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.

  • 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.

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