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Normal Anatomy and Strains of the Deep Musculotendinous Junction of the Proximal Rectus Femoris: MRI Features

¹ Department of Radiology, Beth Israel Medical Center, First Ave. at 16th St., New York, NY 10003.
² Department of Radiology, NYU Hospital for Joint Diseases, New York, NY 10003.

View larger version (33K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Drawing of rectus femoris muscle. Direct head originates from anterior–inferior iliac spine (gray arrow) and blends with anterior fascia. Indirect head originates more posteriorly from acetabulum (black arrow) and dives into rectus femoris muscle belly. Modified with permission from [8].

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —T1-weighted images show normal MRI anatomy of rectus femoris in multiple patients. Axial image (TR/TE, 500/12) shows origin of direct head (arrow) is off anterior–inferior iliac spine.

View larger version (160K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —T1-weighted images show normal MRI anatomy of rectus femoris in multiple patients. Axial image (500/12) shows indirect head as it originates, slightly more distally (white arrow), from superior acetabulum and joins direct head to form conjoined tendon (black arrow).

View larger version (172K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —T1-weighted images show normal MRI anatomy of rectus femoris in multiple patients. Axial image (500/12) shows blending of direct head, more distally, with anterior fascia of rectus femoris (black arrow). Note that indirect head (white arrow) is now intrasubstance.

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —T1-weighted images show normal MRI anatomy of rectus femoris in multiple patients. Sagittal T1-weighted image (550/14) shows direct head (black arrow), conjoined tendon (white arrow), and deep tendon (arrowheads).

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2E —T1-weighted images show normal MRI anatomy of rectus femoris in multiple patients. Coronal image (500/12) shows origin of direct head off anterior–inferior iliac spine (black arrow), conjoined tendon (white arrow), and deep tendon (arrowheads).

View larger version (175K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2F —T1-weighted images show normal MRI anatomy of rectus femoris in multiple patients. Coronal image (500/12), more posterior than E, depicts indirect head as it originates from acetabular ridge (arrow).

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —"Bull's-eye" sign after rectus femoris injury. Bull's-eye sign after rectus femoris injury in 19-year-old man after tearing sensation in thigh. Axial T2 fat-suppressed image (TR/TE, 5,050/50) depicts halo of increased signal (white arrows) around deep tendon (black arrow).

View larger version (101K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —"Bull's-eye" sign after rectus femoris injury. Bull's-eye sign after rectus femoris injury in 35-year-old woman. Axial T1-weighted image (600/13) shows halo of increased signal (arrow) surrounding low-signal deep tendon, which is consistent with fatty atrophy due to remote injury.

View larger version (76K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Fibrous scarring after remote rectus femoris injury. 19-year-old man who presented with persistent thigh pain after remote rectus femoris injury. Coronal T1-weighted image (TR/TE, 500/14) shows longitudinal scar (arrow) adjacent to deep tendon and scarring and irregularity of distal tendon (arrowhead).

View larger version (77K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Fibrous scarring after remote rectus femoris injury. 21-year-old man with fibrous scarring from remote rectus femoris injury. Axial T1-weighted image (500/14) shows low signal surrounding left deep tendon (white arrow) representing fibrous encasement. Compare this finding to normal-appearing right deep tendon (black arrow).

View larger version (91K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —Pseudocyst in 12-year-old boy with remote rectus femoris injury. Axial fat-saturated T1-weighted image after IV gadolinium injection (TR/TE, 600/14) reveals fluid collection with rim enhancement (white arrow); these findings are consistent with pseudocyst adjacent to deep tendon (black arrow).

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