NMR of skeletal muscle. Differences in relaxation parameters related to extracellular/intracellular fluid spaces

T2 Distribution in the Forearm Muscles and the T2 Threshold for Defining Activated Muscle

Purpose:

In order to detect exercised muscles by the increase in T₂, we have defined a Gaussian T₂ distribution and reference values (T_2r and SD_r) in resting state muscles, and a threshold for detecting exercised muscles.

Methods:

The subjects were healthy adult volunteers (14 males and 12 females). Multiple-spin-echo (MSE) MR images were obtained with 10 TE values from 10 to 100 ms using a 0.2T MRI system. T₂ values for 10 forearm muscles were obtained in the resting state and after isometric wrist flexion exercise with 5%, 15%, and 25% of the maximum voluntary contraction (MVC). Z values were obtained by (T_2e − T_2r)/SD_r, where T_2e was T₂ after exercise. Based on sample size calculations, three thresholds (Z_T = 1.00, 2.56, and 3.07) were applied to agonist and antagonist muscles.

Results:

A normal distribution of T₂ was detected in resting muscles at 34 ± 3 ms (mean ± standard deviation [SD]) in 26 subjects using the Kolmogorov–Smirnov test, the Shapiro–Wilk test, and the Jarque–Bera test (P > 0.05). No gender differences were shown between the T₂ or SD, and a similar result was obtained in 12 measurements on a single subject (P < 0.01). The T_2r and SD_r were used for reference values. The threshold Z_T = 1.00 showed the highest sensitivity (0.86) even with 5% MVC, but it showed a lower specificity (0.85) than the other thresholds. Z_T = 3.07 showed the highest specificity (1.0), but it showed a lower sensitivity (0.36) with the 5% MVC, compared with Z_T = 2.56 (0.50). The receiver operating characteristics analysis also supported these results.

Conclusion:

We found that the T₂ distribution in muscles was Gaussian, suggesting that a one-sample t-test can be applied, and that Z_T = 2.56 could cover low-intensity exercise with high specificity and a low false-positive rate.

Renal tumors with low signal intensities on T2-weighted MR image: radiologic-pathologic correlation

Accurate characterization of renal masses is essential for ensuring appropriate management. Low T2 signal intensity is a common feature of papillary renal cell carcinoma and fat-poor angiomyolipoma. Nonetheless, other types of renal cell carcinoma, oncocytoma, hemangioma, lymphoma, leiomyoma, and urothelial cell carcinoma also can show low signal intensities on T2-weighted imaging (T2WI). Histopathologic features that can lead to low T2 signal intensities in renal tumors include smooth muscle component, papillary architecture, a high nucleus-to-cytoplasm ratio, and hemorrhage. To establish an appropriate differential diagnosis for renal tumors on MRI, it is necessary to understand the relationship between the MR signal intensities and the histopathologic and morphologic features, in addition to contrast enhancement patterns and diffusion characteristics of the tumors.

MR Imaging of Experimental Intramuscular Hemorrhage AT 0.02 T

Intramuscular hemorrhage was induced by injecting autologous blood into the paraspinal muscle of 8 rabbits. In order to evaluate the time-dependent changes of hemorrhage observed on MRI, the animals were imaged at different stages of blood resolution at 0.02 tesla (T), and control examined with ultrasound using a 7.5 MHz linear transducer. Six inversion recovery sequences (TR= 1000 ms. TE = 30 ms, and TI = 18, 48, 148, 201, 302, and 398 ms) were used for the invivo calculation of T1 relaxation times. IR 1000 (398)/30 imaging was performed before and after the Gd-DOTA administration. The hemorrhage was evident on MR images throughout the study, especially on the T2 weighted (SE 1000/100) images. MRI showed the healing lesion longer than ultrasound. The T1 relaxation time increased during the time of resolution. Lesions on days 4 to 7 enhanced in intensity after the injection of Gd-DOTA.

Mr Relaxation Times and Fiber Type Predominance of the Psoas and Multifidus Muscle

MR relaxation times, fiber composition, nonmyofiber space, water content, and fat content of human psoas and multifidus muscle samples of 10 male cadavers were studied in vitro. The T1 and T2 relaxation times of multifidus muscle were significantly longer than those of the psoas muscle. On average, type 1 fibers (slow fibers with a small cross-sectional diameter) predominated in both muscles. There was no correlation between the relative mass of type 1 or 2 fibers (fast fibers with a large cross-sectional diameter) or nonmyofiber space and the relaxation times. The quantity of fat in the muscle did not correlate with the relaxation times either.

Rapid assessment of quantitative T1, T2 and T2* in lower extremity muscles in response to maximal treadmill exercise

MRI provides a non-invasive diagnostic platform to quantify the physical and physiological attributes of skeletal muscle at rest and in response to exercise. MR relaxation parameters (T1, T2 and T2*) are characteristic of tissue composition and metabolic properties. With the recent advent of quantitative techniques that allow rapid acquisition of T1, T2 and T2* maps, we posited that an integrated treadmill exercise-quantitative relaxometry paradigm can rapidly characterize exercise-induced changes in skeletal muscle relaxation parameters. Accordingly, we investigated the rest/recovery kinetics of T1, T2 and T2* in response to treadmill exercise in the anterior tibialis, soleus and gastrocnemius muscles of healthy volunteers, and the relationship of these parameters to age and gender. Thirty healthy volunteers (50.3 ± 16.6 years) performed the Bruce treadmill exercise protocol to maximal exhaustion. Relaxometric maps were sequentially acquired at baseline and for approximately 44 minutes post-exercise. Our results show that T1, T2 and T2* are significantly and differentially increased immediately post-exercise among the leg muscle groups, and these values recover to near baseline within 30-44 minutes. Our results demonstrate the potential to characterize the kinetics of relaxation parameters with quantitative mapping and upright exercise, providing normative values and some clarity on the impact of age and gender.

Comparison of T2-weighted MRI with and without fat suppression for differentiating renal angiomyolipomas without visible fat from other renal tumors

OBJECTIVE

The purpose of this study was to retrospectively compare the usefulness of T2-weighted imaging with and without fat suppression for differentiating angiomyolipomas (AMLs) without visible fat from other renal tumors.

MATERIALS AND METHODS

MRI was performed in 111 patients (66 men and 46 women; age range, 17-78 years) who had pathologically diagnosed (14 AMLs, 86 renal cell carcinomas [RCCs], and three other tumors) and clinically diagnosed (eight AMLs) renal masses without visible fat or a cystic portion on unenhanced CT. The signal intensity (SI), tumor-to-kidney SI ratio, tumor-to-spleen SI ratio on T2-weighted imaging and fat-suppressed T2-weighted imaging, and tumor-fat subtraction index were measured for each tumor. Receiver operating characteristic (ROC) analysis was used to evaluate diagnostic accuracy of SI ratios.

RESULTS

The highest area under the ROC curve was 0.886 for tumor-to-kidney SI ratio on fat-suppressed T2-weighted imaging. With a tumor-to-kidney SI ratio of 0.9 on fat-suppressed T2-weighted imaging, the sensitivity, specificity, positive predictive value, and negative predictive value were 90.9%, 71.1%, 43.5%, and 97%, respectively. The highest tumor-to-kidney SI ratio of AMLs without visible fat was 1.09. Ninety-eight percent of renal tumors with a tumor-to-kidney SI ratio greater than 1.09 were RCCs (51/52), especially clear cell RCCs (82.7%, 43/52).

CONCLUSION

Fat-suppressed T2-weighted imaging is more useful than T2-weighted imaging for differentiating AMLs without visible fat from non-AMLs. The high SI of solid renal masses on fat-suppressed T2-weighted imaging can be indicative of non-AMLs, especially RCCs.

Association of T2 relaxation time determined by magnetic resonance imaging and intramyocellular lipid content of the soleus muscle in healthy subjects

The level of intramyocellular lipids (IMCL) is a physiological marker of skeletal muscle function. ¹H‐magnetic resonance spectroscopy (MRS) is an established method to measure IMCL contents in vivo. However, all of the MR systems do not always contain measurement instruments for ¹H‐MRS, thus in a clinical setting, alternative methods for estimation of IMCL content are needed. Here, we investigated the association between T1 and T2 relaxation times, determined by MR imaging, and IMCL measured by ¹H‐MRS in the soleus and tibialis anterior muscles of 15 healthy male subjects. Intriguingly, in the soleus muscle, but not in the tibialis anterior muscle, T2 relaxation time correlated significantly with IMCL (r = 0.65, P < 0.05). The result suggests the possibility that T2 relaxation time of the soleus muscle can be used to estimate IMCL in a clinical setting. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00108.x, 2011)

Lumbar muscle dysfunction during remission of unilateral recurrent nonspecific low-back pain: evaluation with muscle functional MRI

OBJECTIVES

After cessation of a low-back pain (LBP) episode, alterations in trunk muscle behavior, despite recovery from pain, have been hypothesized to play a pathogenic role in the recurrence of LBP. This study aimed to identify the presence of lumbar muscle dysfunction during the remission of recurrent LBP, while performing a low-load trunk-extension movement.

METHODS

Thirteen participants with unilateral recurrent LBP were tested at least 1 month after cessation of the previous LBP episode and were compared with a healthy control group without any history of LBP (n=13). Also, differences between previously painful and nonpainful sides were examined. Muscle functional magnetic resonance imaging, based on quantitative T2-imaging, was used to examine muscle tissue characteristics (T2 rest) and muscle recruitment (T2 shift) during prone trunk extension. The lumbar multifidus, erector spinae, quadratus lumborum, and psoas were bilaterally visualized on 2 lumbar levels using a T2-weighted (spin-echo multicontrast) magnetic resonance imaging sequence.

RESULTS

Linear mixed model analysis revealed a significantly lower T2 rest (P=0.044) and a significantly higher T2 shift (P=0.034) solely for the multifidus in the LBP group compared with the control group. No significant differences between pain sides were found.

DISCUSSION

Lower T2-rest values have been suggested to correlate with a conversion of the multifidus' fiber typing toward the glycolytic muscle spectrum. Elevated T2 shifts correspond with increased levels of metabolic activity in the multifidus in the LBP group, for which several hypotheses can be put forward. Taken together, these findings provide evidence of concurrent alterations in the multifidus structure and activity in individuals with unilateral recurrent LBP, despite being pain free and functionally recovered.

Postmortem imaging of antemortem myocardial ischaemia

OBJECTIVES

To determine the minimum survival time for detection of antemortem myocardial ischaemia with postmortem imaging (PMI) techniques.

METHODS

Nine pigs underwent ligation of the left anterior descending (LAD) (8) and/or right coronary artery (RCA) branch (4), and were killed 30 min-6 h after ligation. PMI (MRI and CT angiography) was performed 2-55 h after euthanasia. Signal intensity of myocardial segments was measured. The hearts were removed, the coronary arteries injected to mark perfused segments, and sections submitted for histology.

RESULTS

MRI T2-weighted sequences showed the ischaemic area as hyperintense in 4/4 LAD ligations with ≥4 h of ischaemia but in 0/4 with <4 h. Histological evidence of ischaemia was present in 4/4 animals after 4 h. Right ventricular ischaemic myocardium was visible on MRI T2-weighted sequences after 6 h of ischaemia in one animal. CT angiography showed the occluded coronary artery in all cases.

CONCLUSIONS

Ischaemic lesions of the left ventricle, but not of the right, at least 4 h old can be detected as hyperintense areas on T2-weighted postmortem MRI. This technique is most sensitive in the first 24 h after death. Other sequences did not enhance detection.

KEY POINTS

• Left ventricular myocardial ischaemia/infarction can be demonstrated by postmortem imaging (PMI). • Ischaemia/infarction is better detected if survival time is at least 4 h. • Right ventricular ischaemia/infarction is not reliably detected by PMI. • Computed tomography angiography can demonstrate arterial occlusion.

Sequential MR imaging of denervated and reinnervated skeletal muscle as correlated to functional outcome

PURPOSE

To prospectively assess the short inversion time inversion-recovery (STIR) magnetic resonance (MR) signal intensity changes of denervated and reinnervated skeletal muscle over time in clinical patients.

MATERIALS AND METHODS

This study was approved by the institutional review board, and informed consent was obtained from all patients. Twenty-three patients with complete traumatic transection of the median or ulnar nerve in the forearm were prospectively followed for 12 months after surgical nerve repair. STIR MR images of selected intrinsic hand muscles were obtained 1, 3, 6, 9, and 12 months after nerve repair, and signal intensities of denervated and reinnervated muscles were measured semiquantitatively. After 12 months, hand function was assessed. Signal intensity ratios were correlated to functional outcome with analysis of variance.

RESULTS

Of the 23 patients, 10 had good function recovery, while 13 had poor recovery. For the group with good function recovery, mean signal intensity ratios of 1.267 ± 0.060 (standard deviation), 1.357 ± 0.116, 1.297 ± 0.111, 1.205 ± 0.096, and 1.086 ± 0.104 were found at 1-, 3-, 6-, 9-, and 12-month follow-up, respectively. In the group with poor recovery, mean signal intensity ratios of 1.299 ± 0.056, 1.377 ± 0.094, 1.419 ± 0.117, 1.398 ± 0.111, and 1.342 ± 0.095 were found at 1-, 3-, 6-, 9-, and 12-month follow-up, respectively. Comparison of the group with poor function recovery and the group with good function recovery showed significant differences at 6-, 9-, and 12-month follow-up (P = .035, P = .001, and P < .001, respectively), with normalizing signal intensities in the group with good function recovery and sustained high signal intensity in the group with poor function recovery.

CONCLUSION

STIR MR imaging can be used to differentiate between denervated and reinnervated muscles for at least 12 months after nerve transection.

MR imaging mapping of skeletal muscle denervation in entrapment and compressive neuropathies

The diagnoses of entrapment and compressive neuropathies have been based on the findings from clinical examinations and electrophysiologic tests, such as electromyography and nerve conduction studies. The use of magnetic resonance (MR) imaging for the diagnosis of entrapment or compressive neuropathies is increasing because MR imaging is particularly useful for discerning potential causes and for identifying associated muscle denervation. However, it is sometimes difficult to localize nerve entrapment or demonstrate nerve compression lesions with MR imaging. Nevertheless, even in these cases, MR imaging may show denervation-associated changes in specific muscles innervated by the affected nerves. The analysis of denervated muscle distributions by using MR imaging, with a knowledge of nerve innervation patterns, would be helpful for determining the nerves involved and the levels of nerve entrapment or compression. In this context, the mapping of skeletal muscle denervation with MR imaging has a supplementary or even a primary role in the diagnosis of entrapment and compressive neuropathies.

The hypointense liver lesion on T2-weighted MR images and what it means

The vast majority of focal liver lesions are hyperintense on T2-weighted magnetic resonance (MR) images. Rarely, however, hepatic nodules may appear totally or partially hypointense on those images. Causes for this uncommon appearance include deposition of iron, calcium, or copper and are related to the presence of blood degradation products, macromolecules, coagulative necrosis, and other conditions. Although rare, low signal intensity relative to surrounding liver on T2-weighted images may be seen in a wide spectrum of lesions. Examples include cases of focal nodular hyperplasia, hepatocellular adenoma, hepatocellular carcinoma, metastases, leiomyoma, siderotic or dysplastic nodules, nodules in Wilson disease, granuloma, and hydatid cyst. On fat-suppressed T2-weighted images, nodules with a lipomatous component, such as lipoma, angiomyolipoma, hepatocellular adenoma, and hepatocellular carcinoma may also appear partially or totally hypointense. The conjunction of other MR imaging findings and their integration in the clinical setting may allow a correct diagnosis in a considerable proportion of cases. The cause for T2-weighted hypointensity may not be, however, always recognized, and only pathologic correlation may provide the answer. The aims of this work are to discuss the causes and mechanisms of hypointensity of liver lesions on T2-weighted images and proposing an algorithm for classification that may be useful as a quick reminder for the interested reader.

Differentiation between deep and superficial fibers of the lumbar multifidus by magnetic resonance imaging

The purpose of this study was to investigate the differentiation in muscle tissue characteristics and recruitment between the deep and superficial multifidus muscle by magnetic resonance imaging. The multifidus is a very complex muscle in which a superficial and deep component can be differentiated from an anatomical, biomechanical, histological and neuromotorial point of view. To date, the histological evidence is limited to low back pain patients undergoing surgery and cadavers. The multifidus muscles of 15 healthy subjects were investigated with muscle functional MRI. Images were taken under three different conditions: (1) rest, (2) activity without pain and (3) activity after experimentally induced low back muscle pain. The T2 relaxation time in rest and the shift in T2 relaxation time after activity were compared for the deep and superficial samples of the multifidus. At rest, the T2 relaxation time of the deep portion was significantly higher compared to the superficial portion. Following exercise, there was no significant difference in shift in T2 relaxation time between the deep and superficial portions, and in the pain or in the non-pain condition. In conclusion, this study demonstrates a higher T2 relaxation time in the deep portion, which supports the current assumption that the deep multifidus has a higher percentage of slow twitch fibers compared to the superficial multifidus. No differential recruitment has been found following trunk extension with and without pain induction. For further research, it would be interesting to investigate a clinical LBP population, using this non-invasive muscle functional MRI approach.

[Post-traumatic tarsal tunnel syndrome: interest of muscular MRI]

INTRODUCTION

Tarsal tunnel syndrome is a compressive neuropathy of the tibial nerve with multiple causes. This syndrome is difficult to diagnose and can be missed because of its subjective symptomatology.

OBSERVATION

In our patient, suspected post-traumatic tarsal tunnel syndrome was confirmed at MRI. This case highlights muscle signal anomalies caused by their denervation in the tibial nerve territory.

CONCLUSION

MRI can provide supplementary information to the electromyography (EMG) and contribute to positive and etiologic diagnosis of peripheral nerve lesions.

Selective Atrophy of the Abductor Digiti Quinti: An MRI Study

OBJECTIVE

Entrapment of the first branch of the lateral plantar nerve is a well-recognized but diagnostically elusive cause of heel pain. The MR finding of selective atrophy of the abductor digiti quinti (ADQ) muscle has been reported as a marker of such entrapment. We performed a prospective study of consecutive patients undergoing foot and ankle MRI to determine the prevalence of ADQ atrophy and to examine the clinical symptoms of patients found to have ADQ atrophy.

SUBJECTS AND METHODS

A prospective study of all patients referred for ankle and foot MRI examinations was performed. Six hundred two patients were included in the study: 387 females and 215 males. All images were evaluated for the presence of selective fatty atrophy of the ADQ muscle. The clinical notes on all patients with findings of ADQ atrophy were analyzed for descriptions of symptoms leading to the MR examination, the presence of symptoms that might be related to nerve entrapment, and the influence on clinical management related to the MR finding of ADQ atrophy.

RESULTS

Thirty-eight of the 602 patients had selective fatty atrophy of the ADQ, 29 females and nine males. Only one patient had a clinical diagnosis of possible nerve entrapment before MR examination. MRI findings of ADQ atrophy altered clinical management in only one patient.

CONCLUSION

Selective fatty atrophy of the ADQ is not a rare finding on MR examination of the foot and ankle, being seen in 6.3% of all studies and in 7.5% of all studies in females. The clinical relevance of selective ADQ atrophy seen on MRI is uncertain.

MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF CANINE INFLAMMATORY MYOPATHIES IN THREE DOGS

In humans affected with inflammatory myopathies, regions of altered signal intensity are found on magnetic resonance (MR) images of affected muscles. Although electromyography (EMG) is more practical for muscle disease evaluation, and a muscle biopsy is the only manner in which a definitive diagnosis can be made, MR imaging has proven useful if a specific anatomic localization is difficult to achieve. Three dogs with focal inflammatory myopathy diagnosed with the assistance of MR imaging are discussed and the findings are compared with those found in humans. MR images of the affected muscles in each dog were characterized by diffuse and poorly marginated abnormal signal on T1- and T2-weighted images. Marked enhancement was noted in these muscles after contrast medium administration. An inflammatory myopathy was confirmed histologically in all three dogs. A good association existed between the MR images and muscle inflammation identified histopathologically. MR imaging may be a useful adjunctive procedure for canine inflammatory myopathies.

Quantitative assessment of skeletal muscle activation using muscle functional MRI

The purpose of the present study is to determine whether muscle functional MRI (mfMRI) can be used to obtain three-dimensional (3-D) images useful for evaluating muscle activity, and if so, to measure the distribution of muscle activity within a medial gastrocnemius (MG) muscle. Seven men performed 5 sets of 10 repetitions of a calf-raise exercise with additional 15% of body-weight load. Magnetic resonance images were obtained before and immediately after the exercise. To threshold images, only those pixels showing transverse relaxation time (T2) greater than the mean+1 S.D. of the entire regions of interest (ROIs) in the preexercise image and T2 lower than the mean+1 S.D. of the entire ROIs in the postexercise image were identified. The survived pixels showing T2 are defined as active muscle. Those thresholded images were 3-D reconstructed, and this was used to determine area of active muscle along transverse, longitudinal and vertical axes. At the exercise level used in the present study, the percentage volume of activated muscle in the MG was 62.8+/-4.5%. There was a significant correlation between percentage volume of activated muscle and integrated electromyography (r=.78, P<.05). Percentage areas of activated muscle were significantly larger in the medial than in the lateral region, in the anterior than in the posterior region and in the distal than in the proximal region (P<.05). These results suggest that mfMRI can be used to evaluate the muscle activity and to determine intramuscular variations of activity within skeletal muscle.

Steroid Myopathy: Evaluation of Fiber Atrophy with T2 Relaxation Time—Rabbit and Human Study

PURPOSE

To determine whether muscle fiber atrophy associated with steroid myopathy can be detected with T2 relaxation time.

MATERIALS AND METHODS

Animal and human studies were approved by the ethics committee. Informed consent was obtained. Twelve rabbits were divided into a group that received 3 mg/kg of triamcinolone subcutaneously each day for 10 consecutive days (n = 6) and a control group that received saline (n = 6). Magnetic resonance (MR) imaging was performed before and after treatment. T2 and fat deposition ratio (FDR) of soleus and gastrocnemius muscles before and after treatment and between control rabbits and rabbits treated with steroids were compared by using two-way repeated analysis of variance and Bonferroni post hoc test to evaluate effects of steroid treatment. After imaging, rabbits were sacrificed. Extracellular space ratio (ECSR) and fiber diameter were examined. Correlation among T2, ECSR, and diameter of type 2 muscle fibers was analyzed with a Pearson correlation test with Bonferroni correction in gastrocnemius to determine factors affecting T2. In humans, T2 relaxation time and FDR of both muscles were compared between volunteers not treated with steroids and patients treated with steroids by using an unpaired t test to evaluate the effects of steroids.

RESULTS

In rabbits, T2 of gastrocnemius muscle was significantly (P < .01) longer after steroid treatment than before steroid treatment and was also significantly (P < .01) longer than after saline administration. T2 of the gastrocnemius showed no significant difference in control rabbits before or after saline administration or in control rabbits and rabbits before steroid administration. T2 of the soleus muscle or FDR of either muscle showed no significant difference. There was a significant correlation (P < .01) among T2, ECSR, and diameter of type 2 muscle fibers in the gastrocnemius. In humans, T2 of the gastrocnemius was significantly (P < .01) longer in patients than in volunteers. T2 of the soleus or FDR of either muscle showed no significant difference.

CONCLUSION

Muscle fiber atrophy associated with steroid myopathy is detectable as prolongation of T2 relaxation time in the gastrocnemius muscle; the authors believe prolongation of T2 relaxation time is mainly due to increased ECSR reflecting type 2 muscle fiber atrophy.

Hypertrophie musculaire neurogène : à propos de trois cas, imagerie et revue de la littérature

OBJECTIVE

To review the literature on well-documented cases of neurogenic muscle hypertrophy in order to define significant features of this disease.

PATIENTS AND METHODS

The PUBMED and SCIENCE DIRECT web-sites were used to conduct an inventory of all reported cases of this disease. We entered the key-words "hypertrophy", "muscle" and "neurogenic", and found 48 articles, describing 129 cases. Our criteria of inclusion included hypertrophy of one or several muscles of a lower limb, previous realization of at least one imaging study (CT or MRI) and electromyography of lower limbs; criterion of exclusion was hypertrophy related to hereditary or acquired polyneuropathies. Twenty-five cases were retained for investigation along with 3 recent cases observed in our department.

RESULTS

Results show that neurogenic muscle hypertrophy is usually presents with painful enlargement of a calf in a male, aged 32 to 60 years, with previous history of low back pain and sciatica, 68% of the time due to disk herniation or lumbar stenosis. Other clinical findings may include radiation therapy or trauma.

CONCLUSION

The symptoms of neurogenic muscle hypertrophy may lead to MRI examination before electromyography. This disease should be included in the differential diagnosis.

MR neurography and muscle MR imaging for image diagnosis of disorders affecting the peripheral nerves and musculature

Recent advances in the technology of MR imaging are beginning to transform the fundamental methodology of diagnostic evaluations in neuromuscular disorders. When properly implemented, MR neurography is capable of providing high-quality information about nerve compression, nerve inflammation, nerve trauma, systemic neuropathies, nerve tumors, and recovery of nerve from pathologic states. Muscle MR imaging can identify denervation on a precise anatomic basis, document the progression of various conditions causing myopathy and myositis; and even provide insight into abnormal patterns of muscle activation. There is an essential role for the neurologist as well as for the specialist radiologist that requires a high level of familiarity of the various new types of image findings in this steadily advancing field.

Comparison of MRI with EMG to study muscle activity associated with dynamic plantar flexion

This study compared magnetic resonance imaging (MRI) and surface electromyography (EMG) to evaluate the effect of knee angle upon plantar flexion activity in the triceps surae muscles [medial & lateral gastrocnemius (MG, LG) and the soleus (SOL)]. Two weight & height matched groups performed identical protocols, twelve (6M, 6F) in the MRI group, twelve (8M, 4F) in the EMG group. Subjects plantar flexed dynamically for 2 min at 25% of 1-repetition maximum voluntary contraction (1-RM). Exercise was performed with the knee extended (0 degrees flexion), flexed (90 degrees ), and partially flexed (45 degrees ). In the MRI group spin-echo images were acquired before and immediately following each exercise session. T(2) times, calculated at rest and after exercise by fitting the echoes to a monoexponential decay pattern with a least-squares algorithm, were compared with EMG data. In the EMG group a bipolar electrode was used to collect samples were from the MG, LG, SOL, and anterior tibialis (TA) during exercise at each knee angle, MRI also examined the peroneus (PER). At 0 degrees flexion MRI demonstrated a significant post-exercise T(2) increase in the MG (p < or = 0.001), LG (p < or = 0.001), and PER (p < or = 0.01), with no T(2) change in the SOL or TA. At 90 degrees flexion there was a significant T(2) increase in the SOL (p < or = 0.001) with no significant T(2) change in the MG, LG, PER, or TA. At 45 degrees T(2) increased significantly in the SOL (p < or = 0.001) and LG (p < or = 0.05), but not the MG, PER, or TA. EMG produced similar results with the exception that there was significant activity in the TA during the relaxation cycle of the 90 degrees protocol. We conclude that: 1) Soleus activity is measurable by MRI; and 2) MRI and EMG produce similar results from different physiological sources, and are therefore complementary tools for evaluating muscle activity.

MR Imaging in the Diagnosis of Denervated and Reinnervated Skeletal Muscles: Experimental Study in Rats

PURPOSE

To describe the magnetic resonance (MR) imaging findings of denervation and reinnervation of skeletal muscles in rats.

MATERIALS AND METHODS

The posterior tibial nerve was transected in 48 rats (nerve section group) and was repaired just after transection in another 48 rats (nerve repair group). At 2, 4, 6, and 8 weeks after surgery, changes in the area and signal intensity of the gastrocnemius muscle on T1- and T2-weighted MR images in vivo (four rats in each group) and T1s and T2s were analyzed in vitro in both groups (20 rats each) and compared with electromyographic findings. Water volume content and extracellular fluid space of the muscle in vitro were also examined in both groups (24 rats each). Four rats were used as controls for in vitro analysis.

RESULTS

At T2-weighted MR imaging, the muscle showed continuously high signal intensity in the nerve section group. In the nerve repair group, the signal intensity was high until 4 weeks, when it recovered. Increases in signal intensity on T2-weighted MR images and T2s were seen in the nerve section group throughout the study period. In the nerve repair group, increased signal intensity on T2-weighted MR images was noted at 2 and 4 weeks and significantly returned to normal at 6 weeks (P <.014), just after the detection of the M wave at electromyography. T2 increased at 2 weeks, then decreased significantly at 4 weeks (P =.012). Extracellular fluid space significantly increased in the nerve section group at all measurement times and in the nerve repair group at 2 and 4 weeks, then it decreased after 6 weeks (P <.003), which is parallel to the change in signal intensity on T2-weighted MR images, although there was little change in total water volume content in either group.

CONCLUSION

Changes in signal intensity on T2-weighted MR images that are related to denervation may result from an increase of extracellular fluid space. MR imaging clearly demonstrates that changes in rat skeletal muscle are reversed when the nerve heals and reinnervation proceeds.

Effect of muscular contraction on magnetization transfer detected at 1.5 T

The effect of rigor (formation of actomyosin complexes) on magnetization transfer was observed with a 1.5 T clinical magnetic resonance (MR) imaging system. The magnetization transfer ratio of chemically skinned (calcium-sensitive) muscle fiber preparations increased much more in a rigor state than in a relaxed state, while that of calcium-insensitive fiber preparations and solutions showed no difference. These results suggest that the formation of actomyosin complexes increased the magnetization transfer ratio. A clinical MR system is not only effective for medical imaging, but also has the potential to demonstrate physiological characteristics.

Measurements of extracellular volume fraction and capillary permeability in tissues using dynamic spin-lattice relaxometry: studies in rabbit muscles

Dynamic MR longitudinal R(1) relaxometry after administration of a gadolinium contrast bolus (Gd-DTPA) has been used for in vivo measurements of the extracellular volume fraction (v) and the capillary permeability (k min(-1)) in rabbit muscles to distinguish between red slow- and white fast-twitch muscle fiber types. For this purpose a protocol imaging sequence has been used which allows fast R(1) measurements during the contrast agent uptake. Physiological tissue parameters, k and v, were obtained by computing procedures assuming a simplified monoexponential plasma model. These were shown to be about twice as large in the slow-twitch semimembranosous proprius muscle (SP), containing 100% oxidative type-I fiber, that in the fast-twitch rectus femorus muscle (RF), containing only 6% type-I fiber type. The capillary permeability has been found to be 0.25 +/- 0.02 min(-1) for the (SP) and 0.10 +/- 0.01 min(-1) for the (RF). Similarly, the extracellular volume fractions were 0.189 +/- 0.015 and 0.082 +/- 0.006 respectively, in close agreement with literature data and experimental results obtained by invasive radionuclide measurements. For the pool of the 10 studied animals, no significant variation among animals was observed in the extracellular volume fraction and the capillary permeability for the different muscle fiber types. The dynamic relaxometry method used is easy to implement on conventional MR imagers and has potential applications in muscle diseases. The method has also potential applications for tissue characterization based on extracellular volume and capillary permeability quantification. In particular, the method can be used for the evaluation of tumors and their responses to therapies.

Changes in orcine muscle water characteristics during growth--an in vitro low-field NMR relaxation study

This study investigates the effects of developmental stage and muscle type on the mobility and distribution of water within skeletal muscles, using low-field (1)H-NMR transverse relaxation measurements in vitro on four different porcine muscles (M. longissimus dorsi, M. semitendinosus, M. biceps femoris, M. vastus intermedius) from a total of 48 pigs slaughtered at various weight classes between 25 kg and 150 kg. Principal component analysis (PCA) revealed effects of both slaughter weight and muscle type on the transverse relaxation decay. Independent of developmental stage and muscle type, distributed exponential analysis of the NMR T(2) relaxation data imparted the existence of three distinct water populations, T(2b), T(21), and T(22), with relaxation times of approximately 1-10, 45-120, and 200-500 ms, respectively. The most profound change during muscle growth was a shift toward faster relaxation in the intermediate time constant, T(21). It decreased by approx. 24% in all four muscle types during the period from 25 to 150 kg live weight. Determination of dry matter, fat, and protein content in the muscles showed that the changes in relaxation time of the intermediate time constant, T(21), during growth should be ascribed mainly to a change in protein content, as the protein content explained 77% of the variation in the T(21) time constant. Partial least squares (PLS) regression revealed validated correlations in the region of 0.58 to 0.77 between NMR transverse relaxation data and muscle development for all the four muscle types, which indicates that NMR relaxation measurements may be used in the prediction of muscle developmental stage.

MRI quantification of muscle activity after volitional exercise and neuromuscular electrical stimulation

OBJECTIVE

The efficacy, and even the depth, of muscle stimulation during surface electrode neuromuscular electrical stimulation (NMES) is a matter of debate. This study addresses these issues by assessing the utility of a magnetic resonance imaging (MRI) technique in localizing and quantitating changes in the nature of MRI signals in the quadriceps muscle after volitional exercise and NMES.

DESIGN

Volitional isometric and NMES-evoked quadriceps muscle activity was evaluated in two controlled trials. In the first, isometric quadriceps strength was determined during NMES and maximal volitional isometric exercise in six healthy men. In the second, changes in the ratio of MRI T2 signal intensities before and after volitional isometric exercise and NMES were used to quantitate MRI signal changes associated with muscle activation in 12 additional healthy men.

RESULTS

MRI clearly detected quadriceps muscle tissue activation after both volitional and stimulated contractions, even though the NMES knee extension torque was only 23.5% that of maximal volitional isometric exercise. In particular, the T2 intensity ratios increased 26.5% +/- 17.3% (mean +/- standard deviation) after volitional exercise and 12.9% +/- 12.8% after NMES. This pattern of volitional isometric exercise, producing larger T2 intensity ratio values than NMES, was present in both deep and superficial layers and throughout the quadriceps muscle.

CONCLUSIONS

Although volitional muscle contractions were several times stronger than those induced by NMES in this study, our findings support the idea that MRI can provide a noninvasive way to quantitate and localize volitional and electrically stimulated muscle activation.

Accuracy of abnormal paraspinal muscle findings on contrast-enhanced MR images as indirect signs of unilateral cervical root-avulsion injury

PURPOSE

To evaluate the accuracy of abnormal magnetic resonance (MR) findings in the paraspinal muscles as indirect signs of nerve-root avulsion injury.

MATERIALS AND METHODS

Forty-three consecutive patients suspected of having unilateral root-avulsion injury underwent MR imaging and were evaluated. Paraspinal muscles were evaluated for abnormal signal intensity on T1- and T2-weighted images, abnormal enhancement on images obtained after contrast material enhancement, and muscle volume loss. MR images were interpreted independently by two observers for interobserver variability. MR findings were compared with findings of root continuity, determined with a combination of surgery and clinical evaluation. Sensitivities, specificities, and kappa values of the findings were calculated.

RESULTS

Sensitivities of MR findings in the paraspinal muscles indicating root-avulsion injury were 88% (36 of 41 patients) for abnormal enhancement, 83% (34 of 41 patients) for high signal intensity on T2-weighted images, 37% (15 of 41 patients) for high signal intensity on T1-weighted images, and 71% (29 of 41 patients) for muscle volume loss. Specificities for all findings were 100% (two of two patients). Of the paraspinal muscles, findings in the multifidus muscle were the most accurate and provided the highest interobserver agreement (kappa = 0.81).

CONCLUSION

Contrast material-enhanced abnormal MR findings in the paraspinal muscles are accurate in indicating root-avulsion injuries, and abnormal enhancement in the multifidus muscle is the most accurate among paraspinal muscle findings.

Motor Denervation of Tumors of the Head and Neck: Changes in MR Appearance

PURPOSE

We reviewed the MR appearance of motor denervation of the third (mandibular) division of the trigeminal nerve (V3) and of the hypoglossal nerve.

METHOD

Six cases of tumor of the head and neck with motor denervation were retrospectively evaluated. These comprised two patients with V3 denervation, three patients with hypoglossal nerve denervation, and one patient with both V3 and hypoglossal denervation. The observation was conducted for 6 to 44 months after onset. In denervated muscles, changes in signal intensity in T(1)- and T(2)-weighted images, degree of contrast enhancement, and volume of muscle were estimated during the follow-up period.

RESULTS

In all cases of V3 denervation, the muscles showed no change in signal intensity in the T(1)-weighted images up to three months after onset. In two cases of hypoglossal denervation, the tongues appeared ipsilaterally hyperintense in the T(1)-weighted images within the first three months. In one case with V3 denervation and two cases with hypoglossal denervation, denervated muscles appeared hyperintense in the T(2)-weighted images up to three months after onset. At three months after denervation, the signal intensities of all motor-denervated areas increased in both T(1)- and T(2)-weighted images. Postcontrast T(1)-weighted images obtained within the first three months displayed contrast enhancement of all denervated muscles. In three cases of V3 denervation, the volumes of the affected muscles were reduced after the first three months. In three cases of hypoglossal denervation, the ipsilateral volume of the tongue decreased at three months after onset.

CONCLUSION

Up to three months after onset, the denervated muscles appeared hyperintense in the T(2)-weighted images and contrast enhancement in postcontrast T(1)-weighted images before fatty infiltration and volume loss were apparent. Familiarity with the MR appearance of denervated muscles accompanying tumors of the head and neck is important to avoid confusion with inflammatory or neoplastic processes.

Effect of glycogen loading on skeletal muscle cross-sectional area and T2 relaxation time

This study was performed to investigate if glycogen loading of skeletal muscles, by binding water, would effect the cross-sectional area (CSA) and if an altered water content would alter the transverse relaxation time (T2) measured by magnetic resonance imaging (MRI). Five healthy volunteers participated in a programme with 4 days of extremely carbohydrate-restricted meals followed by 4 days of extremely high carbohydrate intake. The CSA and T2 of thigh and calf muscles were related to the intramuscular glycogen content evaluated at days 4 and 8. An increase in glycogen content from 281 to 634 mmol kg(-1) dry wt increased the CSA of the vastus muscles by 3.5% from 78 +/- 11 to 80 +/- 12 cm2 and the thigh circumference by 2.5% from 146 +/- 20 to 150 23 cm2. Calf circumference increased non-significantly by 4% from 78 +/- 15 to 82 +/- 19 cm2. Mono-exponential T2 decreased in m. tibialis anterior from 27.8 +/- 1.2 to 26.9 +/- 1.7 ms, did not change in m. vastus lateralis 26.5 +/- 1.9 ms/26.6 +/- 1.3 ms or in m. gastrocnemius 29.5 +/- 1.0 ms/29.8 +/- 1.9 ms. Glycogen loading increased the signal intensity mainly at different echo times (TE) 15 and 30 ms. The study shows that increased glycogen filling in the muscles increases muscle CSA and that this can be detected by MRI. The signal intensity increased the most at shorter TEs suggesting a more tight intracellular binding of water in glycogen loaded muscles.

Effects of aging on muscle T2 relaxation time: difference between fast- and slow-twitch muscles

RATIONALE AND OBJECTIVES

To determine whether the T2 relaxation time of skeletal muscle is affected by aging and to compare the effects of aging between fast- and slow-twitch muscles in a human study. To investigate the mechanisms of age-related changes in T2 relaxation time in an animal (mouse) study.

METHODS

T2 relaxation times of the soleus (slow-twitch, rich in type I fiber) and gastrocnemius (fast-twitch, rich in type II fiber) muscles were examined in 59 healthy human subjects, 22 to 76 years of age, by clinical magnetic resonance imaging. In mice, T2 relaxation times, fat ratios, and extracellular space ratios (extracellular space/intracellular plus extracellular space) of the spinalis (fast-twitch, rich in type II fiber) muscles were also examined (group of 7 old mice, 24-26 months; group of 7 young mice, 8-10 weeks).

RESULTS

In the human study, the T2 relaxation time of the gastrocnemius muscle increased significantly with aging (r = 0.53, P < 0.01) while that of the soleus muscle did not. In the animal study, the T2 relaxation time of the spinalis muscle was significantly longer (P < 0.05) and the extracellular space ratio of the spinalis muscle significantly wider (P < 0.01) in old than in young mice. No significant difference in fat ratio was observed between old and young mice. A significant, positive correlation was seen between the extracellular space ratio and T2 relaxation time (r = 0.84, P < 0.01).

CONCLUSIONS

The T2 relaxation time of fast-twitch muscle increases with aging, due mainly to increased extracellular space, reflecting age-related type II fiber atrophy.

Magnetic resonance imaging of denervated muscle: comparison to electromyography

The purpose of the study is to further assess the usefulness of short TI (time to inversion) recovery (STIR) magnetic resonance imaging (MRI) in detecting denervation of skeletal muscle compared to needle electromyography (EMG). Ninety subjects with clinical evidence of peripheral nerve injury or radiculopathy underwent STIR MRI and EMG of the affected limb. In 74 (82%) of these subjects, a positive correlation was found between STIR MRI and EMG (P < 0.009). STIR MRI has a relative sensitivity of 84% and specificity of 100% for detecting denervation. A subset of 28 subjects underwent quantitative assessments of signal intensity ratio (SIR) from the STIR MRI. The rank order correlation coefficient between the SIR and abnormal spontaneous activity on EMG was 0.70 (P < 0.001). Increased signal intensity on STIR MRI corresponds closely with spontaneous activity on EMG in denervated muscle. Although less sensitive than EMG in detecting muscle denervation, STIR MRI may be a useful adjunctive diagnostic tool in this setting.

Correlation between quantitative EMG and muscle MRI in patients with axonal neuropathy

The aim of the study was to investigate whether there are correlations between electromyography (EMG) data and findings in muscle magnetic resonance imaging (MRI). Quantitative EMG data and the amount of pathologic spontaneous activity (PSA) were compared with MRI signal intensities of the tibialis anterior muscles of 20 patients with axonal polyneuropathy and 14 healthy subjects. Using hierarchical regression analysis, the mean motor unit action potential (MUAP) size index (SI) and the amount of PSA were accurate predictors of T1-weighted signal intensity in MRI, an expression of fatty degeneration. The MUAP SI was superior to MUAP amplitude in explaining the variance of T1 signal intensity. Age was not a relevant factor. A high correlation was found between the amount of PSA and the T2-weighted signal intensity in short tau inversion recovery sequence. Magnetic resonance imaging demonstrates the structural changes and thus visualizes the outcome of the functional changes of denervation and reinnervation detected by EMG.

Magnetic resonance imaging and histologic evidence of postoperative back muscle injury in rats

STUDY DESIGN

Postoperative back muscle injury was evaluated in rats by magnetic resonance imaging and histologic analyses.

OBJECTIVE

To compare the magnetic resonance imaging manifestation of back muscle injury with the histologic findings in rats and to subsequently clarify the histopathologic appearance of the high intensity regions on T2-weighted images in human postoperative back muscles.

SUMMARY OF BACKGROUND DATA

In a previous study, it was found that the signal intensity on T2-weighted images of the postoperative back muscles was increased in patients who had postsurgical lumbar muscle impairment, especially in those with a prolonged surgery duration. However, the specific histopathologic changes that cause the high signal intensity on T2-weighted images remain unclear.

METHODS

Rats were divided into three groups: sham operation group, 1-hour retraction group, and 2-hour retraction group. Magnetic resonance imaging and histology of the multifidus muscles were examined before surgery and at 2, 7, and 21 days after surgery.

RESULTS

T2-weighted imaging was more useful than T1-weighted imaging to estimate back muscle injury. The high signal intensity of the multifidus muscles on T2-weighted images remained 21 days after surgery only in the 2-hour retraction group. Histologically, the regeneration of the multifidus muscles was complete at 21 days after surgery in the 1-hour retraction group, but the regenerated muscle fibers in the 2-hour retraction group had a small diameter, and the extracellular fluid space remained large.

CONCLUSION

The high signal intensity on T2-weighted images of the postoperative multifidus muscles in the regenerative phase may be due to an increased extracellular space and incomplete muscle fiber regeneration.

Magnetic resonance imaging features of subacute idiopathic brachial neuritis

A 60-year-old man presented with sudden onset of left shoulder pain followed 2 weeks later by the development of left shoulder girdle weakness. A clinical and electrophysiological diagnosis of subacute idiopathic brachial neuritis was made. The MRI features of subacute muscular denervation in this patient are discussed and the relevant literature reviewed.

Tissue characterization in the female pelvis by means of MR imaging

Pelvic imaging techniques such as computed tomography and ultrasonography provide a limited capability for tissue characterization. Fat, fluid, and calcification, for example, can be identified on the basis of parameters such as x-ray attenuation, echogenicity, and sound attenuation. Because of the many tissue parameters, such as T1, T2, magnetic susceptibility, and chemical shift, that contribute to signal intensity, magnetic resonance (MR) imaging may afford an ability to identify a wider array of specific tissues. The purpose of this article is to review the ability of MR imaging to help identify various types of soft tissue and to provide an approach to interpretation of MR images of the female pelvis through tissue characterization. Lipid, fluid, hemorrhage, smooth muscle, fibrosis, solid malignant tissue, and hydrated soft tissue (including edema, mucin, and myxomatous tissue) have typical MR imaging properties, and their presence in a mass can often be established on MR images. Consideration of the tissue composition of various pathologic processes in the pelvis can result in more systematic approaches to image interpretation and thus narrow the differential diagnosis.

Multicomponent T2 relaxation of in vivo skeletal muscle

In vivo spin-spin (T2) relaxation measurements were acquired from the flexor digitorum profundus (FDP) of 13 subjects. A standard imaging T2 measurement technique [number of points (N) = 6, TE = 18 msec, signal-to-noise ratio (SNR) approximately equal to 300] yielded a single T2 value of 31 msec. A novel technique, projection presaturation combined with a CPMG sequence, was used to acquire data (N = 1000, TE = 1.2 msec, SNR 3500) from a cylindrical voxel (2 cm diameter, 5 cm length) within the FDP. All 13 subjects had at least four T2 components, at < 5, 21 +/- 4, 39 +/- 6, and 114 +/- 31 msec, with fractional areas of 11 +/- 2, 28 +/- 15, 46 +/- 12, and 11 +/- 5% respectively. The shortest and longest components have been observed in ex vivo muscle studies, probably corresponding to water associated with macromolecules and extracellular water, respectively. The middle T2 components are suggestive of an organization of in vivo intracellular water.

Serial changes in trunk muscle performance after posterior lumbar surgery

STUDY DESIGN

Serial changes in trunk muscle performance were prospectively studied in 20 patients who underwent posterior lumbar surgery.

OBJECTIVE

To evaluate the influence of back muscle injury on postoperative trunk muscle performance and low back pain, to clarify the significance of minimization of back muscle injury during surgery.

SUMMARY OF BACKGROUND DATA

The current investigators have reported examination of iatrogenic back muscle injury in an animal model and in humans. However, definite impairment caused by such back muscle injury has not been clarified.

METHODS

The patients were divided into a short-retraction-time group (< 80 minutes; n = 12) and a long-retraction-time group (> or = 80 minutes; n = 8). Before surgery and 3 and 6 months after surgery, the degree of back muscle injury was estimated by magnetic resonance imaging, and trunk muscle strength was measured. In addition, the incidence and severity of low back pain were serially analyzed.

RESULTS

Back muscle injury was directly related to the muscle retraction time during surgery. The damage to the multifidus muscle was more severe, and the recovery of extensor muscle strength was delayed in the long-retraction-time group. In addition, the incidence of postoperative low back pain was significantly higher in the long-retraction-time group.

CONCLUSIONS

Postoperative trunk muscle performance is dependent on the muscle retraction time. Thus, it is beneficial to shorten the retraction time to minimize back muscle injury and subsequent postoperative low back pain.

In vivo tissue extracellular volume fraction measurement by dynamic spin-lattice MRI relaxometry: application to the characterization of muscle fiber types

RATIONALE AND OBJECTIVES

The extracellular volume fraction (v) was estimated in leg rabbit muscles by MRI dynamic longitudinal relaxation rate (R1) relaxometry to distinguish between slow- and fast-twitch muscle fiber types.

METHOD

The extracellular volume fraction was calculated from the dynamic increase of the longitudinal relaxation rate after intravenous administration of a gadolinium (Gd-DTPA) contrast bolus, assuming a biexponential plasma concentration model.

RESULTS

It has been shown that the extracellular volume fraction increases with the slow fiber content (oxidative type I); the maximal value (v = 0.186+/-0,018) was obtained in pure slow-twitch muscle fiber (100% type I).

CONCLUSION

NMR extracellular volume estimates closely agree with those obtained using the more classic invasive isotopic method (99mTc-DTPA) carried out on the same rabbit strain and with data reported in the literature. The method has potential applications to characterize the pathophysiologic status of tissues. It is also applicable to a wide range of tissues and pathologies, in particular for the characterization of malignant tissues and their response to therapies.

Tirilazad inhibits surgically induced edema and interleukin-1 production. An experimental study in rats

The aim of this study was to evaluate the anti-inflammatory effect of tirilazad mesylate on edema and interleukin-1 (IL-1) levels in serum following standardized surgical procedures. Four groups, each containing eight rats, were randomized for treatment as follows: A) no medication, B) low-dose tirilazad, C) high-dose tirilazad, and D) corticosteroids. The animals were examined by nuclear magnetic resonance imaging (NMRI) 24 and 72 hours after surgery and the NMRI data were used in the determination of soft tissue edema. In addition, serum was obtained for analysis of IL-1 levels. Four other groups of animals were subjected to the same treatment regimen as groups A-D), respectively, and 24 hours after surgery the animals were killed, whereafter serum was obtained for analysis of IL-1 levels. The present study demonstrated that low-dose tirilazad significantly reduces soft tissue edema compared with all other treatment regimens 24 hours postoperatively. At 72 hours postoperatively significant reduction of soft tissue edema was achieved at low-dose tirilazad when compared to high-dose tirilazad and steroids. In addition, a significant suppression of the expression of IL-1 was observed at 24 and 72 hours when comparing low-dose tirilazad and the control group.

Isometric and dynamic exercise studied with echo planar magnetic resonance imaging (MRI)

PURPOSE

The effect of different types of exercise upon echo planar (EP) magnetic resonance (MR) images was examined during and after both dynamic and isometric dorsi-flexion exercises at matched workloads and durations.

METHODS

Healthy untrained subjects performed either dynamic exercise through a full range of motion and against a constant resistance or isometric exercise at the center of the range of motion and against a constant resistance at 25 or 70% their measured maximum voluntary contraction (MVC). EP MR images were acquired at 1.5 T every 4 s before (4 images), during (27 images), and after (29-65 images) exercise. A spin echo EP sequence was employed with TE = 30 ms, TR = 4000 ms, FOV = 20 x 40 cm, 64 x 128 matrix. The changes in proton transverse relaxation rate (deltaR2, [s(-1)]) relative to values obtained before exercise were calculated from individual images at different times during and after exercise.

RESULTS

At both 70 and 25% of MVC, the maximum deltaR2 after dynamic exercise (-8.38+/-0.32 s(-1) (70%), -6.47+/-1.23s(-1) (25%)) was significantly greater (P < or = 0.05) than after isometric exercise (-5.91+/-0.67 s(-1) (70%), -3.80+/-0.87s(-1) (25%)). Throughout the period that recovery was monitored, the recovery patterns of deltaR2 following isometric and dynamic exercise at both workloads remained parallel.

CONCLUSIONS

We conclude that exercise-induced changes in MR images are influenced not only by workload and exercise duration but also by the type of exercise, and we postulate that these differences result from the different physiological responses elicited by the different types of exercise.