Preliminary Diagnosis: Rhabdomyolysis
I. What imaging technique is first-line for this diagnosis?
Magnetic Resonance Imaging (MRI). The need for gadolinium-based contrast agent is weighed against the benefit, especially in patients with associated renal failure.
II. Describe the advantages and disadvantages of this technique for diagnosing rhabdomyolysis.
Advantages
-
The sensitivity of MRI in detecting abnormal musculature is higher than other methods.
-
The diagnosis can be made in the acute stage of the disease.
Continue Reading -
MRI does not make use of ionizing radiation.
Disadvantages
-
Expensive.
-
Time consuming.
-
Requires significant amount of patient cooperation to minimize motion artifact.
III. What are the contraindications for the first-line imaging technique?
Contraindicated in patients with non-MR compatible metallic hardware or foreign bodies.
IV. What alternative imaging techniques are available?
-
Computed Tomography (CT) with contrast
-
Ultrasound (US)
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing rhabdomyolysis.
CT with contrast
Advantages
-
Can suggest areas of acute myonecrosis, muscular swelling due to edema, and necrotic muscle.
-
Intravenous contrast material provides better demarcation of the lesions and confirms the avascularity of the necrotic areas.
Disadvantages
-
Exposure to ionizing radiation.
-
Contrast material should be avoided in patients with renal failure.
Ultrasound
Advantages
-
Relatively inexpensive and portable imaging modality that does not used ionizing radiation.
-
Suggests areas of inflammation and fluid within and surrounding necrotic muscles and locally disorganized fascicular architecture.
Disadvantages
-
May underestimate the distribution and extension of muscle lesions.
-
Dependent on the skill of the operator.
VI. What are the contraindications for the alternative imaging techniques?
CT with contrast
-
Contraindicated in pregnant women, especially during the first two trimesters.
-
Relative contraindication in patients with renal failure.
-
Relative contraindication in patients with a contrast allergy.
Ultrasound
-
No significant contraindications.
Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.