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Rhabdomyolysis: Magnetic Resonance Imaging and Computed Tomography Findings

Lu, Chia-Hung MD*; Tsang, Yuk-Ming MD*; Yu, Chih-Wei MD*; Wu, Mu-Zon MD; Hsu, Chao-Yu MD*; Shih, Tiffany Ting-Fang MD*

Journal of Computer Assisted Tomography: May-June 2007 - Volume 31 - Issue 3 - p 368-374
doi: 10.1097/01.rct.0000250115.10457.e9
Musculoskeletal Imaging: Original Article

Objective: Our purpose was to describe the magnetic resonance (MR) imaging and computed tomography (CT) findings in patients with rhabdomyolysis.

Methods: The medical records and imaging studies of 10 patients (5 males, 5 females; age range, 14-60 years; mean age, 28.3 years) with rhabdomyolysis were retrospectively reviewed. Magnetic resonance imaging was available in 9 patients and CT in 2 patients.

Results: Two distinct imaging types of rhabdomyolysis were observed. For type 1 rhabdomyolysis (n = 2), the affected muscles revealed homogeneously isointense to hyperintense on T1-weighted, homogeneously hyperintense on T2-weighted and short-tau inversion recovery (STIR) images, and homogeneously enhanced on contrast-enhanced MR images. For type 2 rhabdomyolysis (n = 8), the affected muscles revealed homogeneously or heterogeneously isointense to hyperintense on T1-weighted images, heterogeneously hyperintense on T2-weighted and STIR images, heterogeneously hypodense on CT images, and rim enhanced on contrast-enhanced MR and CT images with the presence of a specific presentation, named as the "stipple sign."

Conclusions: Rhabdomyolysis is a clinical and biochemical syndrome comprising 2 distinct imaging types. Homogeneous signal changes and enhancement in the affected muscles advocate type 1 rhabdomyolysis. The stipple sign is helpful in demonstrating the areas of myonecrosis in type 2 rhabdomyolysis and, together with clinical and laboratory presentations, in reaching the correct diagnosis.

From the *Departments of Medical Imaging and †Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

Received for publication August 13, 2006; accepted September 2, 2006.

Reprints: Chao-Yu Hsu, MD, Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, 7, Chung-Shan S. Rd Taipei, Taiwan 100 (e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.