Skip to main content

Advertisement

SpringerLink
Log in

Imaging spectrum of atraumatic muscle disorders: a radiologist’s guide

  • Review Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Atraumatic muscle disorders comprise a very wide range of skeletal muscle diseases, including metabolic, inflammatory, autoimmune, infectious, ischemic, and neoplastic involvement of the muscles. Therefore, one must take clinical and laboratory data into consideration to elucidate the differential diagnoses, as well as the distribution of the muscle compromise along the body—whether isolated or distributed along the body in a symmetric or asymmetrical fashion. Assessment of muscular disorders often requires imaging investigation before image-guided biopsy or more invasive procedures; therefore, radiologists should understand the advantages and limitations of imaging methods for proper lesion evaluation and be aware of the imaging features of such disorders, thus contributing to proper decision-making and good patient outcomes. In this review, we propose a systematic approach for the assessment of muscle disorders based on their main imaging presentation, dividing them into patterns that can be easily recognized.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12

Similar content being viewed by others

References

  1. Smitaman E, Flores DV, Mejía Gómez C, Pathria MN. MR imaging of atraumatic muscle disorders. Radiographics. 2018;38(2):500–22.

    Article  PubMed  Google Scholar 

  2. May DA, Disler DG, Jones EA, Balkissoon AA, Manaster BJ. Abnormal signal intensity in skeletal muscle at MR imaging: patterns, pearls, and pitfalls. Radiographics. 2000;20:S925–S315.

    Article  Google Scholar 

  3. Ghaoui R, Clarke N, Hollingworth P, Needham M. Muscle disorders: the latest investigations. Intern Med J. 2013;43(9):970–8.

    Article  CAS  PubMed  Google Scholar 

  4. Theodorou DJ, Theodorou SJ, Saba L, Kakitsubata Y, Theodorou S. Skeletal muscle disease: imaging findings simplified. Cureus. 2022;14(9): e29655.

    PubMed  PubMed Central  Google Scholar 

  5. Theodorou DJ, Theodorou SJ, Kakitsubata Y. Skeletal muscle disease: patterns of MRI appearances. Br J Radiol. 2012;85(1020):e1298–308.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Connell P, Koh WS, Vonberg F, Viegas S, Limback-Stanic C, Amiras D. The utility and tolerability of ultrasound guided muscle biopsy in the investigation of myopathy: a follow-up study. J Ultrasound. 2023;26(4):793–7.

    Article  PubMed  Google Scholar 

  7. Mian M, Lim BG, Hossain MN, Wicks I, Day J. Retrospective comparison of ultrasound guided percutaneous and open skeletal muscle biopsies. Intern Med J. 2023;53(8):1383–9.

    Article  PubMed  Google Scholar 

  8. Lee KH, Lau V, Gao Y, et al. Ultrasound-MRI fusion for targeted biopsy of myopathies. Am J Roentgenol. 2019;212(5):1126–8.

    Article  Google Scholar 

  9. Kothekar E, Raynor WY, Al-Zaghal A, Jonnakuti VS, Werner TJ, Alavi A. Evolving role of PET/CT-MRI in assessing muscle disorders. PET clinics. 2019;14(1):71–9.

    Article  PubMed  Google Scholar 

  10. Parida GK, Roy SG, Kumar R. FDG-PET/CT in skeletal muscle: pitfalls and pathologies. Semin Nucl Med. 2016;47(4):362–72.

    Article  Google Scholar 

  11. McMahon CJ, Wu JS, Eisenberg RL. Muscle edema. Am J Roentgenol. 2010;194(4):W284–92.

    Article  Google Scholar 

  12. Kransdorf MJ, Murphey MD. Radiologic evaluation of soft-tissue masses: a current perspective. Am J Roentgenol. 2000;175(3):575–87.

    Article  CAS  Google Scholar 

  13. Nico MAC, Carneiro BC, Zorzenoni FO, Ormond Filho AG, Guimarães JB. The role of magnetic resonance in the diagnosis of chronic exertional compartment syndrome. Revista Brasileira de Ortopedia. 2021;55:673–80.

    Google Scholar 

  14. Pham M, Wolf M, Bäumer P, Bendszus M, Kasprian G. MRI of muscle denervation in central and peripheral nervous system disorders. In: Weber M-A, editor. Magnetic Resonance Imaging of the Skeletal Musculature. Berlin Heidelberg: Springer; 2014. p. 221–40.

    Google Scholar 

  15. Guimarães JB, Nico MA, Ormond AG, et al. Diagnostic imaging of inflammatory myopathies: new concepts and a radiological approach. Curr Rheumatol Rep. 2019;21:1–13.

    Article  Google Scholar 

  16. Schulze M, Kötter I, Ernemann U, et al. MRI findings in inflammatory muscle diseases and their noninflammatory mimics. Am J Roentgenol. 2009;192(6):1708–16.

    Article  Google Scholar 

  17. Dalakas MC. Inflammatory muscle diseases. N Engl J Med. 2015;372(18):1734–47.

    Article  PubMed  Google Scholar 

  18. Agten CA, Buck FM, Dyer L, Flück M, Pfirrmann CW, Rosskopf AB. Delayed-onset muscle soreness: temporal assessment with quantitative MRI and shear-wave ultrasound elastography. Am J Roentgenol. 2017;208(2):402–12.

    Article  Google Scholar 

  19. Rehman N, Sadashiva H, Madakshira MG, Raman DK. Non-traumatic myositis ossificans. Autops Case Rep. 2021;11: e2021316.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Reijnierse M, Schwabl C, Klauser A. Imaging of crystal disorders: calcium pyrophosphate dihydrate crystal deposition disease, calcium hydroxyapatite crystal deposition disease and gout pathophysiology, imaging, and diagnosis. Radiol Clin. 2022;60(4):641–56.

    Article  Google Scholar 

  21. Kransdorf MJ, Meis JM, Jelinek JS. Myositis ossificans: MR appearance with radiologic-pathologic correlation. Am J Roentgenol. 1991;157(6):1243–8.

    Article  CAS  Google Scholar 

  22. Lacout A, Jarraya M, Marcy PY, Thariat J, Carlier RY. Myositis ossificans imaging: keys to successful diagnosis. Indian J Radiol Imag. 2012;22(1):35–9.

    Article  Google Scholar 

  23. Abate M, Salini V, Rimondi E, et al. Post traumatic myositis ossificans: sonographic findings. J Clin Ultrasound. 2011;39(3):135–40.

    Article  PubMed  Google Scholar 

  24. Fathi I, Sakr M. Review of tumoral calcinosis: a rare clinico-pathological entity. World J Clin Cases. 2014;2(9):409.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Olsen KM, Chew FS. Tumoral calcinosis: pearls, polemics, and alternative possibilities. Radiographics. 2006;26(3):871–85.

    Article  PubMed  Google Scholar 

  26. Cobos GA, Femia A, Vleugels RA. Dermatomyositis: an update on diagnosis and treatment. Am J Clin Dermatol. 2020;21(3):339–53.

    Article  PubMed  Google Scholar 

  27. Castro TCM, Guarniero R, Giacomin MFA, Meneghin MBL, Martins GB, Lotufo SA. “Milk of calcium”: a rare presentation of calcinosis. Rev Bras Reumatol. 2013;54(1):65–7.

    Article  Google Scholar 

  28. Yildirim DG, Akdulum I, Talim B, Demir E, Buyan N, Bakkaloğlu SA. Milk of calcium: a rare manifestation of juvenile dermatomyositis. Arch Rheumatol. 2021;36(2):302–4.

    Article  PubMed  Google Scholar 

  29. Catapano M, Robinson DM, Schowalter S, McInnis KC. Clinical evaluation and management of calcific tendinopathy: an evidence-based review. J Am Osteopath Assoc. 2022;122(3):141–51.

    Google Scholar 

  30. Siegal DS, Wu JS, Newman JS, Del Cura JL, Hochman MG. Calcific tendinitis: a pictorial review. Can Assoc Radiol J. 2009;60(5):263–72.

    Article  PubMed  Google Scholar 

  31. Liu H, Juan YH, Wang W, et al. Intramuscular cysticercosis: starry sky appearance. QJM: An International Journal of Medicine. 2014;107(6):459–61.

    Article  PubMed  Google Scholar 

  32. Wasserman PL, Way A, Baig S, Gopireddy DR. MRI of myositis and other urgent muscle-related disorders. Emerg Radiol. 2021;28:409–21.

    Article  PubMed  Google Scholar 

  33. Lawrence L, Tovar-Camargo O, Lansang MC, Makin V. Diabetic myonecrosis: a diagnostic and treatment challenge in longstanding diabetes. Case Rep Endocrinol. 2018;2018:1723695.

    PubMed  PubMed Central  Google Scholar 

  34. Beggs I. Sonography of muscle hernias. Am J Roentgenol. 2003;180(2):395–9.

    Article  Google Scholar 

  35. Nguyen JT, Nguyen JL, Wheatley MJ, Nguyen TA. Muscle hernias of the leg: a case report and comprehensive review of the literature. Canad J Plast Surg. 2013;21(4):243–7.

    Article  Google Scholar 

  36. Wu JS, Hochman MG. Soft-tissue tumors and tumorlike lesions: a systematic imaging approach. Radiology. 2009;253(2):297–316.

    Article  PubMed  Google Scholar 

  37. Hasbani GE, Uthman I, Jawad AS. Musculoskeletal manifestations of sarcoidosis. Clin Med Insights: Arthritis Musculoskeletal Disord. 2022;15:11795441211072476.

    Google Scholar 

  38. Aubart FC, Abbara S, Maisonobe T, et al. Symptomatic muscular sarcoidosis: lessons from a nationwide multicenter study. Neurol –Neuroimmunol Neuroinflam. 2018;5(3): e452.

    Article  Google Scholar 

  39. Kohashi K, Kinoshita I, Oda Y. Soft tissue special issue: skeletal muscle tumors: a clinicopathological review. Head Neck Pathol. 2020;14:12–20.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Surov A, Köhler J, Wienke A, et al. Muscle metastases: comparison of features in different primary tumours. Cancer Imaging. 2014;14(1):1–8.

    Article  Google Scholar 

  41. Surov A, Hainz M, Holzhausen HJ, et al. Skeletal muscle metastases: primary tumours, prevalence, and radiological features. Eur Radiol. 2010;20:649–58.

    Article  PubMed  Google Scholar 

  42. Song Y, Yoon YC, Chong Y, et al. Diagnostic performance of conventional MRI parameters and apparent diffusion coefficient values in differentiating between benign and malignant soft-tissue tumours. Clin Radiol. 2017;72(8):691-e1-691-e10.

    Article  PubMed  Google Scholar 

  43. Subhawong TK, Jacobs MA, Fayad LM. Insights into quantitative diffusion-weighted MRI for musculoskeletal tumor imaging. Am J Roentgenol. 2014;203(3):560–72.

    Article  Google Scholar 

  44. Hassanien OA, Younes RL, Dawoud RM. Diffusion weighted MRI of soft tissue masses: Can measurement of ADC value help in the differentiation between benign and malignant lesions? Egypt J Radiol Nucl Med. 2018;49(3):681–8.

    Article  Google Scholar 

  45. Razek AA, Megahed AS, Denewer A, Motamed A, Tawfik A, Nada N. Role of diffusion-weighted magnetic resonance imaging in differentiation between the viable and necrotic parts of head and neck tumors. Acta Radiol. 2008;49(3):364–70.

    Article  PubMed  Google Scholar 

  46. Cardamone M, Darras BT, Ryan MM. Inherited myopathies and muscular dystrophies. Semin Neurol. 2008;28(2):250–9.

    Article  PubMed  Google Scholar 

  47. Dam LT, van der Kooi AJ, Verhamme C, Wattjes MP, De Visser M. Muscle imaging in inherited and acquired muscle diseases. Eur J Neurol. 2016;23(4):688–703.

    Article  PubMed  Google Scholar 

  48. Wattjes MP, Kley RA, Fischer D. Neuromuscular imaging in inherited muscle diseases. Eur Radiol. 2010;20:2447–60.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Carneiro BC, Cruz IA, Chemin RN, et al. Multimodality imaging of foreign bodies: new insights into old challenges. Radiographics. 2020;40(7):1965–86.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Musculoskeletal Radiology, Fleury Medicina E Saúde, Sao Paulo, Brazil

    Dâmaris Versiani C. Gonçalves, Lucas N. M. da Silva, Júlio Brandão Guimarães, Isabela A. N. da Cruz & Alípio Gomes Ormond Filho

Authors
  1. Dâmaris Versiani C. Gonçalves
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lucas N. M. da Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Júlio Brandão Guimarães
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Isabela A. N. da Cruz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alípio Gomes Ormond Filho
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dâmaris Versiani C. Gonçalves.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Key points

1. Atraumatic muscle changes on imaging may have a broad range of differential diagnoses, which can be narrowed by careful assessment of the lesion distribution along the body and complementary clinical and laboratory data.

2. Muscle disorders can be assessed by a variety of imaging modalities, each method having its own strengths and limitations.

3. Muscle disorders can be divided into the following four patterns according to the main imaging features: intramuscular edema; intramuscular calcification; mass-like effect; and fat infiltration.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gonçalves, D.V.C., da Silva, L.N.M., Guimarães, J.B. et al. Imaging spectrum of atraumatic muscle disorders: a radiologist’s guide. Skeletal Radiol (2024). https://doi.org/10.1007/s00256-024-04659-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00256-024-04659-7

Keywords

Search

Navigation