Decreased water T₂ in fatty infiltrated skeletal muscles of patients with neuromuscular diseases

Quantitative imaging techniques are emerging in the field of magnetic resonance imaging of neuromuscular diseases (NMD). T₂ of water (T_2w) is considered an important imaging marker to assess acute and chronic alterations of the muscle fibers, being generally interpreted as an indicator for “disease activity” in the muscle tissue. To validate the accuracy and robustness of quantitative imaging methods, ¹H magnetic resonance spectroscopy (MRS) can be used as a gold standard. The purpose of the present work was to investigate T_2w of remaining muscle tissue in regions of higher proton density fat fraction (PDFF) in 40 patients with defined NMD using multi-TE single-voxel ¹H MRS. Patients underwent MR measurements on a 3 T system to perform a multi-TE single-voxel stimulated echo acquisition method (STEAM) MRS (TE = 11/15/20/25(/35) ms) in regions of healthy, edematous and fatty thigh muscle tissue. Muscle regions for MRS were selected based on T₂-weighted water and fat images of a two-echo 2D Dixon TSE. MRS results were confined to regions with qualitatively defined remaining muscle tissue without edema and high fat content, based on visual grading of the imaging data. The results showed decreased T_2w values with increasing PDFF with R² = 0.45 (p < 10⁻³) (linear fit) and with R² = 0.51 (exponential fit). The observed dependence of T_2w on PDFF should be considered when using T_2w as a marker in NMD imaging and when performing single-voxel MRS for T_2w in regions enclosing edematous, nonedematous and fatty infiltrated muscle tissue.