MRI of the Intrinsic Muscles of the Hand: Spectrum of Imaging Findings and Clinical Correlation
Gustav Andreisek1,
Martin Kilgus2,
Doris Burg2,
Nadja Saupe1,
David W. Crook1,
Viktor Meyer2,
Borut Marincek1 and
Dominik Weishaupt1
1 Institute of Diagnostic Radiology, Department of Medical Radiology, University
Hospital Zurich, Raemistrasse 100, Zurich CH-8091, Switzerland.
2 Division for Plastic, Hand, and Reconstructive Surgery, Department of Surgery,
University Hospital Zurich (Academic Medical Center), Zurich CH-8091,
Switzerland.
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Fig. 1A —42-year-old man 2 months after hand trauma (resulting from
fall) with final diagnosis of posttraumatic neurogenic edema of dorsal
interosseus muscles. Transaxial T1-weighted spin-echo MR image (TR/TE, 500/14)
shows normal findings; in particular no atrophy of intrinsic hand muscles is
noted. 1 = abductor pollicis brevis muscle; 2 = flexor pollicis brevis muscle;
3 = opponens pollicis muscle; 4 = adductor pollicis muscle; 5 = dorsal
interosseus muscles; 6 = palmar interosseus muscles; 7 = opponens digiti
minimi muscle; 8 = flexor digiti minimi muscle; 9 = abductor digiti minimi
muscle.
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Fig. 1B —42-year-old man 2 months after hand trauma (resulting from
fall) with final diagnosis of posttraumatic neurogenic edema of dorsal
interosseus muscles. On corresponding transaxial STIR MR image (4,300/57;
inversion time, 150 msec), hyperintense signal changes of first
(arrows) and second (arrowhead) dorsal interosseus muscles
are noted.
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Fig. 1C —42-year-old man 2 months after hand trauma (resulting from
fall) with final diagnosis of posttraumatic neurogenic edema of dorsal
interosseus muscles. On more proximal section at level of pisiform bone, deep
branch (white curved arrow) and superficial branch (black curved
arrow) of ulnar nerve and median nerve (straight arrow) are
hyperintense on STIR image (4,300/59).
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Fig. 2A —31-year-old woman with grade 1 atrophy of opponens digiti
minimi muscle and grade 2 atrophy of interosseus muscles. Transaxial
T1-weighted spin-echo MR image (TR/TE, 320/9) shows reduced muscle volume and
fatty streaks (arrowheads) in opponens digiti minimi muscle (grade 1
atrophy).
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Fig. 2B —31-year-old woman with grade 1 atrophy of opponens digiti
minimi muscle and grade 2 atrophy of interosseus muscles. Distal to A,
transaxial T1-weighted image (320/9) shows severe fatty degeneration and
reduction of interosseus muscle volumes (arrows) (grade 2
atrophy).
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Fig. 2C —31-year-old woman with grade 1 atrophy of opponens digiti
minimi muscle and grade 2 atrophy of interosseus muscles. Corresponding STIR
image (3,000/31) shows normal signal in atrophied muscles.
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Fig. 2D —31-year-old woman with grade 1 atrophy of opponens digiti
minimi muscle and grade 2 atrophy of interosseus muscles. On transaxial
T1-weighted spin-echo MR image (320/9) at level of hypothenar muscles,
compression of deep motor branch (arrow) of ulnar nerve by atypical
thickened fibrous tissue (arrowheads) is visible. MRI findings were
confirmed at open surgery.
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Fig. 3A —26-year-old man 2 years after radial fracture with surgical
fixation and postsurgical necrosis of hypothenar muscles. Transaxial
T1-weighted spin-echo image (TR/TE, 420/9) shows focal signal change in
abductor digiti minimi muscle consisting of center (arrow) with
isointense signal (with regard to muscle) surrounded by hypointense rim
(arrowheads).
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Fig. 3B —26-year-old man 2 years after radial fracture with surgical
fixation and postsurgical necrosis of hypothenar muscles. On corresponding
T2-weighted fat-suppressed fast spin-echo image (3,500/100), center
(arrow) is isointense to muscle and has surrounding hypointense rim
(arrowheads).
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Fig. 3C —26-year-old man 2 years after radial fracture with surgical
fixation and postsurgical necrosis of hypothenar muscles. On contrast enhanced
T1-weighted fat-suppressed spin-echo MR image (540/10), center of muscle
abnormality (arrow) shows contrast enhancement identical to normal
muscle, whereas rim shows no contrast enhancement (arrowheads).
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Fig. 4A —42-year-old woman with congenital hemangioma of right forearm
and hand. Transaxial T2-weighted fast spin-echo MR image (TR/TE, 4,000/104)
shows irregular vessels between flexor tendons (asterisks), between
flexor tendons and metacarpal bones (b), and in first interdigital space
(arrow). Opponens pollicis muscle shows hyperintense signal changes
(arrowheads).
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Fig. 4B —42-year-old woman with congenital hemangioma of right forearm
and hand. Corresponding transaxial T1-weighted spin-echo image (480/16) shows
normal signal in intrinsic muscles.
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Fig. 4C —42-year-old woman with congenital hemangioma of right forearm
and hand. On coronal STIR image (4,200/40; inversion time, 150 msec),
localization and size of hemangioma in thenar region (arrowheads), on
index finger (long arrow), at thumb (short arrows), and
between flexor tendons (asterisks) are visible.
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Copyright © 2005 by the American Roentgen Ray Society.
