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In this study, we developed an imaging paradigm to measure muscle twitch dynamics, and the response of the muscle to voluntary fatiguing contractions. We used a novel imaging technique called motor unit magnetic resonance imaging (MUMRI). MUMRI allows visualisation of muscle and motor unit activity by combining in\u2010scanner electrical stimulation with dynamic pulsed gradient spin echo (twitch dynamics, PGSE\u2010MUMRI) and phase contrast (fatigue, PC\u2010MUMRI) imaging. In Part I of this study, we scanned 10 healthy controls, we measured the muscle rise (T<jats:sub>rise<\/jats:sub>), contraction (T<jats:sub>contract<\/jats:sub>) and half\u2010relaxation time (T<jats:sub>half\u2010relax<\/jats:sub>) of the tibialis anterior (TA) muscle on a voxel\u2010wise basis using PGSE\u2010MUMRI. Five controls were scanned twice to assess reproducibility; PGSE\u2010MUMRI demonstrated reproducible results, with low variation between scans 3.4% for T<jats:sub>rise<\/jats:sub>, 6.4% for T<jats:sub>contract<\/jats:sub> and 7.1% for T<jats:sub>half\u2010relax<\/jats:sub>. We then developed a PC\u2010MUMRI paradigm to measure the recovery of the TA in response to a fatiguing voluntary exercise. In Part II of the study, we applied these two novel imaging paradigms in a cohort study of nine patients with single large\u2010scale mtDNA deletion primary mitochondrial myopathy (PMM). Patients underwent a 12\u2010week resistance exercise programme and baseline, and follow\u2010up MRI was performed. PGSE\u2010MUMRI detected a significantly longer muscle contraction time between baseline and follow\u2010up in PMM patients 108.7\u2009\u00b1\u20097.9 vs. post\u2010119.3\u2009\u00b1\u200910.4\u2009ms; <jats:italic>p<\/jats:italic>\u2009=\u20090.018. There was no statistical difference in the recovery half maximum measured using PC\u2010MUMRI in PMM patients between baseline and follow\u2010up 254\u2009\u00b1\u2009109 vs. 137\u2009\u00b1\u200941\u2009s; <jats:italic>p<\/jats:italic>\u2009=\u20090.074. In conclusion, PGSE\u2010MUMRI has detected differences in muscle twitch dynamics between controls and PMM following an exercise programme, and we can visualise differences in twitch dynamics subregions of muscle using this technique. The PC\u2010MUMRI technique has shown promise as a novel measure of muscle fatigue.<\/jats:p>","DOI":"10.1002\/nbm.70021","type":"journal-article","created":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T02:02:36Z","timestamp":1744250556000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Measurement of Twitch Dynamics in Response to Exercise Induced Changes in Mitochondrial Disease Using Motor Unit Magnetic Resonance Imaging (MUMRI): A Proof\u2010of\u2010Concept Study"],"prefix":"10.1002","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6041-8052","authenticated-orcid":false,"given":"Matthew\u00a0G.","family":"Birkbeck","sequence":"first","affiliation":[{"name":"Newcastle University Translational and Clinical Research Institute (NUTCRI) Newcastle University  Newcastle upon Tyne UK"},{"name":"Northern Medical Physics and Clinical Engineering, Freeman Hospital Newcastle Hospitals NHS Foundation 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