Diabetic Myopathy: MRI Patterns and Current Trends

Huang, Brady K.; Monu, Johnny U. V.; Doumanian, John

doi:10.2214/ajr.09.2494

Cited by 58 publications

(61 citation statements)

References 19 publications

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“…In most cases, it is associated with a long duration of diabetes, with an average of 14.3 years, and occurs in association with multiple chronic diabetic complications (3). Although DMI is more frequently reported in patients with type 1 diabetes (3), it can be encountered in those with type 2 diabetes of a short duration and less microangiopathy, as observed in the current patient (4). Surprisingly, there was only one patient with type 1 diabetes among the dozen cases of DMI reported in China.…”

Section: Discussionsupporting

confidence: 48%

Diabetic Muscle Infarction in a Patient Admitted to the Cardiac Ward

Liu²,

Wang

et al. 2014

Intern. Med.

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Diabetic muscle infarction (DMI) is a rare complication of long-standing diabetes mellitus. This is the first case of DMI reported by cardiologists. A 49-year-old patient with a history of diabetes and hypertension for only two years was admitted to the cardiac ward due to pain in the left thigh with pitting edema in both lower extremities. Magnetic resonance imaging finally confirmed the presence of DMI in the left thigh, which was improved by treatment with anticoagulants, analgesics and rest. However, the typical clinical symptoms of DMI were unrecognizable at the start of treatment, which may be attributed to a lack of awareness of this rare condition among non-endocrinologist physicians. Case ReportA 49-year-old Chinese man was admitted to our cardiac ward due to uncontrolled hypertension and lower limb edema, although he complained of acute pain with localized swelling in his left thigh lasting for three days at the clinic visit. Two years prior to admission, he was found to have essential hypertension and type 2 diabetes mellitus, at which time oral medications were initiated. His blood pressure and glucose level were poorly controlled with oral medication for two years, and he had experienced recurrent lower limb edema that was usually diminished with diuretics. Three days earlier, he had felt pitting edema in the lower extremities and pain in the left thigh that restricted him to bed rest at home. He denied any trauma, stinging, fever or chills before the onset of pain.The patient was afebrile. A cardiac examination revealed slight cardiac dullness and normal heart sounds with no murmurs. No wheezes or rales were identified in his lungs. Moderate pitting edema was observed in both lower extremities, although it was more obvious on the left side. A palpable mass measuring 15 cm × 15 cm was found in the middle of the left thigh, which was hard and warm with mild erythema and tenderness. The circumference of the thigh (15 cm above the patella) was 50.1 cm on the left side and 46.1 cm on the right, while the circumference of the leg (15 cm below the patella) was 35.5 cm on the left side and 34.5 cm on the right. However, the popliteal pulse, posterior tibial pulse and dorsalis pedis pulse were strong and symmetrical in both lower limbs.Laboratory tests demonstrated a normal total white blood cell count with a slightly increased neutrophil level of 77.8%, as well as normal liver and renal functions. Neither proteinuria nor microalbuminuria was present. However, both the fasting glucose (9.6 mmol/L) and hemoglobin A1C (7.9%) values were elevated. The levels of creatine kinase (CK) (268 IU/L, reference: 20-140 IU/L), troponin T (34.3 ng/L, reference: <14 ng/L), D-dimer (0.52 mg/L, reference: <0.24 mg/L) and N-terminal pro-B-type natriuretic peptide (2,645 pg/mL, reference: 0-88 pg/mL) were elevated on admission.In addition to the administration of irbesartan and insulin for blood pressure and diabetes control, oral furosemide was given to relieve the patient's symptoms of heart failure, including lowe...

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Section: Discussionsupporting

confidence: 48%

Diabetic Muscle Infarction in a Patient Admitted to the Cardiac Ward

Liu²,

Wang

et al. 2014

Intern. Med.

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“…In a magnetic resonance imaging study performed on the extremities of 14 patients with type 2 diabetes, 38% had evidence of muscle infarction and necrosis. This was coexisting with neuropathy in 50% of the cases [16]. In another study aiming at evaluating characteristics of body composition in 198 patients with type 2 diabetes, measurement of regional body composition was obtained using bioelectrical impedance analysis.…”

Section: Discussionmentioning

confidence: 99%

“…It has been attributed to systemic and cellular imbalances in metabolites of glucose and lipids [16]. Diabetic neuropathy can be sensory with resultant numbness and pain in the extremities.…”

Section: Discussionmentioning

confidence: 99%

Vocal characteristics in patients with type 2 diabetes mellitus

Hamdan

Jabbour

Nassar

et al. 2012

Eur Arch Otorhinolaryngol

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The objective of this study is to report the vocal characteristics of patients with type 2 diabetes mellitus in relation to disease duration, glycemic control, and neuropathy. This is a prospective study. The setting is institutional setting. A total of 82 patients were recruited for this study, and a healthy control group matched according to age and gender was recruited. Subjects underwent acoustic analysis and perceptual evaluation using the GRABS classification where G stands for grading, R for roughness, A for asthenia, B for breathiness, and S for straining using a scale of 0–3 where o stands for normal and three for severe deviation from normal. There was no significant difference in any of the acoustic variables between diabetic patients and control. There was no significant difference in the mean score of any of the perceptual evaluation parameters between diabetic patients and control, despite the fact that the mean scores were all higher in the diseased group except for roughness. When looking at subgroups, we see that diabetic patients with poor glycemic control and with neuropathy had significantly higher mean score for the G overall grade of the voice compared to controls with P values of 0.005 and 0.009, respectively. What is also worth noting is that diabetic patients with poor glycemic control had more straining compared to controls, P value 0.043. Patients with type 2 diabetes mellitus and poor glycemic control or neuropathy have a significant difference in the grade of their voice compared to controls.

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“…Although myonecrosis is infrequently encountered in clinical practice, it is important to distinguish from other conditions because myonecrosis usually requires only conservative management [8]; inappropriate intervention can be avoided if myonecrosis is recognized as such. Poorly controlled diabetes is the most well-known cause of myonecrosis, typically involving muscle compartments of anterior thigh or posterior calf [2, 8–10]. MRI appearances reported in diabetic myonecrosis include diffuse muscle enlargement, partial loss of normal fatty intermuscular septa on T1-weighted images, fascial fluid collections, and subcutaneous edema [9].…”

Section: Discussionmentioning

confidence: 99%

Acute myonecrosis on MRI: etiologies in an oncological cohort and assessment of interobserver variability

et al. 2016

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Objective To determine etiologies of myonecrosis in oncology patients and to assess interobserver variability in interpreting its MRI features. Materials and Methods Pathology records in our tertiary cancer hospital were searched for proven myonecrosis, and MRIs of affected regions in those patients were identified. MRI reports that suggested myonecrosis also were identified. Each MRI was reviewed independently by two of six readers to assess anatomic site, size, and signal intensities of muscle changes, and presence of the previously reported stipple sign (enhancing foci within a region defined by rim enhancement). The stipple sign was assessed again, weeks after a training session. Cohen kappa and percent agreement were calculated. Medical records were reviewed for contemporaneous causes of myonecrosis. Results MRI reports in 73 patients suggested the diagnosis of myonecrosis; pathologic proof was available in another two. Myonecrosis was frequently associated with radiotherapy (n=34 (45%) patients)); less frequent causes included intraoperative immobilization, trauma, therapeutic embolization, ablation therapy, exercise, and diabetes. Myonecrosis usually involved lower extremity, pelvis, and upper extremity; mean size was 13.0 cm. Stipple sign was observed in 55–95% of patients at first assessment (k=0.09–0.42; 60–80% agreement) and 55–100% at second (k=0.0–0.58; 72–90% agreement). Enhancement surrounded myonecrosis in 55–100% patients (k=0.03 – 0.32; 58–70% agreement). Conclusion Myonecrosis in oncology patients usually occurred after radiotherapy, and less commonly after intraoperative immobilization, trauma, therapeutic embolization, ablation therapy, exercise, or diabetes. Although interobserver variability for MRI features of myonecrosis exists (even after focused training), a combination of findings facilitates diagnosis and conservative management.

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Diabetic Myopathy: MRI Patterns and Current Trends

Cited by 58 publications

References 19 publications

Diabetic Muscle Infarction in a Patient Admitted to the Cardiac Ward

Diabetic Muscle Infarction in a Patient Admitted to the Cardiac Ward

Vocal characteristics in patients with type 2 diabetes mellitus

Acute myonecrosis on MRI: etiologies in an oncological cohort and assessment of interobserver variability

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