title: Lower leg muscle involvement in Duchenne muscular dystrophy: an MR imaging and spectroscopy study.
abstract: OBJECTIVE
  To describe the involvement of lower leg muscles in boys with Duchenne muscular dystrophy (DMD) by using MR imaging (MRI) and spectroscopy (MRS) correlated to indices of functional status.
  
  
  METHODS
  Nine boys with DMD (mean age, 11 years) and eight healthy age- and BMI-matched boys (mean age, 13 years) prospectively underwent lower leg MRI, 1H-MRS of tibialis anterior (TA) and soleus (SOL) for lipid fraction measures, and 31P-MRS for pH and high-energy phosphate measures. DMD subjects were evaluated using the Vignos lower extremity functional rating, and tests including 6 min walk test (6MWT) and 10 m walk.
  
  
  RESULTS
  DMD subjects had highest fatty infiltration scores in peroneal muscles, followed by medial gastrocnemius and soleus. Compared to controls, DMD boys showed higher intramuscular fat (P = 0.04), lipid fractions of TA and SOL (P = 0.02 and 0.003, respectively), pH of anterior compartment (P = 0.0003), and lower phosphocreatine/inorganic phosphorus ratio of posterior compartment (P = 0.02). The Vignos rating correlated with TA (r = 0.79, P = 0.01) and SOL (r = 0.71, P = 0.03) lipid fractions. The 6MWT correlated with fatty infiltration scores of SOL (r = -0.76, P = 0.046), medial (r = -0.80, P = 0.03) and lateral (r = -0.84, P = 0.02) gastrocnemius, intramuscular fat (r = -0.80, P = 0.03), and SOL lipid fraction (r = -0.89, P = 0.007). Time to walk 10 m correlated with anterior compartment pH (r = 0.78, P = 0.04).
  
  
  CONCLUSIONS
  Lower leg muscles of boys with DMD show a distinct involvement pattern and increased adiposity that correlates with functional status. Lower leg MRI and 1H-MRS studies may help to noninvasively demonstrate the severity of muscle involvement.
authors.affiliation: Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. mtorriani@hms.harvard.edu
authors.forename: Martin
authors.initials: M
authors.lastname: Torriani
authors.forename: Elise
authors.initials: E
authors.lastname: Townsend
authors.forename: Bijoy J
authors.initials: BJ
authors.lastname: Thomas
authors.forename: Miriam A
authors.initials: MA
authors.lastname: Bredella
authors.forename: Reza H
authors.initials: RH
authors.lastname: Ghomi
authors.forename: Brian S
authors.initials: BS
authors.lastname: Tseng
mesh_terms: D000293:Adolescent; D002648:Child; D006801:Humans; D007866:Leg; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D018482:Muscle, Skeletal / Q000503:physiopathology; D020388:Muscular Dystrophy, Duchenne / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies