Imaging in the diagnosis of idiopathic inflammatory myopathies; indications and utility

Paramalingam, Shereen; Counsel, Peter; Mastaglia, Frank; Keen, Helen; Needham, Merrilee

doi:10.1080/14737175.2019.1572507

Cited by 7 publications

(12 citation statements)

References 82 publications

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“…intense muscle exercise, infections, early neuropathy, ischemia, injury, neoplasm, radiation, and compartment syndrome). 24,30,32 Consistent with recent findings, 22,23 the majority of patients with myositis as the final diagnosis showed muscle fatty replacement (63% of patients), followed by edema (47% of patients) and CM uptake (29% of patients). In the myositis group, highest MRI scores were observed for muscle fatty replacement, followed by edema and CM uptake (Figure 3).…”

Section: Discussionsupporting

confidence: 86%

“…23 Specific findings may differ between the acute/active (edema, high signal intensity on STIR, and fat-saturated gadolinium-enhanced T1W images) and chronic phase (atrophy and muscle fat replacement on T1W images). 22,23,30…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have already shown that muscle MRI is a useful tool in the diagnostic procedures of neuromuscular disorders, especially in uncertain cases and monitoring of disease progression in myositis, in addition for the identification of a moderately involved muscle for biopsy to increase quality and diagnostic output. 2,3,22 Although potentially useful in pointing to specific viable muscles for biopsy, it is possible within a severely affected muscle to take a specimen from a very atrophic fascicle that will show "end-stage atrophy" because the biopsies are not MRIguided. A very careful clinical examination with functional assessment of the muscle strength and palpation of the candidate muscle before proceeding to the biopsy remains essential.…”

Section: Discussionmentioning

confidence: 99%

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The value of qualitative muscle MRI in the diagnostic procedures of myopathies: a biopsy-controlled study in 191 patients

Urban

Mohamed

Ludolph

et al. 2021

Ther Adv Neurol Disord

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Background and aims: The role of muscle magnetic resonance imaging (MRI) in the diagnostic procedures of myopathies is still controversially discussed. The current study was designed to analyze the status of qualitative muscle MRI, electromyography (EMG), and muscle biopsy in different cases of clinically suspected myopathy. Methods: A total of 191 patients (male: n = 112, female: n = 79) with suspected myopathy who all received muscle MRI, EMG, and muscle biopsy for diagnostic reasons were studied, with the same location of biopsy and muscle MRI (either upper or lower extremities or paravertebral muscles). Muscle MRIs were analyzed using standard rating protocols by two different raters independently. Results: Diagnostic findings according to biopsy results and genetic testing were as follow: non-inflammatory myopathy: n = 65, inflammatory myopathy (myositis): n = 51, neurogenic: n = 18, unspecific: n = 23, and normal: n = 34. The majority of patients showed myopathic changes in the EMG. Edema, atrophy, muscle fatty replacement, and contrast medium enhancement (CM uptake) in MRI were observed across all final diagnostic groups. Only 30% of patients from the myositis group ( n = 15) showed CM uptake. Discussion and conclusion: The study provides guidance in the definition of the impact of muscle MRI in suspected myopathy: despite being an important diagnostic tool, qualitative MRI findings could not distinguish different types of neuromuscular diagnostic groups in comparison with the gold standard histopathologic diagnosis and/or genetic testing. The results suggest that neither muscle edema nor gadolinium enhancement are able to secure a diagnosis of myositis. The current results do not support qualitative MRI as aiding in the diagnostic distinction of various myopathies. Quantitative muscle MRI is, however, useful in the diagnostic procedure of a suspected neuromuscular disease, especially with regard to assessing progression of a chronic myopathy by quantification of the degree of atrophy and fatty replacement and in exploring patterns of muscle group involvements in certain genetic myopathies.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The value of qualitative muscle MRI in the diagnostic procedures of myopathies: a biopsy-controlled study in 191 patients

Urban

Mohamed

Ludolph

et al. 2021

Ther Adv Neurol Disord

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“…One limitation of sMRI in the assessment of myopathy is the lack of standardised scoring systems. Visual assessment scales that semi-quantitatively evaluate the burden of muscle atrophy and fatty infiltration on T1-weighted images and muscle oedema on either short tau inversion recovery (STIR) or T2-weighted sequences have been developed and validated for hereditary myopathies [ 21 – 24 ]. However, there is only fair-to-moderate correlation between scorers when such scales are applied to IIM [ 19 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…Visual assessment scales that semi-quantitatively evaluate the burden of muscle atrophy and fatty infiltration on T1-weighted images and muscle oedema on either short tau inversion recovery (STIR) or T2-weighted sequences have been developed and validated for hereditary myopathies [ 21 – 24 ]. However, there is only fair-to-moderate correlation between scorers when such scales are applied to IIM [ 19 , 21 ]. Quantitative measures of skeletal myopathy are emerging, namely T2-mapping, as a measure of oedema, and fat fraction (FF) to quantify fatty muscle infiltration and measure damage [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Using magnetic resonance imaging to map the hidden burden of muscle involvement in systemic sclerosis

et al. 2022

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Background Skeletal muscle can be directly affected by systemic sclerosis (SSc); however, a significant burden of SSc-associated myopathy is undetected because clinical parameters such as weakness and creatine kinase (CK) are unreliable biomarkers of muscle involvement. This study presents qualitative and quantitative magnetic resonance imaging (MRI) findings that quantify the prevalence of myopathy and evaluate any association between skeletal and cardiac muscle involvement in SSc. Methods Thirty-two patients with SSc who fulfilled the 2013 American College of Rheumatology/European League Against Rheumatism classification criteria underwent skeletal muscle MRI in addition to cardiac MRI. Skeletal muscles were independently assessed by two musculoskeletal radiologists for evidence of oedema, fatty infiltration and atrophy. Skeletal muscle T2 mapping times and percentage fat fraction were calculated. Linear regression analysis was used to evaluate the clinical and myocardial associations with skeletal muscle oedema and fatty infiltration. Cardiac MRI was performed using post gadolinium contrast imaging and parametric mapping techniques to assess focal and diffuse myocardial fibrosis. Results Thirteen participants (40.6%) had MRI evidence of skeletal muscle oedema. Five (15.6%) participants had fatty infiltration. There was no association between skeletal muscle oedema and muscle strength, creatine kinase, inflammatory markers or fibroinflammatory myocardial disease. Patients with skeletal muscle oedema had higher T2-mapping times; there was a significant association between subjective assessments of muscle oedema and T2-mapping time (coef 2.46, p = 0.02) and percentage fat fraction (coef 3.41, p = 0.02). Diffuse myocardial fibrosis was a near-universal finding, and one third of patients had focal myocardial fibrosis. There was no association between skeletal myopathy detected by MRI and burden of myocardial disease. Conclusions MRI is a sensitive measure of muscle oedema and systematic assessment of SSc patients using MRI shows that myopathy is highly prevalent, even in patients without symptoms or other signs of muscle involvement. Similarly, cardiac fibrosis is highly prevalent but occurs independently of skeletal muscle changes. These results indicate that novel quantitative MRI techniques may be useful for assessing sub-clinical skeletal muscle disease in SSc.

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Conventional ultrasound and elastography as imaging outcome tools in autoimmune myositis: A systematic review by the OMERACT ultrasound group

Paramalingam

Morgan

Becce

et al. 2021

Seminars in Arthritis and Rheumatism

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Imaging in the diagnosis of idiopathic inflammatory myopathies; indications and utility

Cited by 7 publications

References 82 publications

The value of qualitative muscle MRI in the diagnostic procedures of myopathies: a biopsy-controlled study in 191 patients

The value of qualitative muscle MRI in the diagnostic procedures of myopathies: a biopsy-controlled study in 191 patients

Using magnetic resonance imaging to map the hidden burden of muscle involvement in systemic sclerosis

Conventional ultrasound and elastography as imaging outcome tools in autoimmune myositis: A systematic review by the OMERACT ultrasound group

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