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Acute myonecrosis on MRI: etiologies in an oncological cohort and assessment of interobserver variability

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Abstract

Objective

To determine the etiologies of myonecrosis in oncology patients and to assess interobserver variability in interpreting its MRI features.

Materials and methods

Pathology records in our tertiary cancer hospital were searched for proven myonecrosis, and MRIs of affected regions in those patients were identified. MRI reports that suggested myonecrosis were also identified. Each MRI was reviewed independently by 2 out of 6 readers to assess anatomical site, size, and signal intensities of muscle changes, and the presence of the previously reported stipple sign (enhancing foci within a region defined by rim enhancement). The stipple sign was assessed again, weeks after a training session. Cohen kappa and percentage agreement were calculated. Medical records were reviewed for contemporaneous causes of myonecrosis.

Results

MRI reports in 73 patients suggested the diagnosis of myonecrosis; pathological proof was available in another 2. Myonecrosis was frequently associated with radiotherapy (n = 34 patients, 45 %); less frequent causes included intraoperative immobilization, trauma, therapeutic embolization, ablation therapy, exercise, and diabetes. Myonecrosis usually involved the lower extremity, the pelvis, and the upper extremity; mean size was 13.0 cm. The stipple sign was observed in 55–100 % of patients at first assessment (κ = 0.09–0.42; 60–80 % agreement) and 55–100 % at second (κ = 0.0–0.58; 72–90 % agreement). Enhancement surrounded myonecrosis in 55–100 % patients (κ = 0.03–0.32; 58–70 % agreement).

Conclusion

Myonecrosis in oncology patients usually occurred after radiotherapy, and less commonly after intraoperative immobilization, trauma, therapeutic embolization, ablation therapy, exercise, or diabetes. Although interobserver variability for MRI features of myonecrosis exists (even after focused training), a combination of findings facilitates diagnosis and conservative management.

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Acknowledgements

The authors thank Ramon Sosa and Sumar Hayan for their assistance with data management.

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Authors and Affiliations

  1. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Jane Cunningham, Richa Sharma, Anna Kirzner, Sinchun Hwang, Robert Lefkowitz, Daniel Greenspan, Anton Shapoval & David M. Panicek

  2. Weill Medical College of Cornell University, New York, NY, 10065, USA

    Sinchun Hwang, Robert Lefkowitz & David M. Panicek

Authors
  1. Jane Cunningham
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  2. Richa Sharma
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  3. Anna Kirzner
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  4. Sinchun Hwang
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Correspondence to David M. Panicek.

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Funding

This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

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The authors declare that they have no conflicts of interest.

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Cunningham, J., Sharma, R., Kirzner, A. et al. Acute myonecrosis on MRI: etiologies in an oncological cohort and assessment of interobserver variability. Skeletal Radiol 45, 1069–1078 (2016). https://doi.org/10.1007/s00256-016-2389-4

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  • DOI: https://doi.org/10.1007/s00256-016-2389-4

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