W image. Mid leg. Compartmental muscle anatomy. a., artery; Ant. Tib., anterior tibial; DPN, deep
peroneal nerve; EDL, extensor digitorum longus; EHL, extensor hallucis longus; FDL, flexor digitorum longus; FHL,
flexor hallucis longus; Gastroc. M.H./L.H., gastrocnemius, medial and lateral heads; m., muscle; n., nerve; Peron. L.,
Br., peroneus longus, brevis; Peron., peroneal; Post. tib., posterior tibialis; Tib. Ant., tibialis anterior; Tib. Post.,
tibialis posterior; Tib., tibial.

Key Points

 The anterior tibial artery and the deep peroneal nerve course inferiorly adjacent to the anterior aspect
of the interosseous membrane.
 The posterior tibial artery and the tibial nerve maintain a constant relationship in this region, which
continues inferiorly to the level of the ankle, interposed between the flexor hallucis longus and flexor
digitorum longus muscles.
 Nutrient vessel can be seen within the posterior cortex of the tibia.
634 Vohra et al

Fig. 10. Axial T1W image. Mid leg. Compartmental muscle anatomy. a., artery; Ant. Tib., anterior tibial; DPN,
deep peroneal nerve; EDL, extensor digitorum longus; EHL, extensor hallucis longus; FDL, flexor digitorum lon-
gus; FHL, flexor hallucis longus; M.H. Gastroc., gastrocnemius, medial head; m., muscle; n., nerve; Peron. Lg., Brv.,
peroneus longus, brevis; Peron., peroneal; Post Tib, posterior tibialis; SPN, superficial peroneal nerve; Tib. Ant.,
tibialis anterior; Tib. Post., tibialis posterior; Tib., tibial.

Fig. 11. Axial T1W image. Lower leg. Compartmental muscle anatomy. a., artery; Ant Tib., anterior tibial; DPN,
deep peroneal nerve; EDL, extensor digitorum longus; EHL, extensor hallucis longus; FDL, flexor digitorum lon-
gus; FHL, flexor hallucis longus; Gastroc., gastrocnemius; m., muscle; n., nerve; Peron. L., Br., peroneus longus, bre-
vis; Peron., peroneal; Post Tib, posterior tibialis; SPN, superficial peroneal nerve; t., tendon; Tib. Ant., tibialis
anterior; Tib. Post., tibialis posterior; Tib., tibial.

Key Point
 The peroneal artery is situated near the fibula between the tibialis posterior muscle and flexor hallucis
longus muscle.
 Normal MR Imaging Anatomy of the Thigh and Leg 635

Fig. 12. Axial T1W image. Lower leg. Compartmental muscle anatomy. a., artery; Ant Tib., anterior tibial; DPN,
deep peroneal nerve; EDL, extensor digitorum longus; EHL, extensor hallucis longus; FDL, flexor digitorum lon-
gus; FHL, flexor hallucis longus; Gastroc., gastrocnemius; m., muscle; n., nerve; Peron. Lg., Br., peroneus longus,
brevis; Peron., peroneal; Post Tib, posterior tibialis; SPN, superficial peroneal nerve; t., tendon; Tib. Ant., tibialis
anterior; Tib. Post., tibialis posterior; Tib., tibial.

Key Points

 The extensor hallucis longus muscle is almost entirely tendinous.

 The posterior tibial artery and the tibial nerve are interposed between the flexor hallucis longus
muscle and the tibialis posterior muscle. As the soleus muscle belly decreases in size, the gastrocnemius
tendon thickens.
636 Vohra et al

Fig. 13. Axial T1W images. Compartmental muscle anatomy. (A) Mid thigh. Compartmental boundaries are delin-
eated by solid black lines. (B) Mid leg. Compartmental boundaries are delineated by solid black lines.

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