Rare Variant of Vastus Medialis Detected in vivo by Ultrasound and Confirmed by High-resolution MRI

Comparisons between skeletal muscle imaging techniques and histology in tracking midthigh hypertrophic adaptations following 10 weeks of resistance training

This study had two aims. AIM1 was to determine the agreement between mid-thigh vastus lateralis (VL) cross-sectional area measured by ultrasound (mCSA_US) versus magnetic resonance imaging (mCSA_MRI) at a single time point, and the ability of each to detect hypertrophic changes. AIM2 was to assess the relationships between pre-to-post training changes in thigh lean mass determined by DXA, VL mCSA_US, ultrasound-determined VL thickness (VL_Thick), and VL mean myofiber cross-sectional area (fCSA) with changes in VL mCSA_MRI. Twelve untrained males (Age: 20±1 y, BMI: 26.9±5.4 kg/m²; n=12) engaged in a 10-week resistance training program (2x/week) where right mid-thigh images and VL biopsies were obtained prior to and 72-hours following the last training bout. Participants' VL mCSA_MRI (p=0.005), DXA thigh lean mass (p=0.015), and VL_Thick (p=0.001) increased following training, whereas VL mCSA_US and fCSA did not. For AIM1, mCSA_US demonstrated excellent concordance (CCC = 0.830) with mCSA_MRI, albeit mCSA_US values were systematically lower compared to mCSA_MRI (mean bias: -2.29 cm²). Additionally, PRE-to-POST VL mCSA changes between techniques exhibited good agreement (CCC = 0.700; mean bias: -1.08 cm²). For AIM2, moderate, positive correlations existed for PRE-to-POST changes in VL mCSA_MRI and DXA thigh lean mass (r=0.580, p=0.048), mCSA_US (r=0.622, p=0.031), and VL_Thick (r=0.520, p=0.080). A moderate, negative correlation existed between mCSA_MRI and fCSA (r=-0.569, p=0.054). Our findings have multiple implications: i) resistance training-induced hypertrophy was dependent on the quantification method, ii) ultrasound-determined mCSA shows good agreement with MRI, and iii) tissue-level changes poorly agreed with mean fCSA changes and this requires further research.

Limitation of Knee Flexion by a Fibrotic Band of a Fifth Component of the Quadriceps Muscle in a Child: A Case Report

CASE

We describe the case of a 3-year-old boy who presented with limited flexion in the left knee. High-resolution magnetic resonance imaging allowed visualization of a fibrotic muscle band in the anatomic position of the fifth component of the quadriceps muscle, which was confirmed by surgical findings. After surgical resection, the patient achieved full recovery of range of motion of the knee.

CONCLUSION

To our knowledge, this is the first reported case of a fibrotic muscle band in the anatomic position of a previously described fifth accessory component of the quadriceps muscle that caused limited knee flexion in a child.