Ann Rehabil Med.  2012 Jun;36(3):320-327. 10.5535/arm.2012.36.3.320.

Magnetic Resonance Imaging as a Determinant for Surgical Release of Congenital Muscular Torticollis: Correlation with the Histopathologic Findings

• Hwang JH
• Lee HB
• Kim JH
• Park MC
• Kwack KS
• Han JD
• Yim SY

• KMID: 2266736
• DOI: http://doi.org/10.5535/arm.2012.36.3.320

Abstract

OBJECTIVE
(1) To present the magnetic resonance imaging (MRI) findings of congenital muscular torticollis (CMT) of subjects who underwent surgical release and subjects who showed a good prognosis with stretching exercises and (2) to correlate the MRI findings with the histopathologic findings of CMT for subjects who underwent surgical release in order to examine the hypothesis that the MRI findings of CMT can be used as a determinant to perform surgical release of CMT. METHOD: The neck MRI findings of 33 subjects who underwent surgical release for CMT were compared with those of 18 subjects who were successfully managed only with conservative management. The MRI findings were correlated with the histopathologic sections of the CMT mass.
RESULTS
All 33 subjects (100%) who underwent surgical release showed one or more low signal intensities within the involved sternocleidomastoid muscle (SCM) on the T1- and T2-weighted images of neck MRI. The eighteen non-surgical candidates showed only enlargement of the SCM without low signal intensity within the SCM. The histopathologic findings showed interstitial fibrosis and/or the presence of aberrant tendon-like excessive dense connective tissue that was either well-arranged or disorganized.
CONCLUSION
The histopathologic findings and MRI findings showed good correlation in terms of the amount of fibrosis and aberrant dense connective tissue within the SCM. If multiple or large low signal intensities within the SCM are noted, we think that surgical release should be considered.

Keyword

Congenital torticollis; Magnetic resonance imaging (MRI); Fibrosis

MeSH Terms

Connective Tissue
Exercise
Fibrosis
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Magnetics
Magnets
Muscles
Neck
Prognosis
Torticollis
Torticollis

Figure

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  Fig. 1 The algorithm for enrollment of subjects from January 2009 to October 2009.

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  Fig. 2 The neck MRI findings of a one month old girl with right congenital muscular torticollis show high signal intensity on the (A) T2-weighted image compared to the (B) T1-weighted image (arrows).

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  Fig. 3 Typical neck MRI findings of subjects who show a good response to stretching exercises. Thickened sternocleidomastoid muscles do not have low signal intensities (arrows).

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  Fig. 4 Typical neck MRI findings of subjects who underwent surgical release for congenital muscular torticollis (CMT). (A) Eleven month old boy with right CMT showing low signal intensities on the T1- and T2-weighted axial images of both the sternal head and clavicular head (arrows) of the right sternocleidomastoid muscle (SCM). (B) Four month old girl with left CMT showing low signal intensities on the T1-weighted axial and sagittal images of the left SCM (arrows). (C) Six month old girl with right CMT showing low signal intensities on both the T1- and T2-weighted axial images of the right SCM (arrows). (D) Eighteen month old girl with right CMT showing low signal intensity on both the T1- and T2-weighted axial images of the right SCM (arrows).

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  Fig. 5 Pictures showing subjects with atrophy or same thickness of the shortened sternocleidomastoid muscle (SCM) with low signal intensities on the T1-weighted axial images of the SCM. (A) Twenty-two year old man with right congenital muscular torticollis (CMT) showing a cord-like right SCM (arrows). Neck MRI showed low signal intensities (arrows) and did not show significant difference of thickness between the right and left SCM. (B) Five year old girl with left CMT showing a cord-like left SCM (arrows) and low signal intensity (arrows) on left SCM. (C) Twenty year old woman with right CMT showing atrophied cord-like right SCM (arrows) with low signal intensity (arrows) on right SCM.

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  Fig. 6 The histologic findings of the normal sternocleidomastoid muscle without congenital muscular torticollis (H&E, (A) ×100; (B) ×200).

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  Fig. 7 The histopathological findings of the sternocleidomastoid muscle with congenital muscular torticollis. (A) Diffuse interstitial fibrosis with accompanying atrophic muscle fibers is noted (H&E, ×200). (B) Interstitial fibrosis with presence of aberrant tendon-like excessive dense connective tissue (arrows) (H&E, ×200). (C) Interstitial fibrosis with presence of aberrant tendon-like excessive dense connective tissue which was well-arranged (H&E, ×40). (D) Aberrant tendon-like excessive dense connective tissue and prominent fat infiltration (arrow) (H&E, ×40).

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