OBJECTIVE: To assess the evidence of a relationship between muscle MRI and 
disease severity in Duchenne muscular dystrophy (DMD).
METHODS: We conducted a systematic review of studies that analyzed correlations 
between MRI measurements and motor function in patients with DMD. PubMed, 
Cochrane, Scopus, and Web of Science were searched using relevant keywords and 
inclusion/exclusion criteria (January 1, 1990-January 31, 2019). We evaluated 
article quality using the Joanna Briggs Institute scale. Information regarding 
the samples included, muscles evaluated, MRI protocols and motor function tests 
used was collected from each article. Correlations between MRI measurements and 
motor function were reported exhaustively.
RESULTS: Seventeen of 1,629 studies identified were included. Most patients 
included were ambulant with a mean age of 8.9 years. Most studies evaluated 
lower limb muscles. Moderate to excellent correlations were found between MRI 
measurements and motor function. The strongest correlations were found for 
quantitative MRI measurements such as fat fraction or mean T2. Correlations were 
stronger for lower leg muscles such as soleus. One longitudinal study reported 
that changes in soleus mean T2 were highly correlated with changes in motor 
function.
CONCLUSION: The findings of this systematic review showed that MRI measurements 
can be used as biomarkers of disease severity in ambulant patients with DMD. 
Guidelines are proposed to help clinicians choose the most appropriate MRI 
measurements and muscles to evaluate. Studies exploring upper limb muscles, 
other stages of the disease, and sensitivity of measurements to change are 
needed.