Multiregional Pathologic Processes - Continuing Medical Education

Abnormal Signal Intensity in Skeletal Muscle at MR Imaging: Patterns, Pearls, and Pitfalls

Abnormal signal intensity within skeletal muscle is frequently encountered at magnetic resonance (MR) imaging. Potential causes are diverse, including traumatic, infectious, autoimmune, inflammatory, neoplastic, neurologic, and iatrogenic conditions. Alterations in muscle signal intensity seen in pathologic conditions usually fall into one of three recognizable patterns: muscle edema, fatty infiltration, and mass lesion. Muscle edema may be seen in polymyositis and dermatomyositis, mild injuries, infectious myositis, radiation therapy, subacute denervation, compartment syndrome, early myositis ossificans, rhabdomyolysis, and sickle cell crisis. Fatty infiltration may be seen in chronic denervation, in chronic disuse, as a late finding after a severe muscle injury or chronic tendon tear, and in corticosteroid use. The mass lesion pattern may be seen in neoplasms, intramuscular abscess, myonecrosis, traumatic injury, myositis ossificans, muscular sarcoidosis, and parasitic infection. Some of these conditions require prompt medical or surgical management, whereas others do not benefit from medical intervention. The ability to accurately diagnose these conditions is therefore necessary, and biopsy may be required to establish the correct diagnosis. Clues to the correct diagnosis and whether biopsy is necessary or appropriate are often present on the MR images, especially when they are correlated with clinical features and the findings from other imaging modalities.

References

  • 1 Hernandez RJ, Keim DR, Chenevert TL, Sullivan DB, Aisen AM. Fat-suppressed MR imaging of myositis. Radiology 1992; 182:217-219. LinkGoogle Scholar
  • 2 Greco A, McNamara MT, Escher MB, Trifilio G, Parient J. Spin-echo and STIR MR imaging of sports related muscle injuries at 1.5T. J Comput Assist Tomogr 1991; 15:994-999. Crossref, MedlineGoogle Scholar
  • 3 May DA, Good RB, Smith DK, Parsons TW. MR imaging of musculoskeletal tumors and tumor mimickers with intravenous gadolinium: experience with 242 patients. Skeletal Radiol 1997; 26:2-15. Crossref, MedlineGoogle Scholar
  • 4 Resnick D. Dermatomyositis and polymyositis. In: Resnick D, eds. Diagnosis of bone and joint disorders. 3rd ed. Philadelphia, Pa: Saunders, 1995; 1218-1231. Google Scholar
  • 5 Reimers CD, Schedel H, Fleckenstein JL, et al. Magnetic resonance imaging of skeletal muscles in idiopathic inflammatory myopathies of adults. J Neurol 1994; 241:306-314. Crossref, MedlineGoogle Scholar
  • 6 Fleckenstein JL, Watumull D, Conner KE, et al. Denervated human skeletal muscle: MR imaging evaluation. Radiology 1993; 187:213-218. LinkGoogle Scholar
  • 7 Mattila KT, Lukka R, Hurme T, Komu M, Alanen A, Kalimo H. Magnetic resonance imaging and magnetization transfer in experimental myonecrosis in the rat. Magn Reson Med 1995; 33:185-192. Crossref, MedlineGoogle Scholar
  • 8 West GA, Haynor DR, Goodkin R, et al. Magnetic resonance imaging signal changes in denervated muscles after peripheral nerve injury. Neurosurgery 1994; 35:1077-1085. Crossref, MedlineGoogle Scholar
  • 9 Morikawa S, Inubushi T, Kito K. Lactate and pH mapping in calf muscles of rats during ischemia/reperfusion assessed by in vivo proton and phosphorus magnetic resonance chemical shift imaging. Invest Radiol 1994; 29:217-223. Crossref, MedlineGoogle Scholar
  • 10 Park JH, Vansant JP, Kumar NG, et al. Dermatomyositis: correlative MR imaging and P-31 MR spectroscopy for quantitative characterization of inflammatory disease. Radiology 1990; 177:473-479. LinkGoogle Scholar
  • 11 Lamminen AE. Magnetic resonance imaging of primary skeletal muscle diseases: patterns of distribution and severity of involvement. Br J Radiol 1990; 63:946-950. Crossref, MedlineGoogle Scholar
  • 12 Fujino H, Kobayashi T, Goto I, Onitsuka H. Magnetic resonance imaging of the muscles in patients with polymyositis and dermatomyositis. Muscle Nerve 1991; 14:716-720. Crossref, MedlineGoogle Scholar
  • 13 Fraser DD, Frank JA, Dalakas M, Miller FW, Hicks JE, Plotz P. Magnetic resonance imaging in the idiopathic inflammatory myopathies. J Rheumatol 1991; 18:1693-1700. MedlineGoogle Scholar
  • 14 Hernandez RJ, Sullivan DB, Chenevert TL, Keim DR. MR imaging in children with dermatomyositis: musculoskeletal findings and correlation with clinical and laboratory findings. AJR Am J Roentgenol 1993; 161:359-366. Crossref, MedlineGoogle Scholar
  • 15 Fleckenstein JL, Reimers CD. Inflammatory myopathies: radiologic evaluation. Radiol Clin North Am 1996; 34:427-439. MedlineGoogle Scholar
  • 16 Fleckenstein JL, Weatherall PT, Parkey RW, Payne JA, Peshock RM. Sports-related muscle injuries: evaluation with MR imaging. Radiology 1989; 172:793-798. LinkGoogle Scholar
  • 17 McCully K, Shellock FG, Bank WJ, Posner JD. The use of nuclear magnetic resonance to evaluate muscle injury. Med Sci Sports Exerc 1992; 24:537-542. MedlineGoogle Scholar
  • 18 De Smet AA. Magnetic resonance findings in skeletal muscle tears. Skeletal Radiol 1993; 22:479-484. Crossref, MedlineGoogle Scholar
  • 19 Shellock FG, Fleckenstein JL. Magnetic resonance imaging of muscle injuries. In: Stoller DW, eds. Magnetic resonance imaging in orthopaedics and sports medicine. 2nd ed. Philadelphia, Pa: Lippincott-Raven, 1997; 1341-1362. Google Scholar
  • 20 Palmer WE, Kuong SJ, Elmadbouh HM. MR imaging of myotendinous strain. AJR Am J Roentgenol 1999; 173:703-709. Crossref, MedlineGoogle Scholar
  • 21 Nurenberg P, Giddings CJ, Stray-Gundersen J, Fleckenstein JL, Gonyea WJ, Peshock RM. MR imaging–guided muscle biopsy for correlation of increased signal intensity with ultrastructural change and delayed-onset muscle soreness after exercise. Radiology 1992; 184:865-869. LinkGoogle Scholar
  • 22 Steinbach LS, Tehranzadeh J, Fleckenstein JL, Vanarthos WJ, Pais MJ. Human immunodeficiency virus infection: musculoskeletal manifestations. Radiology 1993; 186:833-838. LinkGoogle Scholar
  • 23 Resnick D, Niwayama G. Osteomyelitis, septic arthritis, and soft tissue infection: mechanisms and situations. In: Resnick D, eds. Diagnosis of bone and joint disorders. 3rd ed. Philadelphia, Pa: Saunders, 1995; 2325-2418. Google Scholar
  • 24 Sayers ME, Chou SM, Calabrese LH. Inclusion body myositis: analysis of 32 cases. J Rheumatol 1992; 19:1385-1389. MedlineGoogle Scholar
  • 25 Calabrese LH, Chou SM. Inclusion body myositis. Rheum Dis Clin North Am 1994; 20:955-972. Crossref, MedlineGoogle Scholar
  • 26 Beltran J, Rosenberg ZS. Diagnosis of compressive and entrapment neuropathies of the upper extremity: value of MR imaging. AJR Am J Roentgenol 1994; 163:525-531. Crossref, MedlineGoogle Scholar
  • 27 Fritz RC, Helms CA, Steinbach LS, Genant HK. Suprascapular nerve entrapment: evaluation with MR imaging. Radiology 1992; 182:437-444. LinkGoogle Scholar
  • 28 Helms CA, Martinez S, Speer KP. Acute brachial neuritis (Parsonage-Turner syndrome): MR imaging appearance—report of three cases. Radiology 1998; 207:255-259. LinkGoogle Scholar
  • 29 Bredella MA, Tirman PFJ, Fritz RC, Wischer TK, Stork A, Genant HK. Denervation syndromes of the shoulder girdle: MR imaging with electrophysiologic correlation. Skeletal Radiol 1999; 28:567-572. Crossref, MedlineGoogle Scholar
  • 30 Stoller DW, Ferkel RD. The ankle and foot. In: Stoller DW, eds. Magnetic resonance imaging in orthopaedics and sports medicine. 2nd ed. Philadelphia, Pa: Lippincott-Raven, 1997; 443-595. Google Scholar
  • 31 Resnick D, Georgen TG, Niwayama G. Physical injury: concepts and terminology. In: Resnick D, eds. Diagnosis of bone and joint disorders. 3rd ed. Philadelphia, Pa: Saunders, 1995; 2561-2692. Google Scholar
  • 32 Kransdorf MJ, Meis JM, Jelinek JS. Myositis ossificans: MR appearance with radiologic-pathologic correlation. AJR Am J Roentgenol 1990; 157:243-248. Google Scholar
  • 33 DeSmet AA, Norris MA, Fisher DR. Magnetic resonance imaging of myositis ossificans: analysis of seven cases. Skeletal Radiol 1992; 21:503-507. Crossref, MedlineGoogle Scholar
  • 34 Resnick D, Niwayama G. Soft tissues. In: Resnick D, eds. Diagnosis of bone and joint disorders. 3rd ed. Philadelphia, Pa: Saunders, 1995; 4491-4622. Google Scholar
  • 35 Shintani S, Shiigai T. Repeat MRI in acute rhabdomyolysis: correlation with clinicopathological findings. J Comput Assist Tomogr 1993; 17:786-791. Crossref, MedlineGoogle Scholar
  • 36 Feldman F, Zwass A, Staron RB, Haramati N. MRI of soft tissue abnormalities: a primary cause of sickle cell crisis. Skeletal Radiol 1993; 22:501-506. MedlineGoogle Scholar
  • 37 Fleckenstein JL, Weatherall PT, Parkey RW, et al. Acute effects of exercise on MR imaging of skeletal muscle in normal volunteers. AJR Am J Roentgenol 1988; 151:231-237. Crossref, MedlineGoogle Scholar
  • 38 Disler DG, Cohen MS, Krebs DE, Roy SH, Rosenthal DI. Dynamic evaluation of exercising leg muscle in healthy subjects with echo planar MR imaging: work rate and total work determine rate of T2 change. J Magn Reson Imaging 1995; 5:588-593. Crossref, MedlineGoogle Scholar
  • 39 Kransdorf MJ. Is it necessary to routinely use gadolinium in the MR imaging evaluation of soft-tissue tumors of the extremities? AJR Am J Roentgenol 1995; 165:1545. CrossrefGoogle Scholar
  • 40 Laitt RD, Hoh B, Wakeley C, et al. The value of the short tau inversion recovery sequence in magnetic resonance imaging of thyroid eye disease. Br J Radiol 1994; 67:244-247. Crossref, MedlineGoogle Scholar
  • 41 Pelligrini VD, Reid JS, Evarts CM. Complications. In: Rockwood CA, Green DP, eds. Fractures in adults. 4th ed. Philadelphia, Pa: Lippincott-Raven, 1996; 425-511. Google Scholar
  • 42 Resnick D. Disorders due to medications and other chemical agents. In: Resnick D, eds. Diagnosis of bone and joint disorders. 3rd ed. Philadelphia, Pa: Saunders, 1995; 3309-3342. Google Scholar
  • 43 Pareyson D, Morandi L, Scaioli V, Marazzi R, Boiardi A, Sghirlanzoni A. Neurogenic muscle hypertrophy: report of two cases. J Neurol 1989; 236:292-295. Crossref, MedlineGoogle Scholar
  • 44 Stoller DW, Johnston JO, Steinkirchner TM. Bone and soft tissue tumors. In: Stoller DW, eds. Magnetic resonance imaging in orthopaedics and sports medicine. 2nd ed. Philadelphia, Pa: Lippincott-Raven, 1997; 1231-1339. Google Scholar
  • 45 Nunez-Hoyo M, Gardner CL, Motta AO, Ashmead JW. Skeletal muscle infarction in diabetes: MR findings. J Comput Assist Tomogr 1993; 17:986-988. Crossref, MedlineGoogle Scholar
  • 46 Van Slyke MA, Ostrov BE. MRI evaluation of diabetic muscle infarction. Magn Reson Imaging 1995; 13:325-329. Crossref, MedlineGoogle Scholar
  • 47 Kiers L. Diabetic muscle infarction: magnetic resonance imaging (MRI) avoids the need for biopsy (letter). Muscle Nerve 1995; 18:129-130. MedlineGoogle Scholar
  • 48 Chason DP, Fleckenstein JL, Burns DK, Rojas G. Diabetic muscle infarction: radiologic evaluation. Skeletal Radiol 1996; 25:127-132. Crossref, MedlineGoogle Scholar
  • 49 Matsuo M, Ehara S, Tamakawa Y, Chida E, Nishida J, Sugai T. Muscular sarcoidosis. Skeletal Radiol 1995; 24:535-537. MedlineGoogle Scholar
  • 50 Martin J, Marco V, Zidan A, Marco C. Hydatid disease of the soft tissues of the lower limb: findings in three cases. Skeletal Radiol 1993; 22:511-514. Crossref, MedlineGoogle Scholar
  • 51 Beltran J, Simon DC, Katz W, Weis LD. Increased MR signal intensity in skeletal muscle adjacent to malignant tumors: pathologic correlation and clinical relevance. Radiology 1987; 162:251-255. LinkGoogle Scholar
  • 52 Kuno RC, Richardson ML, Zink-Brody GC, Coldwell DM. Prevalence of muscle injury following intra-arterial chemotherapy. Skeletal Radiol 1996; 25:345-348. Crossref, MedlineGoogle Scholar
  • 53 Pastakia B, Horvath K, Kurtz D, Udelsman R, Doppman JL. Giant rectus sheath hematomas of the pelvis complicating anticoagulant therapy: CT findings. J Comput Assist Tomogr 1984; 8:1120-1123. Crossref, MedlineGoogle Scholar
  • 54 Goldman AB. Myositis ossificans circumscripta: a benign lesion with a malignant differential diagnosis. AJR Am J Roentgenol 1976; 126:32-40. Crossref, MedlineGoogle Scholar

Article History

Published in print: Oct 2000