Subscribe to RSS
DOI: 10.1055/s-2007-962925
© Georg Thieme Verlag KG Stuttgart · New York
Radiologische Diagnostik von Muskelerkrankungen
Radiological Diagnostics of Muscle DiseasesPublication History
eingereicht: 27.11.2006
angenommen: 5.1.2007
Publication Date:
09 May 2007 (online)
![](https://www.thieme-connect.de/media/roefo/200707/lookinside/thumbnails/10.1055-s-2007-962925-1.jpg)
Zusammenfassung
Muskelerkrankungen sind eine große heterogene Gruppe von Erkrankungen mit oft sehr schwieriger Differenzialdiagnose. Der vorliegende Artikel gibt eine Übersicht über morphologische und funktionelle radiologische Techniken bei Muskelerkrankungen. Morphologisch können ödematöse, lipomatöse und atrophische Veränderungen des Muskelgewebes erfasst werden, jedoch sind diese Bildbefunde oft nicht für eine bestimmte Muskelerkrankung spezifisch, sodass Kliniker bisher der Radiologie bei der Aufarbeitung von Myopathien einen eher nachgeordneten Rang einräumen. Funktionelle radiologische Techniken erlauben mittlerweile die Beurteilung u. a. der Muskelfaserarchitektur, der Skelettmuskelperfusion, der Natrium-Homöostase der Muskelzellen sowie des Lipid- und Energiephosphatstoffwechsels. Durch die Erfassung und räumliche Zuordnung pathophysiologischer Phänomene können diese neuen Techniken den Stellenwert der radiologischen Diagnostik bei Muskelkrankheiten erhöhen.
Abstract
Muscular diseases are a heterogeneous group of diseases with difficult differential diagnosis. This article reviews morphological and functional radiological techniques for assessment of muscular diseases. Morphological techniques can describe edema-like changes, lipomatous and atrophic changes of muscular tissue. However, these imaging signs are often not disease-specific. As a result, clinicians assign radiology a secondary role in the management of muscular diseases. Meanwhile, functional radiological techniques allow the assessment of muscle fiber architecture, skeletal muscle perfusion, myocellular sodium-homoeostasis, lipid- and energy-phosphate metabolism, etc. By detecting and spatially localizing pathophysiological phenomena, these new techniques can increase the role of radiology in muscular diseases.
Key words
MR imaging - muscular - ultrasound - MR spectroscopy
Literatur
- 1 Dalakas M C, Hohlfeld R. Polymyositis and dermatomyositis. Lancet. 2003; 362 971-982
- 2 Scott D L, Kingsley G H. Use of imaging to assess patients with muscle disease. Curr Opin Rheumatol. 2004; 16 678-683
- 3 Zierz S, Jerusalem F. Muskelerkrankungen. Stuttgart; Thieme 2003 3. Aufl
- 4 Garcia J. MRI in inflammatory myopathies. Skeletal Radiol. 2000; 29 425-438
- 5 Maillard S M, Jones R, Owens C. et al . Quantitative assessment of MRI T2 relaxation time of thigh muscles in juvenile dermatomyositis. Rheumatology. 2004; 43 603-608
- 6 Mastaglia F L, Garlepp M J, Phillips B A. et al . Inflammatory myopathies: clinical, diagnostic and therapeutic aspects. Muscle Nerve. 2003; 27 407-425
- 7 May D A, Disler D G, Jones E A. et al . Abnormal signal intensity in skeletal muscle at MR imaging: patterns, pearls, and pitfalls. Radiographics. 2000; 20 Spec No S295-315
- 8 Reimers C D, Finkenstaedt M. Muscle imaging in inflammatory myopathies. Curr Opin Rheumatol. 1997; 9 475-485
- 9 Mercuri E, Jungbluth H, Muntoni F. Muscle imaging in clinical practice: diagnostic value of muscle magnetic resonance imaging in inherited neuromuscular disorders. Curr Opin Neurol. 2005; 18 526-537
- 10 Olsen N J, Qi J, Park J H. Imaging and skeletal muscle disease. Curr Rheumatol Rep. 2005; 7 106-114
- 11 McCarthy E F, Sundaram M. Heterotopic ossification: a review. Skeletal Radiol. 2005; 34 609-619
- 12 Peetrons P. Ultrasound of muscles. Eur Radiol. 2002; 12 35-43
- 13 Kane D, Grassi W, Sturrock R. et al . Musculoskeletal ultrasound - a state of the art review in rheumatology. Part 2: Clinical indications for musculoskeletal ultrasound in rheumatology. Rheumatology. 2004; 43 829-838
- 14 Dock W, Grabenwöger F, Happak W. et al . Sonographie der Skelettmuskulatur mit hochfrequenten Ultraschallköpfen. Fortschr Röntgenstr. 1990; 152 47-50
- 15 Trusen A, Beissert M, Schulz G. et al . Ultrasound and MRI features of pyomyositis in children. Eur Radiol. 2003; 13 1050-1055
- 16 Dion E, Cherin P, Payan C. et al . Magnetic resonance imaging criteria for distinguishing between inclusion body myositis and polymyositis. J Rheumatol. 2002; 29 1897-1906
- 17 O’Connell M J, Powell T, Brennan D. et al . Whole-body MR imaging in the diagnosis of polymyositis. AJR Am J Roentgenol. 2002; 179 967-971
- 18 Park J H, Olsen N J. Utility of magnetic resonance imaging in the evaluation of patients with inflammatory myopathies. Curr Rheumatol Rep. 2001; 3 334-345
- 19 Schweitzer M E, Fort J. Cost-effectiveness of MR imaging in evaluating polymyositis. AJR Am J Roentgenol. 1995; 165 1469-1471
- 20 Ladd S C, Zenge M, Antoch G. et al . MR-Ganzkörperdiagnostik. Fortschr Röntgenstr. 2006; 178 763-770
- 21 Beese M S, Winkler G, Nicolas V. et al . Diagnostik entzündlicher Muskel- und Gefäßerkrankungen in der MRT mit STIR Sequenzen. Fortschr Röntgenstr. 1993; 158 542-549
- 22 Yosipovitch G, Beniaminov O, Rousso I. et al . STIR magnetic resonance imaging: a noninvasive method for detection and follow-up of dermatomyositis. Arch Dermatol. 1999; 135 721-723
- 23 Weber M A, Jappe U, Essig M. et al . Contrast-enhanced ultrasound in dermatomyositis and polymyositis. J Neurol. 2006; 253 1625-1632
- 24 Weber M A, Krix M, Jappe U. et al . Detection of pathologic skeletal muscle perfusion in patients with myositis using quantitative contrast-enhanced ultrasound - Initial results. Radiology. 2006; 238 640-649
- 25 Bendszus M, Koltzenburg M. Visualization of denervated muscle by gadolinium-enhanced MRI. Neurology. 2001; 57 1709-1711
- 26 Zaraiskaya T, Kumbhare D, Noseworthy M D. Diffusion tensor imaging in evaluation of human skeletal muscle injury. J Magn Reson Imaging. 2006; 24 402-408
- 27 Folkman J. Angiogenesis in cancer, vascular, rheumatoid and other disease. Nat Med. 1995; 1 27-31
- 28 Clark M G, Colquhoun E Q, Rattigan S. et al . Vascular and endocrine control of muscle metabolism. Am J Physiol. 1995; 268 E797-812
- 29 Wheatley C M, Rattigan S, Richards S M. et al . Skeletal muscle contraction stimulates capillary recruitment and glucose uptake in insulin-resistant obese Zucker rats. Am J Physiol Endocrinol Metab. 2004; 287 E804-E809
- 30 Slaaf D W, Oude Egbrink M G. Capillaries and flow redistribution play an important role in muscle blood flow reserve capacity. J Mal Vasc. 2002; 27 63-67
- 31 Nuutila P, Kalliokoski K. Use of positron emission tomography in the assessment of skeletal muscle and tendon metabolism and perfusion. Scand J Med Sci Sports. 2000; 10 346-350
- 32 Krix M, Weber M A, Krakowski-Roosen H. et al . Assessment of skeletal muscle perfusion using contrast-enhanced ultrasound. J Ultrasound Med. 2005; 24 431-441
- 33 Weber M A, Krakowski-Roosen H, Delorme S. et al . Relationship of skeletal muscle perfusion measured by contrast-enhanced ultrasonography to histologic microvascular density. J Ultrasound Med. 2006; 25 583-591
- 34 Frank L R, Wong E C, Haseler L J. et al . Dynamic imaging of perfusion in human skeletal muscle during exercise with arterial spin labeling. Magn Reson Med. 1999; 42 258-267
- 35 Parrish T B, Fieno D S, Fitzerald S W. et al . Theoretical Basis for Sodium and Potassium MRI of the Human Heart at 1.5T. Magn Reson Med. 1997; 38 653-661
- 36 Boada F E, Shen G X, Chang S Y. et al . Spectrally weighted twisted projection imaging: reducing T2 signal attenuation effects in fast three-dimensional sodium imaging. Magn Reson Med. 1997; 38 1022-1028
- 37 Constantinides C D, Gillen J S, Boada F E. et al . Human skeletal muscle: Sodium MR imaging and quantification - Potential applications in exercise and disease. Radiology. 2000; 216 559-568
- 38 Ouwerkerk R, Bleich K B, Gillen J S. et al . Tissue Sodium Concentration in Human Brain Tumors as Measured with 23Na MR Imaging. Radiology. 2003; 227 529-537
- 39 Lehmann-Horn F, Jurkat-Rott K. Voltage-gated ion channels and hereditary disease. Physiol Rev. 1999; 79 1317-1371
- 40 Weber M A, Nielles-Vallespin S, Essig M. et al . Muscle Na+ channelopathies - MRI detects intracellular 23Na accumulation during episodic weakness. Neurology. 2006; 67 1151-1158
- 41 Weber M A, Nielles-Vallespin S, Huttner H B. et al . 23Na MRI for evaluation of paramyotonia patients during cold-induced weakness. Radiology. 2006; 240 489-500
- 42 Argov Z, Lofberg M, Arnold D L. Insights into muscle diseases gained by phosphorus magnetic resonance spectroscopy. Muscle Nerve. 2000; 23 1316-1334
- 43 Vogl T J, Söllner O, Dadashi A R. et al . Wertigkeit der In-vivo-31Phosphorspektroskopie bei der Diagnostik generalisierter Muskelerkrankungen. Klinische Ergebnisse und differentialdiagnostische Aspekte. Fortschr Röntgenstr. 1995; 162 455-463
- 44 Pfleiderer B, Lange J, Loske K D. et al . Metabolic disturbances during short exercises in dermatomyositis revealed by real-time functional 31P magnetic resonance spectroscopy. Rheumatology (Oxford). 2004; 43 696-703
- 45 Schröder L, Weber M A, Ulrich M. et al . Metabolic imaging of atrophic muscle tissue using appropriate markers in 1H and 31P NMR spectroscopy. Neuroradiology. 2006; 48 809-816
- 46 Boesch C, Kreis R. Observation of intramyocellular lipids by 1H-magnetic resonance spectroscopy. Ann N Y Acad Sci. 2000; 904 25-31
- 47 Howald H, Boesch C, Kreis R. et al . Content of intramyocellular lipids derived by electron microscopy, biochemical assays, and (1)H-MR spectroscopy. J Appl Physiol. 2002; 92 2264-2272
- 48 Thamer C, Machann J, Bachmann O. et al . Intramyocellular lipids: anthropometric determinants and relationships with maximal aerobic capacity and insulin sensitivity. J Clin Endocrinol Metab. 2003; 88 1785-1791
Dr. Marc-André Weber
Abteilung Radiologie, Deutsches Krebsforschungszentrum
Im Neuenheimer Feld 280
69123 Heidelberg
Phone: ++49/62 21/42 24 93
Fax: ++49/62 21/42 24 62
Email: m.a.weber@dkfz.de