Medical Radiology Diagnostic Imaging Marc-André Weber M.F. Reiser Editor H. Hricak M. Knauth Magnetic Resonance Imaging of the Skeletal Musculature 123 Medical Radiology Diagnostic Imaging Series editors Maximilian F. Reiser Hedvig Hricak Michael Knauth Editorial Board Andy Adam, London Fred Avni, Brussels Richard L. Baron, Chicago Carlo Bartolozzi, Pisa George S. Bisset, Durham A. Mark Davies, Birmingham William P. Dillon, San Francisco D. David Dershaw, New York Sam Sanjiv Gambhir, Stanford Nicolas Grenier, Bordeaux Gertraud Heinz-Peer, Vienna Robert Hermans, Leuven Hans-Ulrich Kauczor, Heidelberg Theresa McLoud, Boston Konstantin Nikolaou, Munich Caroline Reinhold, Montreal Donald Resnick, San Diego Rüdiger Schulz-Wendtland, Erlangen Stephen Solomon, New York Richard D. White, Columbus For further volumes: http://www.springer.com/series/4354 Marc-Andre´ Weber Editor Magnetic Resonance Imaging of the Skeletal Musculature 123 Editor Prof. Dr. med. Marc-André Weber, M.Sc. Diagnostic and Interventional Radiology University Hospital Heidelberg Heidelberg Germany ISSN 0942-5373 ISSN 2197-4187 (electronic) ISBN 978-3-642-37218-6 ISBN 978-3-642-37219-3 (eBook) DOI 10.1007/978-3-642-37219-3 Springer Heidelberg New York Dordrecht London Library of Congress Control Number: 2013954837 Ó Springer-Verlag Berlin Heidelberg 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) To my wife, Daniela, and our daughters, Anna Sophie and Leonie Marie, for making every day a special and joyful one Foreword Endorsement on behalf of the European Society of MusculoSkeletal Radiology (ESSR) Muscle imaging is inherently complex and presents unique morphologic challenges and continuing integration of dynamic, pathophysiologic, and functional capabilities as imaging technology progresses. Compared to the several textbooks dedicated to imaging of the joints, an updated monography addressing muscle MRI is relatively rare. In this regard, this textbook provides a much-wanted survey and update of the current litera- ture on the subject. This comprehensive work is written by internationally renowned experts in the field and is richly illustrated by well-selected high quality images. The work reads fluently and covers all technical issues related to the most advanced tech- niques for morphologic and functional imaging of the skeletal muscle, such as whole body MRI, diffusion-weighted and diffusion-tensor imaging, 23Na MRI, muscle perfu- sion imaging and metabolite quantification in MR spectroscopy. Although emphasis has been placed on MRI as a diagnostic modality, correlation with ultrasound is provided in the first part of this book. All aspects of muscle pathology, including inherited disorders, sport-related conditions, inflammatory and ischemic disorders, tumors and non-neo- plastic masses are well covered and extensively discussed. We are convinced that this work will be a very useful tool for both certified general and musculoskeletal radiologists, as well as for orthopedic surgeons, geneticists, rheu- matologists, sports physicians, physiatrists, neurologists, and all other colleagues involved in the diagnosis and management of muscle disorders. On behalf of the ESSR, vii viii Foreword we wish to congratulate the editor, Prof. Marc-Andre´Weber, most warmly on this superb work, and it is our great privilege to recommend this book as a reference stan- dard in modern muscle imaging. Antwerp Filip M. Vanhoenacker, Secretary ESSR Genoa Carlo Martinoli, Chairman of the Educational Committee ESSR Preface The muscular system is one of the largest organ systems of the human body. In almost every MR image, skeletal muscles are also displayed. Although muscular diseases encompass a huge and heterogeneous group of both hereditary and acquired disorders, in most cases of progressive disease, myopathy presents with focal or general muscle weakness, which is, however, an unspecific symptom. Since the clinical presentation of these disorders may be quite similar, there is a need for ancillary testing. Therefore, in principle, imaging techniques that offer differential diagnostic clues are urgently needed. The ancillary testing in cases of suspected myopathy has traditionally included, besides clinical data, electrodiagnostic, histopathologic, and genetic information, whereas imaging of the peripheral nerves and skeletal muscles was in the past not routinely included in this integrated approach to diagnosis and treatment. There is increasing evidence, however, that MRI has many advantages for imaging the skeletal muscle, e.g., it can image both superficial and deep structures with equal efficacy (better than ultrasonography), and it can image large areas of the body and is thus ideal for describing patterns of muscle involvement. Moreover, MRI provides excellent differentiation between the skeletal muscle, fat, and adjacent tissues, including bones and tendons. Quantitative MRI measures are valuable for monitoring disease progression. Thus, by virtue of the excellent contrast that it offers between healthy and diseased tissues, MRI is currently the most sensitive imaging modality for displaying the skeletal muscle and its pathologic changes. To date, nevertheless, MRI has often been assigned a subsidiary role in the diagnostic work-up of muscular diseases since routine MRI protocols frequently reveal no pathognomonic findings. This is because morpho- logic alterations such as edema-like or lipomatous changes are sensitive indicators of disease but are not very disease specific and do not visualize the underlying (patho) physiologic changes. Now, however, exciting new advances in modern MRI technology make possible the acquisition of functional images that provide deeper insights into the muscle metabolism and even allow for dynamic assessment of the muscular motion. Surrogate patho- physiologic parameters, such as muscular microcirculation, sodium homeostasis, energy and lipid metabolism, and muscle fiber architecture, can now be investigated using these functional MR techniques. Therefore, a much higher level of acceptance and also demand by clinicians are to be expected for these new techniques in the near future, and radiologists will have to face up to the increasing value of MRI in imaging the skeletal musculature. In order to help in meeting these demands, this book provides a comprehensive overview of the potential of MRI of the skeletal musculature. Recognized authors from all around the world present their experiences regarding the current role of MRI in imaging the skeletal musculature and the diagnostic work-up of myopathies. The book starts with three chapters on the role of MRI in imaging the skeletal musculature, with a focus on clinical needs, the correlation of imaging to anatomy, and when to use MRI and when to use ultrasonography. ix x Preface The next six chapters present cutting-edge research findings obtained using modern morphologic and functional MRI techniques for assessment of the skeletal musculature and give some examples of the added value offered by these techniques in the evaluation of muscular diseases. A wide range of topics are covered, from whole-body MRI for evaluation of the entire muscular system to the insights into muscle cell metabolism provided by spectroscopic imaging. Furthermore, promising techniques for the skeletal muscle that have already been introduced in other organ systems, such as diffusion and perfusion imaging and dynamic MRI techniques, are thoroughly discussed. The last part of the book describes the value of MRI in the diagnostic work-up of different pathologies of the skeletal musculature. In detail, the role of MRI is elucidated in muscle injuries, in neurogenic myopathies, and in establishing the cause of muscle denervation. Of course, the MRI findings in the large fields