Jawahar Anugayathri, Balaji Ravikanth
Iowa Orthop J. 2014;34:74-7.
Diabetic muscle infarction (DMI) occurs as a rare complication of long standing or severe diabetes mellitus. The condition usually occurs spontaneously and patients usually present with acute pain and swelling of affected muscles which persists for weeks, and resolves spontaneously without intervention. Magnetic resonance (MR) imaging is the modality of choice in patients with suspected DMI based on appropriate clinical setting and plays a major role in the diagnosis, assessing the extent of involvement and differentiating DMI from other conditions. The DMI affected muscles are bulky and appear heterogeneous with hyperintense signals on T2-weighted and STIR sequences, hypo or isointense on T1-weighted images with loss of normal fatty intramuscular septae. Subcutaneous and perifascial edema can be present. On postgadolinium scans, there is diffuse heterogeneous enhancement with non-enhancing foci, which may represent areas of necrosis. Biopsy can be avoided as MR findings are highly sensitive and specific. Treatment is usually conservative. Surgical intervention is required only in patients who do not respond to conservative management. The common differential diagnosis includes cellulitis, abscess, necrotizing fasciitis and polymyositis. We present two cases below to highlight the clinical, MR imaging findings and differential diagnosis of DMI.
糖尿病性肌肉梗死（DMI）是长期或严重糖尿病的一种罕见并发症。该病通常自发发生，患者通常表现为受累肌肉的急性疼痛和肿胀，持续数周，未经干预可自行缓解。基于适当的临床情况，磁共振（MR）成像对于疑似DMI的患者是首选检查方式，在诊断、评估受累范围以及将DMI与其他疾病鉴别方面发挥着重要作用。DMI受累肌肉体积增大，在T2加权和短T1反转恢复（STIR）序列上呈高信号，表现为不均匀，在T1加权图像上呈低信号或等信号，正常肌内脂肪间隔消失。可出现皮下和筋膜周围水肿。钆增强扫描后，可见弥漫性不均匀强化，伴有无强化灶，可能代表坏死区域。由于MR表现具有高度敏感性和特异性，可避免进行活检。治疗通常采用保守治疗。仅在对保守治疗无反应的患者中需要进行手术干预。常见的鉴别诊断包括蜂窝织炎、脓肿、坏死性筋膜炎和多发性肌炎。我们在此呈现两例病例，以突出DMI的临床、MR成像表现及鉴别诊断。
