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Atrophy of calf muscles by unloading results in an increase of tissue sodium concentration and fat fraction decrease: a 23Na MRI physiology study



23Na MRI demonstrated increased tissue sodium concentrations in a number of pathologies. Acute atrophy results in muscle fibre volume shrinking that may result in a relative increase of extracellular volume and might affect sodium concentration. Thus, we hypothesized that local unloading of the calf muscles would lead to a decrease in muscle volume and an increase in muscle tissue sodium concentration.


One lower leg of 12 healthy male subjects was submitted to a 60 day long period of unloading using the Hephaistos orthosis, while the other leg served as control. 23Na MRI and 2D PD-weighted Dixon turbo spin echo were obtained from the control and orthosis leg using a 3T scanner. For quantification, a sodium reference phantom was used with 10, 20, 30, and 40 mmol/L NaCl solution.


Tissue sodium concentration (TSC) increased as an effect of unloading in the orthosis leg. Relative increases were 17.4 ± 16.8% (P = 0.005) in gastrocnemius medialis muscle, 11.1 ± 12.5 (P = 0.037) in gastrocnemius lateralis muscle, 16.2 ± 4.7% (P < 0.001) in soleus muscle, 10.0 ± 10.5% (P = 0.009) in the ventral muscle group, and 10.7 ± 10.0% (P = 0.003) in the central muscle group, respectively. TSC in the control leg did not significantly change. In the orthosis leg, muscle volume decreased as follows: medial gastrocnemius muscle: −5.4 ± 8.3% (P = 0.043) and soleus muscle: −7.8 ± 15.0% (P = 0.043).


Unloading atrophy is associated with an increase in muscle sodium concentration. 23Na MRI is capable of detecting these rather small changes.

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Field of view (FoV)


Linear mixed effects


Proton density


Regions of interest


Signal-to-noise ratio


Tissue sodium concentration


Turbo spin echo


Acquisition time


Echo time


Repetition time

T2 :

Transversal relaxation time


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K. Schopen received a Helmholtz Space Life Sciences Research School (SpaceLife) Ph.D. scholarship. SpaceLife was funded in equal parts by the Helmholtz Association (Grant No.: VH-KO-300) and the German Aerospace Center (DLR). The NutriHEP study was funded by the DLR internal cost object 2475 101.

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Correspondence to D. A. Gerlach.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The authors declare that they have no conflict of interest.

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Communicated by Guido Ferretti.

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Gerlach, D.A., Schopen, K., Linz, P. et al. Atrophy of calf muscles by unloading results in an increase of tissue sodium concentration and fat fraction decrease: a 23Na MRI physiology study. Eur J Appl Physiol 117, 1585–1595 (2017).

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  • Sodium
  • MRI
  • 23Na MRI
  • Tissue sodium concentration (TSC)
  • Quantification
  • Muscle unloading