Idiopathic and diabetic skeletal muscle necrosis: Evaluation by magnetic resonance imaging

Taj M. Kattapuram, Rajeev Suri, Michael S. Rosol, Andrew Rosenberg, Susan V. Kattapuram

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Objective: Idiopathic and diabetic-associated muscle necrosis are similar, uncommon clinical entities requiring conservative management and minimal intervention to avoid complications and prolonged hospitalization. An early noninvasive diagnosis is therefore essential. We evaluated the magnetic resonance imaging (MRI) characteristics of muscle necrosis in 14 patients, in eight of whom the diagnoses were confirmed histologically. Design and patients: Two experienced musculos keletal radiologists performed retrospective evaluations of the MRI studies of 14 patients with the diagnoses of skeletal muscle infarction. In 10 cases gadolinium-enhanced (T1-weighted fat-suppressed) sequences were available along with T1-weighted, T2-weighted images and STIR sequences, while in four cases contrast-enhanced images were not available. Results: Eight patients had underlying diabetes and in six patients the cause of the myonecrosis was considered idiopathic. T1-weighted images demonstrated isointense swelling of the involved muscle, with mildly displaced fascial planes. There was effacement of the fat signal intensity within the muscle. Fat-suppressed T2-weighted images showed diffuse heterogeneous high signal intensity in the muscles suggestive of edema. Perifascial fluid collection was seen in eight cases. Subcutaneous edema was present in seven patients. Following intravenous gadolinium administration, MRI demonstrated a focal area of heterogeneously enhancing mass with peripheral enhancement. Within this focal lesion, linear dark areas were seen with serpentine enhancing streaks separating them in eight cases. In two cases, a central relatively nonenhancing mass with irregular margins and peripheral enhancement was noted. The peripheral enhancement involved a significant part of the muscle. No focal fluid collection was noted. Conclusions: We believe that the constellation of imaging findings on T1- and T2-weighted images and post-gadolinium sequences is highly suggestive of muscle necrosis. We consider certain specific findings on gadolinium-enhanced images to be characteristic. The findings reported here should provide radiologists with useful information in making the diagnosis of skeletal muscle necrosis without resorting to invasive procedures.

Original languageEnglish
Pages (from-to)203-209
Number of pages7
JournalSkeletal Radiology
Volume34
Issue number4
DOIs
StatePublished - Apr 1 2005
Externally publishedYes

Fingerprint

Skeletal Muscle
Necrosis
Magnetic Resonance Imaging
Muscles
Gadolinium
Fats
Edema
Intravenous Administration
Infarction
Early Diagnosis
Hospitalization
Radiologists

Keywords

  • Diabetes
  • Diabetic myonecrosis
  • Idiopathic
  • MRI
  • Muscle necrosis
  • Myonecrosis
  • Skeletal muscle necrosis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Idiopathic and diabetic skeletal muscle necrosis : Evaluation by magnetic resonance imaging. / Kattapuram, Taj M.; Suri, Rajeev; Rosol, Michael S.; Rosenberg, Andrew; Kattapuram, Susan V.

In: Skeletal Radiology, Vol. 34, No. 4, 01.04.2005, p. 203-209.

Research output: Contribution to journalArticle

Kattapuram, Taj M. ; Suri, Rajeev ; Rosol, Michael S. ; Rosenberg, Andrew ; Kattapuram, Susan V. / Idiopathic and diabetic skeletal muscle necrosis : Evaluation by magnetic resonance imaging. In: Skeletal Radiology. 2005 ; Vol. 34, No. 4. pp. 203-209.
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AB - Objective: Idiopathic and diabetic-associated muscle necrosis are similar, uncommon clinical entities requiring conservative management and minimal intervention to avoid complications and prolonged hospitalization. An early noninvasive diagnosis is therefore essential. We evaluated the magnetic resonance imaging (MRI) characteristics of muscle necrosis in 14 patients, in eight of whom the diagnoses were confirmed histologically. Design and patients: Two experienced musculos keletal radiologists performed retrospective evaluations of the MRI studies of 14 patients with the diagnoses of skeletal muscle infarction. In 10 cases gadolinium-enhanced (T1-weighted fat-suppressed) sequences were available along with T1-weighted, T2-weighted images and STIR sequences, while in four cases contrast-enhanced images were not available. Results: Eight patients had underlying diabetes and in six patients the cause of the myonecrosis was considered idiopathic. T1-weighted images demonstrated isointense swelling of the involved muscle, with mildly displaced fascial planes. There was effacement of the fat signal intensity within the muscle. Fat-suppressed T2-weighted images showed diffuse heterogeneous high signal intensity in the muscles suggestive of edema. Perifascial fluid collection was seen in eight cases. Subcutaneous edema was present in seven patients. Following intravenous gadolinium administration, MRI demonstrated a focal area of heterogeneously enhancing mass with peripheral enhancement. Within this focal lesion, linear dark areas were seen with serpentine enhancing streaks separating them in eight cases. In two cases, a central relatively nonenhancing mass with irregular margins and peripheral enhancement was noted. The peripheral enhancement involved a significant part of the muscle. No focal fluid collection was noted. Conclusions: We believe that the constellation of imaging findings on T1- and T2-weighted images and post-gadolinium sequences is highly suggestive of muscle necrosis. We consider certain specific findings on gadolinium-enhanced images to be characteristic. The findings reported here should provide radiologists with useful information in making the diagnosis of skeletal muscle necrosis without resorting to invasive procedures.

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