(Fig 4-C.06) Quadriceps Fat Pad Edema

https://youtu.be/mnufX-5CQ6E

https://youtu.be/EiNzQqJbmYs

 

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📌 Quadriceps Fat Pad (Anterior Suprapatellar Fat Pad)

✅ Evaluation Criteria

• Radiologists should assess the quadriceps fat pad for size, morphology, and signal intensity. 
• An abnormal signal on fluid-sensitive MRI is defined as greater than muscle but less than fluid. 
• As the signal intensity approaches that of fluid, a mass effect with a posterior convex border is more likely (1).

 

✅Pathology and Clinical Significance

• The quadriceps fat pad resembles Hoffa’s disease, representing an overuse injury causing edema and hemorrhage rather than impingement. 
• Edema and mass effect in this region are linked to knee osteoarthritis, especially at the patellofemoral joint (2).
• In some cases, the intratendinous fat of the adjacent quadriceps tendon (entheseal fat) is involved, which may be more symptomatic due to the innervation of the fat enthesis (1).

 

✅ Common MRI Findings

• High signal intensity deep to the distal portion of the tendon within the quadriceps fat pad is common. 
• While often incidental, it can be associated with anterior knee pain when there is a mass effect indenting the suprapatellar pouch (3)).
• High signal intensity on T2-weighted images may indicate an inflammatory cyst within the quadriceps fat pad, necessitating further investigation to understand its impact on knee function (4).

 

✅ Clinical Relationship with Knee Pain

• Unlike the infrapatellar fat pad (IFP), which is directly related to knee pain due to its rich innervation, the relationship between the anterior suprapatellar fat pad (ASPFP) and knee pain is more controversial (1).

 

✅ Anatomy of Anterior Suprapatellar (Quadriceps) Fat Pad

• The quadriceps fat pad is a small triangular structure located superior to the patella and deep to the quadriceps tendon.
• It is separated from the prefemoral fat pad by the suprapatellar bursa. This fat pad is believed to promote stress dissipation or act as a mechanosensory organ (1).

References

1. Magn Reson Imaging Clin N Am 22 (2014) 725–741
2. Skeletal Radiology (2020) 49:823–836
3. Radiol Clin N Am 51 (2013) 393–411
4. Diagn Interv Imaging. 2016;97(7-8):789-807

 

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