title: Foot small muscle atrophy is present before the detection of clinical neuropathy.
abstract: OBJECTIVE
  To characterize structural changes and the metabolic profile of foot muscles and correlate them with diabetic neuropathy measurements using phosphorus-31 ((31)P) rapid acquisition with relaxation enhancement (RARE) magnetic resonance imaging (MRI).
  
  
  METHODS
  We studied 12 control subjects, 9 non-neuropathic diabetic patients, and 12 neuropathic diabetic patients using (31)P RARE and proton ((1)H) MRI at 3 Tesla. The ratio of the total cross-sectional area of the foot to that of the muscle tissue was calculated from transaxial (1)H and (31)P images. The average (31)P concentration across the metatarsal head region was measured from the (31)P images.
  
  
  RESULTS
  The muscle area-to-total area ratio differed among all three groups (means +/- SD): 0.55 +/- 0.04 vs. 0.44 +/- 0.05 vs. 0.06 +/- 0.06 for control, non-neuropathic, and neuropathic subjects, respectively (P < 0.0001). The average (31)P concentration also differed among all groups: 27.7 +/- 3.8 vs. 21.7 +/- 4.8 vs. 7.9 +/- 8.8 mmol/l for control, non-neuropathic, and neuropathic subjects (P < 0.0001). The muscle area-to-total area ratio strongly correlated with clinical measurements: Neuropathy Disability Score, r = -0.83, P < 0.0001; vibration perception threshold, r = -0.79, P < 0.0001; and Semmes-Weinstein monofilaments, r = -0.87, P < 0.0001.
  
  
  CONCLUSIONS
  Small muscle atrophy is present in diabetes before clinical peripheral neuropathy can be detected using standard clinical techniques. The (31)P RARE MRI method evaluates the severity of muscle atrophy, even in the early stages when neuropathy is absent. This technique may prove to be a useful diagnostic tool in identifying early-stage diabetic foot problems.
authors.affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Rd., Boston, MA 02115, USA. rgreenma@bidmc.harvard.edu
authors.forename: Robert L
authors.initials: RL
authors.lastname: Greenman
authors.forename: Lalita
authors.initials: L
authors.lastname: Khaodhiar
authors.forename: Christina
authors.initials: C
authors.lastname: Lima
authors.forename: Thanh
authors.initials: T
authors.lastname: Dinh
authors.forename: John M
authors.initials: JM
authors.lastname: Giurini
authors.forename: Aristidis
authors.initials: A
authors.lastname: Veves
mesh_terms: D001284:Atrophy / Q000473:pathology*; D015992:Body Mass Index; D017719:Diabetic Foot / Q000175:diagnosis; D003929:Diabetic Neuropathies / Q000473:pathology*; D005260:Female; D005528:Foot; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology*; D015203:Reproducibility of Results; D014316:Tritium
chemical_list: D014316:Tritium