Magnetic resonance imaging of muscle disease: a pattern-based approach

Magnetic resonance imaging (MRI) is a powerful tool to assess the severity, distribution, and progression of muscle injury and disease. However, a muscle's response to a pathological insult is limited to only a few patterns on MRI, and findings can be nonspecific. A pattern-based approach is therefore essential to correctly interpret MR studies of abnormal muscle. In this article we review the anatomy, function, and normal MRI appearance of skeletal muscle. We present a classification scheme that categorizes abnormal MR appearances of muscle into 4 main pattern descriptors: (1) distribution; (2) change in size and shape; (3) T1 signal; and (4) T2 signal. Each category is further subdivided into the various patterns seen on MRI. Such an approach allows one to systematically assess abnormal findings on muscle MRI studies and ascertain clues to the diagnosis or differential diagnosis, particularly when findings are correlated with the clinical context.