Denervation hypertrophy of muscle: MR features

Denervation hypertrophy is an entity well recognized in the neurology literature, but with little mention in the radiology literature. Denervation hypertrophy occurs when a muscle paradoxically enlarges rather than atrophies in response to loss of innervation. The purpose of this report is to describe the MR appearance of true hypertrophy and pseudohypertrophy of muscle following denervation.

The clinical data and MRI findings in three patients with muscle enlargement due to denervation hypertrophy are reviewed retrospectively. Two women and one man aged 19-80 years were included. Denervation resulted from spinal stenosis in one patient, a herniated thoracic disc in another, and spina bifida with a tethered cord in the third.

True hypertrophy of a single muscle was seen in one patient and pseudohypertrophy of two muscles was present in one patient. One patient had one muscle with true hypertrophy and one muscle with pseudohypertrophy. Electromyographic examination was performed and was consistent with denervation in two patients. Biopsy confirmation of denervation was obtained in two patients. All five abnormal muscles exhibited increased volume, well defined margins, and normal contour. In true hypertrophy the enlarged muscle was isointense with normal muscle on all MRI sequences. In pseudohypertrophy the MRI appearance was consistent with an excessive amount of fat interspersed throughout normal muscle.

Magnetic resonance in these cases established muscle hypertrophy rather than neoplasm as the cause of a palpable mass. If muscle hypertrophy or pseudohypertrophy is seen on an MR examination of an enlarged extremity, the possibility of an underlying neurologic process should be considered.