OBJECTIVE: To describe the involvement of lower leg muscles in boys with 
Duchenne muscular dystrophy (DMD) by using MR imaging (MRI) and spectroscopy 
(MRS) correlated to indices of functional status.
SUBJECTS AND METHODS: Nine boys with DMD (mean age, 11 years) and eight healthy 
age- and BMI-matched boys (mean age, 13 years) prospectively underwent lower leg 
MRI, 1H-MRS of tibialis anterior (TA) and soleus (SOL) for lipid fraction 
measures, and 31P-MRS for pH and high-energy phosphate measures. DMD subjects 
were evaluated using the Vignos lower extremity functional rating, and tests 
including 6 min walk test (6MWT) and 10 m walk.
RESULTS: DMD subjects had highest fatty infiltration scores in peroneal muscles, 
followed by medial gastrocnemius and soleus. Compared to controls, DMD boys 
showed higher intramuscular fat (P = 0.04), lipid fractions of TA and SOL 
(P = 0.02 and 0.003, respectively), pH of anterior compartment (P = 0.0003), and 
lower phosphocreatine/inorganic phosphorus ratio of posterior compartment 
(P = 0.02). The Vignos rating correlated with TA (r = 0.79, P = 0.01) and SOL 
(r = 0.71, P = 0.03) lipid fractions. The 6MWT correlated with fatty 
infiltration scores of SOL (r = -0.76, P = 0.046), medial (r = -0.80, P = 0.03) 
and lateral (r = -0.84, P = 0.02) gastrocnemius, intramuscular fat (r = -0.80, 
P = 0.03), and SOL lipid fraction (r = -0.89, P = 0.007). Time to walk 10 m 
correlated with anterior compartment pH (r = 0.78, P = 0.04).
CONCLUSION: Lower leg muscles of boys with DMD show a distinct involvement 
pattern and increased adiposity that correlates with functional status. Lower 
leg MRI and 1H-MRS studies may help to noninvasively demonstrate the severity of 
muscle involvement.