Multiparametric MRI Assessment of Morpho-Functional Muscle Changes Following a 6-Month FES-Cycling Training Program: Pilot Study in People With a Complete Spinal Cord Injury

Background: Spinal cord injuries (SCIs) cause debilitating secondary conditions such as severe muscle deterioration, cardiovascular, and metabolic dysfunctions, significantly impacting patients' quality of life. Functional electrical stimulation (FES) combined with cycling exercise (FES-cycling) has shown promise in improving muscle function and health in individuals with SCI.<br /> Objective: This pilot study aimed to investigate the potential role of multiparametric magnetic resonance imaging (MRI) to assess muscle health during and after an FES-cycling rehabilitation program. Methods: Four male participants with chronic SCI underwent a 6-month FES-cycling training program, consisting of two 30-minute sessions per week. MRI scans were performed at baseline (T0), after 3 months (T1), at the end of the training (T2), and 1-month posttraining (T3). The MRI protocol included T1-weighted imaging for volume quantification, Dixon imaging for fat fraction, multi-echo spin echo for T2 relaxation times, and diffusion tensor imaging to assess diffusion parameters.<br /> Results: Muscle hypertrophy was observed, with an average increase in muscle volume of 22.3% at T1 and 36.7% at T2 compared with baseline. One month posttraining, muscle volume remained 23.2% higher than baseline. Fat fraction decreased from 11.1% at T0 to 9.1% at T2, with a rebound to 10.9% at T3. T2 relaxation times showed a reduction even though this was not consistent among participants. Diffusion tensor imaging parameters revealed subtle changes in muscle tissue microstructure, with a decrease in fractional anisotropy mainly associated to an increase of radial diffusivity.<br /> Conclusions: Although preliminary, this study provides evidence that 6 months of low-intensity FES-bike training can increase muscle volume and decrease fat infiltration in individuals with SCI. The study demonstrates that the use of a multiparametric MRI provides comprehensive insights into both macroscopic and microscopic changes within muscle tissues, supporting its integration into clinical practice for assessing the efficacy of rehabilitation interventions.