Bochum, Grönemeyer Institut, Germany

Authored date:2006-03-13

Patient History

A 10-year-old patient referred due to pain in the right thigh that had started one week previously following a soccer match. Prior to the investigation no trauma was described. 

Positioning of the patient 

For the diagnostic imaging the patient is placed in supine position. For a better orientation, a nitro-capsule is stuck onto the patient’s skin where the pain is localized. The body-array-coil is placed centrally above the pain zone and subsequently tightly fixed with belts to the patient table.

Image Findings

In the STIR-weighting, at the level of the proximal third of the right thigh, in a cranio-caudal direction, there is a 4-cm hyperintense zone in the rectus femoris muscle. In the axial scans, this zone is located relatively far ventrally in the rectus femoris muscle, its circular cross-section measuring approximately 1.5 x 1 cm. In the T1-weighting, a moderate rise of the signal can be noticed representing a hemorrhage. Furthermore, the STIR-weighting shows an extension of the hyperintense areas periseptally towards the right lateral vastus muscle. In the complementary measuring sequence with contrast medium, a ribbon-shaped absorption of contrast medium can be seen at the edge of the said hemorrhage.The other muscle structures, the parts of both femora that were represented, are normal. The comparison of both sides shows that the volume of the right rectus femoris muscle is slightly increased. 

Assessment

In the proximal third of the right rectus femoris muscle there is a hemorrhage about the size of a hazelnut, indicating a ruptured muscle fiber with periseptal edema. This has caused a slight increase of volume. Due to the missing anamnesis of trauma, a short-term control was done after 4 weeks to exclude other diseases such as tumor mass.

Fig. 1, 2, 9 STIR cor.  TR = 5180 ms, TE = 48 ms, TI = 150 ms, slice thickness = 6mm, FOV = 285 x 300 mm, Matrix = 173 x 384 i, TA = 2.45 min.

Fig. 3, 10a STIR ax.  TR = 5380 ms, TE = 48 ms, TI = 150 ms, slice thickness = 10 mm, FOV = 225 x 300 mm, Matrix = 202 x 384 i, TA = 3.24 min.

Fig. 4, 5 T1 ax.  TR = 556 ms, TE = 12 ms, slice thickness = 10 mm, FOV = 225 x 300 mm, Matrix = 173 x 384 , TA = 2.50 min.

Fig. 4, 5 T1 ax.  TR = 556 ms, TE = 12 ms, slice thickness = 10 mm, FOV = 225 x 300 mm, Matrix = 173 x 384 , TA = 2.50 min.

Fig. 6 T1 ax. fs.  - iPAT 2, TR = 490 ms, TE = 13 ms, slice thickness = 10 mm, FOV = 225 x 300 mm, Matrix = 307 x 512 , PAT Modus = GRAPPA, PAT Faktor = 2, Ref. Zeilen = 50, TA = 3.10 min.

Fig. 7, 8 T2 sag. fs.  TR = 4160 ms, TE = 111 ms, slice thickness = 6 mm, FOV = 238 x 380 mm, Matrix = 320 x 512 , TA = 2.21 min.

Fig. 1, 2, 9 STIR cor.  TR = 5180 ms, TE = 48 ms, TI = 150 ms, slice thickness = 6mm, FOV = 285 x 300 mm, Matrix = 173 x 384 i, TA = 2.45 min.

One month later, in the STIR- and T1-weighting of the control imaging, there is no evidence of any hemorrhage into the proximal right rectus femoris muscle (no pathological changes). In the complementary T2* GRE-sequence, a small area without a signal is visible indicating blood degradation products. Neither does the previously provable slight space extension exist any longer which had affected the right rectus femoris muscle.

Fig. 3, 10a STIR ax.  TR = 5380 ms, TE = 48 ms, TI = 150 ms, slice thickness = 10 mm, FOV = 225 x 300 mm, Matrix = 202 x 384 i, TA = 3.24 min. 

Fig. 10b T2 flash ax.  TR = 700 ms, TE = 26 ms, slice thickness = 8 mm, FOV = 225 x 300 mm, Matrix = 216 x 384 , TA = 5.04 min.

Scanner and Software

The measurements have been carried out in a 1.5 Tesla magnet resonance tomograph (MAGNETOM Symphony with quantum gradients, Siemens AG, Medical Solution, Erlangen). The tomography is equipped with the Syngo version 2004A.