Exertional muscle injury: evaluation of concentric versus eccentric actions with serial MR imaging

Eccentric muscular actions involve the forced lengthening or stretching of muscles and tend to produce exertional injuries. This study used magnetic resonance (MR) imaging to serially evaluate muscles in five healthy, untrained subjects who performed exhaustive biceps exercise by doing isolated eccentric and concentric actions with a dumbbell. Symptoms were assessed, and T2-weighted images of the arms were obtained before exercise and 1, 3, 5, 10, 25, 40, 50, 60, and 80 days after exercise. Statistically significant increases in T2 relaxation times indicative of muscle injury occurred on each day of MR imaging evaluation in muscles performing eccentric actions, peaking on day 3 in two subjects; day 5, two subjects; and day 10, one subject. The pattern and extent of the abnormalities on MR images were variable. Pain, soreness, and joint stiffness were present on days 1, 3, and 5 in muscles that performed eccentric actions. MR imaging showed subclinical abnormalities that lasted as long as 75 days after the disappearance of symptoms (two subjects). Muscles that performed concentric actions had no changes in T2 relaxation times and were asymptomatic throughout the study.     

Magnetic resonance imaging of the rotator cuff muscles after baseball pitching

AIM: The purposes of present study were to investigate quantitatively using functional MR imaging the effect of a series of throwing activities on rotator cuff muscles and to compare the effect of pitching with that of all-out shoulder external rotator exercise as the targeted external rotator muscle group (the infraspinatus and the teres minor). METHODS: Experimental design: MRI measurements after 135 baseball pitches or all-out shoulder external rotator exercise (concentric mode) in each subject's nondominant shoulder. Participants: 6 amateur baseball pitchers. Measures: serial T2-weighted images of rotator cuff muscles were obtained before pitching (or shoulder exercise) and immediately, 30, 60 min, 24, 48, 96 hrs after pitching (or shoulder exercise). T2 relaxation times (T2) at each measurement time were calculated for the rotator cuff muscles. RESULTS: Both the supraspinatus and the external rotator muscle group showed significant T2 elevations until 96 hrs after pitching. The subscapularis also showed significantly increased T2 until postpitching 48 hrs. On the other hand, a significant T2 elevation continued until 60 min after shoulder exercise, but thereafter returned towards the value at rest over the next 24 hrs. CONCLUSION: Long lasting T2 elevations in rotator cuff muscles would be associated with an increase in each intramuscular water content, and may be attributed to the muscle damage that resulted from eccentric contraction during pitching. This information should serve as a useful complement to shoulder injury prevention for baseball pitchers.     

Localization and quantification of muscle damage by magnetic resonance imaging following step exercise in young women

Eccentric exercise affects muscles differentially according to intensity, duration, and previous exposure to the specific exercise activity. We used T2-weighted magnetic resonance imaging sequences to localize and quantify muscle damage following step exercise and to determine correlations between transverse relaxation time (T2) and other markers of muscle damage. Eight women performed two-step exercise bouts (30 min) separated by 8 weeks. Blood samples, MR scans, measurements of muscle strength, and muscle soreness were obtained immediately before, after, and up to 9 days after each bout. Resting muscle T2 (40.3+/-0.6 ms) increased exclusively in m. Adductor magnus (AM) in the thigh performing eccentric contractions and peaked 3 days after bout 1 (73.5+/-9.7 ms, P<0.05). Plasma creatine kinase (CK) activity peaked on day 3 after bout 1 and correlated with T2 in AM (r=0.96, P<0.001). After bout 2 CK and T2 were almost unaffected. This indicates that T2-weighted MRI can be applied to identify muscles from which enzymes are being released into the circulation.     

Fatigue and recovery at long and short muscle lengths after eccentric training

PURPOSE: To determine the effects of high-speed eccentric training of rat plantar flexor muscles on: 1) maximum (120 Hz) force at 90 degrees ankle position; 2) fatigue (40 concentric muscle actions, ROM 50 degrees) and recovery (6 concentric muscle actions) tested at short or long muscle lengths; and 3) low-frequency fatigue. METHODS: Training consisted of eccentric muscle actions from ankle positions of 140 degrees to 40 degrees (velocity approximately 400 degrees x s(-1)) followed by unresisted concentric muscle actions (5 x 10 repetitions, 5 d x wk(-1) for 6 wk). Fatigue was induced by concentric muscle actions with a rest of 12.5 s between muscle actions, and recovery consisted of equivalent concentric muscle actions performed every 5 min for 30 min. Low-frequency fatigue was measured 35 min after testing at 90 degrees ankle position by using the ratio of isometric force produced by 20- and 100-Hz stimulation frequencies. RESULTS: Eccentric training increased maximal isometric force per muscle weight by 22% whereas muscle weights were unchanged. In control muscles (C), isometric force immediately preceding each concentric muscle action decreased more at long lengths than at short lengths during the fatigue protocol; this length-dependent difference disappeared after 30 min of recovery. At short lengths, isometric force decreased less in trained muscles (T) (C: 78.4 +/- 3.6%; T: 59.6 +/- 4.4%) and recovered more during the following 30-min period (C: 84.7 +/- 2.5%; T: 95.4 +/- 2.8% of initial values). Changes in F20/F100 were smaller for trained muscles (C: 35.4 +/- 2.0%; T: 22.0 +/- 1.4%). CONCLUSIONS: High-speed eccentric training (5 d x wk(-1) for 6 wk) reduced fatigability and enhanced recovery mainly at long muscle lengths. It also reduced low-frequency fatigue, which may be attributed to alterations in intracellular calcium handling.     

Direct relationship between proton T2 and exercise intensity in skeletal muscle MR images

Exercise selectively increases the signal intensities (SI) of active muscles in T2-weighted magnetic resonance (MR) images. If these SI increases are graded with exercise intensity, the identification of muscle recruitment patterns may be possible using MR imaging. The purpose of this study was to determine the effect of force generation during exercise on muscle T2 values. Also, we examined the effects of extracellular fluid volume (ECV) expansion on muscle T2 values. Transaxial midcalf images were collected before and after exercise on eight volunteers in a 1.5T GE magnet using a standard spin echo sequence. Exercise consisted of three consecutive bouts of ankle dorsiflexion against graded loads. Three subjects also underwent brief bouts of lower leg venous occlusion (ECV expansion) during and in addition to the exercise protocol. T2 values for the dorsiflexors significantly increased after exercise. Greater mean force produced during exercise caused greater increases in T2 after exercise (T2 = 29.6 +/- 0.9 X Force). Exercise and venous occlusion caused equivalent increases in muscle cross-sectional area. These equivalent increases in ECV were not accompanied by equivalent increases in muscle T2; venous occlusion alone caused less than a 5% increase in T2 while exercise caused a 14% to 25% increase. Consequently, a direct relationship between increases in T2 and in ECV after exercise was not established. Venous occlusion during exercise, however, did significantly augment the increase in T2 and ECV of the anterior compartment muscles. Contrast enhancement among muscles after exercise in T2-weighted MR images is dependent on generated force during exercise.(ABSTRACT TRUNCATED AT 250 WORDS)     

Muscle activity localization with 31P spectroscopy and calculated T2-weighted 1H images

Using 31P spectroscopy and magnetic resonance imaging (MRI), the authors studied changes in muscle phosphorous metabolites and T2 with isometric knee extension to evaluate the potential role of T2 images in coil placement for exercise spectroscopy studies. Increased signal intensity was visible in active muscles on T2 images after exercise. Calculated T2-weighted values were elevated immediately after exercise in the quadriceps (P less than .01). T2 increases for individual quadricep muscles varied, with the largest changes in the rectus femoris and the least in the vastus lateralis. 31P spectroscopy studies demonstrated similar findings: percent change in T2 correlated positively with inorganic phosphorus to phosphocreatine ratio (Pi/PCr) (r = 0.89, P less than .01) and negatively with pH (r = -0.88, P less than .01). The correlations between imaging and spectroscopy suggest that T2 images may allow more precise placement of phosphorous coils in exercise studies. The heterogeneity of T2 changes within the quadriceps with exercise suggests that assumptions about muscle activity may be misleading. T2 images may provide muscle activity verification for exercise studies.     

Assessment of magnetic resonance techniques to measure muscle damage 24 h after eccentric exercise

The study examined which of a number of different magnetic resonance (MR) methods were sensitive to detecting muscle damage induced by eccentric exercise. Seventeen healthy, physically active participants, with muscle damage confirmed by non‐MR methods were tested 24 h after performing eccentric exercise. Techniques investigated whether damage could be detected within the quadriceps muscle as a whole, and individually within the rectus femoris, vastus lateralis (VL), vastus medialis (VM), and vastus intermedius (VI). Relative to baseline values, significant changes were seen in leg and muscle cross‐sectional areas and volumes and the resting inorganic phosphate concentration. Significant time effects over all muscles were also seen in the transverse relaxation time (T2) and apparent diffusion coefficient (ADC) values, with individually significant changes seen in the VL, VM, and VI for T2 and in the VI for ADC. A significant correlation was found between muscle volume and the average T2 change (r = 0.59) but not between T2 and ADC or Pi alterations. There were no significant time effects over all muscles for magnetization transfer contrast images, for baseline pH, phosphocreatine (PCr), phosphodiester, or ATP metabolite concentrations or the time constant describing the rate of PCr recovery following exercise.     

Human knee: in vivo T1(rho)-weighted MR imaging at 1.5 T--preliminary experience

A fast spin-echo sequence weighted with a time constant that defines the magnetic relaxation of spins under the influence of a radio-frequency field (T1(rho)) was used in six subjects to measure magnetic resonance (MR) relaxation times in the knee joint with a 1.5-T MR imager. A quantitative comparison of T2- and T1(rho)-weighted MR images was also performed. Substantial T1(rho) dispersion was demonstrated in human articular cartilage, but muscle did not demonstrate much dispersion. T1(rho)-weighted images depicted a chondral lesion with 25% better signal-difference-to-noise ratios than comparable T2-weighted images. This technique may depict cartilage and muscular abnormalities.     

Strength gains following different combined concentric and eccentric exercise regimens

BACKGROUND: Loss of muscle strength and cross-sectional area is a well-recognized consequence of spaceflight. Existing countermeasures have not been fully effective in preventing muscle weakness and atrophy in microgravity. Resistance exercise programs that consist of both eccentric and concentric actions have resulted in strength and muscle mass gains in ground-based studies. HYPOTHESES: 1) A concentric/eccentric combination exercise regimen (with a bias of either concentric or eccentric exercise) will result in a greater strength gain than concentric exercise alone; and 2) an eccentrically biased regimen will result in the greatest strength gain of all. METHODS: The 31 subjects were randomly assigned to one of three isokinetic exercise groups (CON-ECC: 75% concentric and 25% eccentric; ECC-CON: 75% eccentric and 25% concentric; CON: 100% concentric); each subject trained the right leg 3 d per week for 5 wk. Pre- and post-training isokinetic concentric/ eccentric strength tests and DEXA scans assessed changes in muscle strength and/or mass. RESULTS: All three groups showed an increase in eccentric muscle strength with the CON group showing the smallest gain (10.1%). Significantly larger gains were noted in the two combination groups (19.5%, 18.1%; p < 0.042), with the largest gains in eccentric strength. No significant change was noted in muscle mass. CONCLUSIONS: A resistance exercise protocol which includes eccentric as well as concentric exercise, particularly when the eccentric exercise is emphasized, appears to result in greater strength gains than concentric exercise alone. Findings suggest eccentric exercise may be an important component of the in-flight resistance exercise protocol for long-duration spaceflight.     

Eccentric/concentric training of ankle evertor and dorsiflexors in recreational athletes: Muscle latency and strength

The aim of this study was to investigate the effects of a combined eccentric–concentric exercise program of the ankle evertors and dorsiflexors on the latency time of the peroneus longus and tibialis anterior muscles. Twenty‐four healthy male recreational athletes were admitted to this study and were randomly assigned to either the exercise group (n = 12) or the control group (n = 12). Subjects in the exercise group performed an isokinetic exercise program of the ankle evertors and dorsiflexors in a combined eccentric–concentric mode for 3 days per week for 6 weeks. Before and after the exercise program, muscle reaction times of the peroneus longus and tibialis anterior muscles to sudden supinating maneuvers on a tilting platform, and isokinetic strength of the ankle joint musculature were evaluated. The peroneus longus and tibialis anterior reaction times showed significant (P < 0.01–0.05) reductions following six weeks of intervention in the exercise group. Additionally, eccentric peak torques for the ankle evertor and dorsiflexors represented significant (P < 0.05) increases in the exercise group compared with the control group. The results of this study suggest that it is possible to reduce peroneal and anterior tibial reaction times following a six week eccentric/concentric isokinetic training program in healthy ankles.     

The effects of eccentric versus concentric resistance training on muscle strength and mass in healthy adults: a systematic review with meta-analysis

The aim of this systematic review was to determine if eccentric exercise is superior to concentric exercise in stimulating gains in muscle strength and mass. Meta-analyses were performed for comparisons between eccentric and concentric training as means to improve muscle strength and mass. In order to determine the importance of different parameters of training, subgroup analyses of intensity of exercise, velocity of movement and mode of contraction were also performed. Twenty randomised controlled trials studies met the inclusion criteria. Meta-analyses showed that when eccentric exercise was performed at higher intensities compared with concentric training, total strength and eccentric strength increased more significantly. However, compared with concentric training, strength gains after eccentric training appeared more specific in terms of velocity and mode of contraction. Eccentric training performed at high intensities was shown to be more effective in promoting increases in muscle mass measured as muscle girth. In addition, eccentric training also showed a trend towards increased muscle cross-sectional area measured with magnetic resonance imaging or computerised tomography. Subgroup analyses suggest that the superiority of eccentric training to increase muscle strength and mass appears to be related to the higher loads developed during eccentric contractions. The specialised neural pattern of eccentric actions possibly explains the high specificity of strength gains after eccentric training. Further research is required to investigate the underlying mechanisms of this specificity and its functional significance in terms of transferability of strength gains to more complex human movements.     

Sequential MR imaging of denervated muscle: experimental study

BACKGROUND AND PURPOSE: MR changes in denervated muscles have been reported to occur within days up to several weeks after peripheral nerve damage. The purpose of this experimental study was to investigate the longitudinal changes in denervated muscles by using MR imaging. METHODS: In 12 Lewis rats, the left sciatic nerve was transected at the level of the proximal thigh. MR imaging of both legs was performed before and 1 hour, 24 hours, 48 hours, 7 days, 14 days, 28 days, and 2 months after the procedure. The MR protocol included T1-weighted spin-echo, T2-weighted double turbo spin-echo, and turbo inversion recovery magnitude (TIRM) sequences obtained in the axial plane. Signal intensities (T2-weighted double turbo spin-echo and TIRM sequences) and the T2 TR (T2-weighted double turbo spin-echo sequence) were recorded for the soleus, peroneal, and gracilis muscles of both sides. Moreover, the circumferences of both lower legs were determined on the basis of T1-weighted images. RESULTS: Twenty-four hours after denervation, a signal intensity increase in the denervated peroneal and soleus muscles was present on TIRM images. On T2-weighted images, only the peroneal muscle exhibited slightly increased signal intensities and T2 TR. Forty-eight hours after nerve transection, the denervated soleus and peroneal muscles revealed prolonged T2 TR and marked increased signal intensities on T2-weighted and TIRM images when compared with the contralateral side, which further increased at or less than 2 months after denervation. Muscle atrophy of the denervated muscles was present as early as 7 days after denervation and was also increased at follow-up examinations. CONCLUSION: The TIRM sequence is more sensitive than is T2-weighted imaging in the detection of signal intensity changes in denervated muscle. These changes occur as early as 24 (TIRM sequence) and 48 (T2-weighted sequence) hours, respectively, after complete transection of the sciatic nerve in rats and precede muscle atrophy. The sensitivity to early signal intensity changes in denervated muscles may support the use of MR imaging in the diagnosis of peripheral nerve lesions.     

Differential effects of exhaustive cycle ergometry on concentric and eccentric torque production

The purpose of this study was to investigate the potential differences in peak isokinetic concentric end eccentric torque following low- and high-intensity cycle exercise fatigue protocols. Ten healthy, recreationally-active men were tested in a balanced, randomized testing sequence for peak eccentric and concentric isokinetic torque (60 degrees/sec) immediately before and after three experimental conditions each separated by 48 hours: 1) a bout of high intensity cycling consisting of a maximal 90-second sprint; 2) a bout of low-intensity cycling at 60 rpm equated for total work with the high-intensity protocol: and 3) no exercise (control bout). Blood was drawn from an antecubital vein and plasma lactate concentrations were determined immediately before and after each experimental bout. Post-exercise plasma lactate concentrations were 15.1 +/- 2.5 and 4.7 +/- 1.9 mmol l(-1), respectively, following the high- and low-intensity protocols. The high intensity exercise bout resulted in the only post-exercise decrease in concentric and eccentric isokinetic peak torque. The percent decline in maximal force production was significantly (P< 0.05) greater for concentric muscle actions compared to eccentric (29 vs 15%, respectively). In conclusion, a 90-second maximal cycling sprint results in a significant decline in maximal torque of both concentric and eccentric muscle actions with the greatest magnitude observed during concentric muscle actions.     

Perceived exertion responses to novel elbow flexor eccentric action in women and men

PURPOSE: The primary aim was to describe perceived exertion responses to different intensities of eccentric exercise in women and men. METHODS: 42 adults (21 men and 21 women, 7 per condition) completed elbow extension exercises with a weight corresponding to 80%, 100%, or 120% of maximal voluntary concentric strength. Total work was equated by manipulating the number of repetitions in the 80% (N = 45), 100% (N = 36), and 120% (N = 30) conditions. RESULTS: A two-way ANOVA showed significant main effects for the intensity and sex factors. Perceived exertion ratings were strongly dependent on exercise intensity, and women reported lower RPEs than men. A separate three-way mixed model ANOVA that included a repetition factor showed that perceived exertion ratings increased similarly across the first 30 repetitions in all exercise conditions. Significant partial correlations were found between mean RPE during the eccentric exercise bout, and the mean intensity of delayed-onset muscle pain measured from 12- to 72-h postexercise after controlling for the relative exercise intensity (r12.3 = 0.28) or the maximum concentric strength of the elbow flexors (r12.3 = 0.33). CONCLUSIONS: 1) for both women and men, there is a positive association between the intensity of eccentric exercise performed with the elbow flexors and RPE; 2) perceived exertion ratings increase significantly then plateau when repeated eccentric muscle actions are performed at constant, submaximal absolute intensities; 3) women rate eccentric exercise performed at the same intensity (relativized to MVC-C) as being less effortful compared with men; and 4) RPE during eccentric exercise can account for a small but significant amount of variability in delayed-onset muscle pain after statistically controlling for differences in strength or relative intensity.     

Effect of activation force on knee extensor torques

The purpose of this study was to determine whether the magnitude of the activation force, defined as the force that must be applied to the load cell in order to activate the resistance arm of an isokinetic dynamometer, affected knee extensor torques. Twenty-four healthy female subjects performed resisted knee extension through the range of 95 degrees to 5 degrees knee flexion, with a 5-s rest between concentric and eccentric muscle actions. Six exercise sets, composed of the combinations of activation force (20,50, and 100 N) and angular velocity (45 and 135 degrees.s-1), were randomly assigned on each of two occasions, completed within a 10-d period. Although peak torques were not affected by the activation force, average torques, eccentric torques at mid-range (50 degrees knee flexion), and torques during the initial portion of each muscle action (80 degrees knee flexion during concentric muscle actions and 20 degrees flexion during eccentric actions) increased as the activation force increased. The effect of the activation force tended to be more pronounced during eccentric than during concentric muscle actions, and at the faster angular velocity. Comparisons of torques should be based on similar test protocols, including activation force.     

Central versus peripheral adaptations following eccentric resistance training

Aim of the present investigation was to study the effects of an eccentric training on the neuromuscular properties of the plantar-flexor muscles. The experiment was carried out on 14 males divided into two groups (eccentric and control). Eccentric training consisted of six sets of six eccentric contractions at 120 % of one maximal concentric repetition and it was performed four times a week during four weeks. Before and after the 4-wk period, the plantar-flexor torque and the associated electromyographic activity were recorded during voluntary contractions (isometric, concentric and eccentric) and electrically induced contractions (twitch and tetanus), in order to distinguish central from peripheral adaptations. For the eccentric group, voluntary torque significantly increased after training independent of the action mode (relative gains 14 - 30 %, p < 0.05). This was associated with an increase in agonist EMG activity during isometric action and a decrease in antagonist coactivation in concentric (-27 %) and eccentric actions (-22 %) (p < 0.05). Voluntary activation level significantly increased from 80 +/- 5 % to 91 +/- 2 % (p < 0.05). Some of the twitch contractile properties (peak torque and maximal rate of twitch tension relaxation) were significantly modified (p < 0.05), but no changes were observed for the tetanus characteristics. These results allowed to conclude that the torque gains observed after the present training were more likely associated to central adaptations, affecting both agonist and antagonist muscles.     

Effects of eccentric exercise on trunk extensor torque and lumbar paraspinal EMG

PURPOSE: Little is known about the effects of eccentric contractions on the function of the lumbar paraspinal muscles. The purpose of this study was to determine the effects of a single bout of eccentric contractions using the trunk extensor muscles on torque and lumbar paraspinal electromyographic (EMG) parameters. METHODS: Twenty healthy men between the ages of 18 and 49 yr participated in the study. Subjects performed a single bout of 50 maximal voluntary concentric (N = 10) or eccentric (N = 10) trunk extension movements while surface EMG signals were recorded from the multifidus and iliocostalis lumborum muscles. A series of isometric contractions were performed both before the exercise protocol and at five additional time points over the following 7 d. RESULTS: During the exercise protocol, peak torque decreased 30% and 24% in the eccentric and concentric groups, respectively, whereas no change occurred in EMG root-mean-square (RMS). There were no group differences in peak torque generation at any of the postexercise protocol time points. Compared with the preexercise protocol values, multifidus EMG was elevated 27% immediately post and 15 min post in the eccentric group. Similarly, compared with the concentric group, multifidus EMG in the eccentric group was increased 34%, 40%, and 25% immediately post, 15 min post, and 1 d after the exercise protocol, respectively. CONCLUSION: Eccentric contractions using the trunk extensor muscles result in higher levels of multifidus EMG activity to produce a given level of torque. This reduction in neuromuscular efficiency persisted for one day with recovery to baseline levels by the third day. Contrary to studies using other muscle groups, no sustained alteration in muscle function was observed.     

NMR of skeletal muscle. Differences in relaxation parameters related to extracellular/intracellular fluid spaces

The relationships between the T1 and T2 relaxation times, tissue water content and extracellular fluid space of two types of skeletal muscle groups were studied in rabbits and rats by means of NMR proton spectroscopy (10 MHz). Although there was no significant difference in the total water content between muscles rich in type I (74.5 +/- .8%; soleus) or type II (75.0 +/- .7%; gastrocnemius) fibers, the respective T1 (521 +/- 25 vs. 486 +/- 16 millisecond; p less than .01) and T2 (39.5 +/- 1.8 vs. 36.5 +/- 1.0 millisecond; p less than .01) relaxation times were consistently prolonged. The longer relaxation times of the soleus as compared with the gastrocnemius muscle were related to a larger extracellular fluid space as measured by (35S) sulfate +34.5%; p less than .01). For this reason, it seems likely selective changes in these spaces will be detectable by NMR proton imaging.     

Effect of perfusion on exercised muscle: MR imaging evaluation.

An ischemic clamp model of exercise was used to evaluate the potential role of blood flow in mediating changes in the magnetic resonance imaging appearance of skeletal muscle. Proton relaxation times of muscle were serially estimated in 10 healthy subjects (a) before exercise, (b) after exercise in the presence of vascular occlusion (VO1), (c) during vascular reocclusion after 1 minute of reperfusion (VO2), and (d) after reinstitution of continuous flow. T1 and T2 of active muscles were increased during VO1. During VO2, there were additional increases in relaxation times of active muscles. Reinstitution of continuous flow was associated with a continuous decrease in the T2 of exercised muscle. Hence, blood flow was not required for increases in T1 and T2 with exercise. Additional relaxation time increases occurred after a brief period of reperfusion; however, continuous flow was associated with a decrease in T2.     

MR imaging in the differential diagnosis of neurogenic foot drop

BACKGROUND AND PURPOSE: Prolonged T2 relaxation time of denervated muscle has been described in several clinical and experimental studies. The purpose of this study was to evaluate the utility of MR imaging in the diagnosis of neurogenic muscle disorders compared with that of clinical and electrophysiologic examination. METHODS: In a prospective study, 40 consecutive patients clinically presenting with a foot drop were included. MR imaging of the lower leg included axial T1-weighted and axial turbo inversion recovery magnitude (TIRM) sequences. Two readers blinded to clinical data evaluated T1-weighted images for anatomic localization of affected muscles and TIRM images for patterns of signal intensity increase. After MR imaging, a detailed neurophysiologic examination was performed. Cause of foot drop was independently determined on the basis of MR and electrophysiologic data. RESULTS: Clinical examination and electromyography (EMG) disclosed 20 peroneal nerve lesions, nine cases of L5 radiculopathy, and 11 nerve lesions extending beyond neural structures. MR imaging revealed three distinct patterns of signal intensity increase on TIRM images: peroneal nerve pattern, L5 pattern, and unspecific pattern. MR imaging and EMG findings were in agreement in 37 (92%) of 40 patients. In three patients, MR imaging revealed a more widespread involvement than did EMG. In one of these patients, denervation in the corresponding muscle was validated by follow-up EMG. No false-negative diagnoses were made by use of MR imaging as compared with use of EMG. CONCLUSION: MR imaging improves accuracy in the differential diagnosis of peripheral nerve lesions compared with that of EMG and can supplement EMG in the diagnosis of denervated muscles.