Awareness of the anatomical variability determined by embryonic vascular development is important for radiologists and surgeons. Popliteal arterial variation may have clinical implications for vascular grafting, direct surgical repair, transluminal angioplasty, or embolectomy. Moreover, differentiating occlusion or arterial injury from variation depends on the clinician's knowledge of variations (1-10). Therefore, we aim to describe popliteal arterial variations. Materials and methodsThe femoral angiograms of 535 extremities (270 right, 265 left) in 350 consecutive patients who provided informed consent for the digital subtraction angiography (DSA) procedure were retrospectively examined. Of these, 226 limbs were evaluated bilaterally, and 83 limbs were evaluated unilaterally.The branching patterns were classified according to the system used by Kim et al. (Figs. 1a, 2a, 3a) (1). A normal level of popliteal branching (below the level of the tibial plateau) was classified as Type I. Type I was further divided into Type IA, in which the anterior tibial artery (AT) is the first branch, and the peroneal artery (PR) and posterior tibial artery (PT) arise from the tibioperoneal trunk (Fig. 1b); IB, in which there is no true tibioperoneal trunk and AT, PT, and PR arise within 0.5 cm (Fig. 1c); and IC, in which the PT is the first branch and AT and PR arise from the anterior tibioperoneal trunk (Fig. 1d).High division of the popliteal artery (at or above the level of the tibial plateau) was classified as Type II. This classification was further divided into Type IIA1, in which the AT arises above the knee and has a normal course (Fig. 2b); IIA2, in which the AT arises above the knee and has an initial medial curve (Fig. 2c); IIB, in which the PT is the first branch and arises above the knee joint, and the AT and PR have a common trunk (Fig. 2d); IIC, in which the PR is the first branch and arises above the knee joint, and the AT and PT have a common trunk; and IID, which involves high division of the popliteal artery with a trifurcation pattern and an AT with an initial medial course and a distal lateral course (Figs. 2e and 2f).Hypoplastic or aplastic branching with altered distal supply was classified as Type III. This group was further divided into Type IIIA, in which the PT is hypoplastic and the distal PT is replaced by the PR (Figs. 3b and 3c); Type IIIB, in which the AT is hypoplastic and the dorsalis pedis (PD) is replaced by the PR (Figs. 3d and 3e); and Type IIIC, in which the AT and PT are hypoplastic and the distal PT and DP are replaced by the PR (Figs. 3f and 3g). INTERVENTIONAL RADIOLOGY ORIGINAL ARTICLE Popliteal artery branching patterns detected by digital subtraction angiographyErtuğrul Mavili, Halil Dönmez, Güven Kahriman, Aysel Özaşlamacı, Nevzat Özcan, Kutay Taşdemir MATERIALS AND METHODSThe popliteal branching patterns were analyzed in 535 extremities (270 right, 265 left). Of these, 226 limbs were evaluated bilaterally, while 83 were evaluated unilaterally. The branching patterns were classifi...

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Objectives: Atlanto-occipital assimilation (AOA) is one of the most common skeletal anomalies of the craniovertebral junction (CVJ). Because its clinical symptomatology is non-specific and it has several variations, many cases go unnoticed which may lead to additional and unnecessary radiological examinations. In this study, we aimed to present CVJ abnormalities with MRI to improve diagnostic accuracy of AOA. Methods: Cervical MRIs of the patients registered in PACS between January 2008 and October 2011 were scanned and AOA was detected in 40 cases. Sagittal FSE T1 and T2-weighted cervical MRIs and axial T2*-GRE sequence images were re-evaluated for AOA typing, anterior atlantodental interval (AADI), posterior atlantodental interval (PADI) measurements, spine fusion anomalies, basilar invagination, tonsillar herniation, myelomalacia, suboccipital muscles and vertebral arteries (VAs). Results: CVJ abnormalities were present in all cases and the most frequent association was observed in suboccipital muscles (100%) and VAs (95%). 60% of the cases had decreased PADI, 32% C2-3 vertebrae fusion, 25% increased AADI, 22.5% basilar invagination, 15% myelomalacia and 5% tonsillar herniation. Conclusion: Suboccipital muscle abnormality was found in all AOA cases whatever the severity and type of the bony fusion. VA anomaly was observed as the second most common abnormality and accompanied preferably the cases with lateral body involvement. Being aware of additional CVJ abnormalities in MRI examinations may reduce unnecessary radiological examinations by increasing the AOA diagnosis rate.

In general, there are five lumbar vertebras in normal human subjects. But occasionally there are six. In such a situation, a radiologist need to discern between lumbarization of S1 (S1 vertebra becomes segmented and mimics L5) or due to hypoplastic 12th ribs, hence the T12 vertebra is wrongly assumed to be L1. These interesting images serve a multimodality approach to right aplasia/left hypoplasia of 12th rib, injury of left 11th rib and subluxation of left 11th Costovertebral joint in a patient with lumbar back pain.