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Pace M, Cannella R, Di Stefano V, Lupica A, Alonge P, Morici G, Brighina F, Brancato F, Midiri F, Galia M. Usefulness and Clinical Impact of Whole-Body MRI in Detecting Autoimmune Neuromuscular Disorders. Brain Sci 2023; 13:1500. [PMID: 37891867 PMCID: PMC10605918 DOI: 10.3390/brainsci13101500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
Autoimmune neuromuscular diseases are a group of heterogenous pathologies secondary to the activation of the immune system that damage the structures of the peripheric nerve, the neuromuscular junction, or the skeleton muscle. The diagnosis of autoimmune neuromuscular disorders comprises a combination of data from clinical, laboratory, electromyography, imaging exam, and biopsy. Particularly, the whole-body MRI examination in the last two decades has been of great use in the assessment of neuromuscular disorders. MRI provides information about the structures involved and the status of activity of the disease. It can also be used as a biomarker, detect the pattern of specific muscle involvement, and is a useful tool for targeting the optimal muscle site for biopsy. In this work, we summarized the most used technical protocol of whole-body MRI and the role of this imaging technique in autoimmune neuromuscular disorders.
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Affiliation(s)
- Mario Pace
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (M.P.); (R.C.); (G.M.)
| | - Roberto Cannella
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (M.P.); (R.C.); (G.M.)
| | - Vincenzo Di Stefano
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (V.D.S.); (A.L.); (P.A.); (F.B.)
| | - Antonino Lupica
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (V.D.S.); (A.L.); (P.A.); (F.B.)
| | - Paolo Alonge
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (V.D.S.); (A.L.); (P.A.); (F.B.)
| | - Giulio Morici
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (M.P.); (R.C.); (G.M.)
| | - Filippo Brighina
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (V.D.S.); (A.L.); (P.A.); (F.B.)
| | - Federica Brancato
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, 90133 Palermo, Italy;
| | - Federico Midiri
- IRCCS Ospedale Galeazzi-Sant’Ambrogio, Via Cristina Belgioioso 173, 20161 Milano, Italy;
| | - Massimo Galia
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (M.P.); (R.C.); (G.M.)
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Galluzzo C, Chiapparoli I, Corrado A, Cantatore FP, Salvarani C, Pipitone N. Rare forms of inflammatory myopathies - part II, localized forms. Expert Rev Clin Immunol 2023; 19:185-191. [PMID: 36469645 DOI: 10.1080/1744666x.2023.2154655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The idiopathic inflammatory myopathies traditionally comprise dermatomyositis, polymyositis, the anti-synthetase syndromes, immune-mediated necrotizing myopathy and inclusion body myositis. However, there are uncommon localized forms that are less known. In this review, we aimed to cover these uncommon forms. AREAS COVERED We identified rare forms of localized myositis on the basis of list provided by the homepage of the Neuromuscular disease center of Washington University, USA and on the basis of the authors' knowledge. We searched PubMed® for relevant articles on these forms with the aim of providing as much as possible information on their clinical manifestations as well as guidance on their work-up and treatment. EXPERT OPINION herein, we provide un updated description of rare forms of localized myositis. These forms are often difficult to diagnose because of their localized nature and are sometimes misdiagnosed as tumors. Knowledge about these rare forms of localized myositis can aid in their recognition and treatment.
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Affiliation(s)
- Claudio Galluzzo
- Department of Internal Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ilaria Chiapparoli
- Department of Internal Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ada Corrado
- Department of Medical and Surgical Sciences, Rheumatology Clinic, University of Foggia, Foggia, Italy
| | - Francesco Paolo Cantatore
- Department of Medical and Surgical Sciences, Rheumatology Clinic, University of Foggia, Foggia, Italy
| | - Carlo Salvarani
- Department of Internal Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Internal Medicine, Università di Modena e Reggio Emilia, Modena, Italy
| | - Nicolò Pipitone
- Department of Internal Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Walter SS, Fritz J. MRI of Muscular Neoplasms and Tumor-Like Lesions: A 2020 World Health Organization Classification-based Systematic Review. Semin Roentgenol 2022; 57:252-274. [DOI: 10.1053/j.ro.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/03/2022] [Accepted: 01/08/2022] [Indexed: 11/11/2022]
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Santos VA, Escobar L, Hormaza-Jaramillo A. Focal Eosinophilic Myositis in the Hand: A Case Report. J Clin Rheumatol 2021; 27:S423-S425. [PMID: 32084073 DOI: 10.1097/rhu.0000000000001340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Malartre S, Bachasson D, Mercy G, Sarkis E, Anquetil C, Benveniste O, Allenbach Y. MRI and muscle imaging for idiopathic inflammatory myopathies. Brain Pathol 2021; 31:e12954. [PMID: 34043260 PMCID: PMC8412099 DOI: 10.1111/bpa.12954] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/11/2021] [Indexed: 12/22/2022] Open
Abstract
Although idiopathic inflammatory myopathies (IIM) are a heterogeneous group of diseases nearly all patients display muscle inflammation. Originally, muscle biopsy was considered as the gold standard for IIM diagnosis. The development of muscle imaging led to revisiting not only the IIM diagnosis strategy but also the patients' follow-up. Different techniques have been tested or are in development for IIM including positron emission tomography, ultrasound imaging, ultrasound shear wave elastography, though magnetic resonance imaging (MRI) remains the most widely used technique in routine. Whereas guidelines on muscle imaging in myositis are lacking here we reviewed the relevance of muscle imaging for both diagnosis and myositis patients' follow-up. We propose recommendations about when and how to perform MRI on myositis patients, and we describe new techniques that are under development.
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Affiliation(s)
- Samuel Malartre
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
| | - Damien Bachasson
- Neuromuscular Physiology Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | - Guillaume Mercy
- Department of Medical Imaging, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles-Foix, Sorbonne Université, Paris, France
| | - Elissone Sarkis
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
| | - Céline Anquetil
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunlogy, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
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He J, Sturgess A. Focal myositis: an unusual cause of hip pain. Intern Med J 2019; 49:929-930. [DOI: 10.1111/imj.14341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/01/2018] [Accepted: 09/04/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Jianna He
- Department of RheumatologySt George Hospital Sydney New South Wales Australia
| | - Allan Sturgess
- Department of RheumatologySt George Hospital Sydney New South Wales Australia
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Focal Myositis of the Leg Presenting as Fever of Unknown Origin Detected by FDG PET/CT. Clin Nucl Med 2019; 44:251-254. [DOI: 10.1097/rlu.0000000000002427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wang J, Jiao J, Zhao G, Shi J, Xia J. Case report: A rare case of focal myositis presenting as Sartorius muscle contracture: A case report and review of literature. Medicine (Baltimore) 2018; 97:e10766. [PMID: 29768366 PMCID: PMC5976314 DOI: 10.1097/md.0000000000010766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
RATIONALE Focal myositis (FM) is a very rare myopathy of unknown etiology characterized by focal enlargement within one single skeletal muscle. In particular, it occurs only involving the Sartorius muscle has never been reported. PATIENT CONCERNS A 25-year-old man was admitted to the hospital with progressive restricted left hip joint extension, left thigh discomfort and gait disturbance for 6 years. DIAGNOSES Combining clinical manifestations with results of radiological and pathological examinations, it was consistent with the diagnosis of FM INTERVENTIONS:: The patient received a surgery under general anesthesia to release the contracted Sartorius tendon. OUTCOMES The range of motion of the patient's left hip and ipsilateral knee has significantly improved as well as the discomfort of his left thigh relieved obviously after the surgery. LESSONS This case report is the first to report FM presenting as sartorius muscle contracture and the surgery is an alternative therapy for these patients.
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Gallay L, Hot A, Petiot P, Thivolet-Bejui F, Maucort-Boulch D, Streichenberger N. Focal myositis: New insights on diagnosis and pathology. Neurology 2018; 90:e1013-e1020. [PMID: 29467303 DOI: 10.1212/wnl.0000000000005160] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 12/20/2017] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To better define in a cohort study the clinical and pathologic features of focal myositis (FM). METHODS With the use of the usual clinicopathologic definition, each confirmed case of FM in the Lyon University Hospital's myopathologic database between 2000 and 2016 was retrieved. Clinical, pathologic, imaging, serologic, and therapeutic data were collected. When data were missing but feasible, appropriate pathologic analyses were performed. RESULTS Of the 924 patients included in the database, 37 (4%) had confirmed FM (14 female, 23 male patients). The main symptoms were pain (n = 30, 81%), muscular mass (n = 16, 43%), erythema at the site of FM (n = 12, 32%), and fever (n = 9, 24%). Serum creatine kinase was normal in most patients (81%); serum immune abnormalities were frequent (inflammatory syndrome in sera [39%], dysglobulinemia [52%], and anti-nuclear antibody positivity [29%]). In addition to confirming previously reported findings, pathologic analyses found significant rates of vasculitis (68%) and fasciitis (73%). Here, FM appeared frequently to be associated with other diseases such as immune-mediated inflammatory disease (IMID; 32%), neoplasia (24%), and radiculopathy (11%). Regarding outcomes, 64% of the cases had received immunosuppressive drugs, and the relapse rate was 41%. CONCLUSION The present study suggests that FM is not as innocuous as previously believed, particularly considering the associated disorders. Notably, patients with FM should receive careful IMID and neoplasia screening.
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Affiliation(s)
- Laure Gallay
- From the Department of Internal Medicine (L.G., A.H.), Edouard Herriot University Hospital, Hospices Civils de Lyon; University Claude Bernard (L.G., A.H., F.T.-B., N.S.); INMG (L.G.), CNRS UMR 5310-INSERM U1217; Department of Neurology (P.P.), Croix-Rousse Hospital, Hospices Civils de Lyon; Department of Pathology, Neurology and Neurosurgery (F.T.-B., N.S.), Pierre Wertheimer University Hospital, Hospices Civils de Lyon; Service de Biostatistique (D.M.-B.), Hospices Civils de Lyon; Université de Lyon (D.M.-B.); Université Lyon 1 (D.M.-B.); and CNRS UMR5558 (D.M.-B.), Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France.
| | - Arnaud Hot
- From the Department of Internal Medicine (L.G., A.H.), Edouard Herriot University Hospital, Hospices Civils de Lyon; University Claude Bernard (L.G., A.H., F.T.-B., N.S.); INMG (L.G.), CNRS UMR 5310-INSERM U1217; Department of Neurology (P.P.), Croix-Rousse Hospital, Hospices Civils de Lyon; Department of Pathology, Neurology and Neurosurgery (F.T.-B., N.S.), Pierre Wertheimer University Hospital, Hospices Civils de Lyon; Service de Biostatistique (D.M.-B.), Hospices Civils de Lyon; Université de Lyon (D.M.-B.); Université Lyon 1 (D.M.-B.); and CNRS UMR5558 (D.M.-B.), Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Philippe Petiot
- From the Department of Internal Medicine (L.G., A.H.), Edouard Herriot University Hospital, Hospices Civils de Lyon; University Claude Bernard (L.G., A.H., F.T.-B., N.S.); INMG (L.G.), CNRS UMR 5310-INSERM U1217; Department of Neurology (P.P.), Croix-Rousse Hospital, Hospices Civils de Lyon; Department of Pathology, Neurology and Neurosurgery (F.T.-B., N.S.), Pierre Wertheimer University Hospital, Hospices Civils de Lyon; Service de Biostatistique (D.M.-B.), Hospices Civils de Lyon; Université de Lyon (D.M.-B.); Université Lyon 1 (D.M.-B.); and CNRS UMR5558 (D.M.-B.), Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Françoise Thivolet-Bejui
- From the Department of Internal Medicine (L.G., A.H.), Edouard Herriot University Hospital, Hospices Civils de Lyon; University Claude Bernard (L.G., A.H., F.T.-B., N.S.); INMG (L.G.), CNRS UMR 5310-INSERM U1217; Department of Neurology (P.P.), Croix-Rousse Hospital, Hospices Civils de Lyon; Department of Pathology, Neurology and Neurosurgery (F.T.-B., N.S.), Pierre Wertheimer University Hospital, Hospices Civils de Lyon; Service de Biostatistique (D.M.-B.), Hospices Civils de Lyon; Université de Lyon (D.M.-B.); Université Lyon 1 (D.M.-B.); and CNRS UMR5558 (D.M.-B.), Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Delphine Maucort-Boulch
- From the Department of Internal Medicine (L.G., A.H.), Edouard Herriot University Hospital, Hospices Civils de Lyon; University Claude Bernard (L.G., A.H., F.T.-B., N.S.); INMG (L.G.), CNRS UMR 5310-INSERM U1217; Department of Neurology (P.P.), Croix-Rousse Hospital, Hospices Civils de Lyon; Department of Pathology, Neurology and Neurosurgery (F.T.-B., N.S.), Pierre Wertheimer University Hospital, Hospices Civils de Lyon; Service de Biostatistique (D.M.-B.), Hospices Civils de Lyon; Université de Lyon (D.M.-B.); Université Lyon 1 (D.M.-B.); and CNRS UMR5558 (D.M.-B.), Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Nathalie Streichenberger
- From the Department of Internal Medicine (L.G., A.H.), Edouard Herriot University Hospital, Hospices Civils de Lyon; University Claude Bernard (L.G., A.H., F.T.-B., N.S.); INMG (L.G.), CNRS UMR 5310-INSERM U1217; Department of Neurology (P.P.), Croix-Rousse Hospital, Hospices Civils de Lyon; Department of Pathology, Neurology and Neurosurgery (F.T.-B., N.S.), Pierre Wertheimer University Hospital, Hospices Civils de Lyon; Service de Biostatistique (D.M.-B.), Hospices Civils de Lyon; Université de Lyon (D.M.-B.); Université Lyon 1 (D.M.-B.); and CNRS UMR5558 (D.M.-B.), Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
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Smitaman E, Flores DV, Mejía Gómez C, Pathria MN. MR Imaging of Atraumatic Muscle Disorders. Radiographics 2018; 38:500-522. [PMID: 29451848 DOI: 10.1148/rg.2017170112] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Atraumatic disorders of skeletal muscles include congenital variants; inherited myopathies; acquired inflammatory, infectious, or ischemic disorders; neoplastic diseases; and conditions leading to muscle atrophy. These have overlapping appearances at magnetic resonance (MR) imaging and are challenging for the radiologist to differentiate. The authors organize muscle disorders into four MR imaging patterns: (a) abnormal anatomy with normal signal intensity, (b) edema/inflammation, (c) mass, and (d) atrophy, highlighting each of their key clinical and imaging findings. Anatomic muscle variants, while common, do not produce signal intensity alterations and therefore are easily overlooked. Muscle edema is the most common pattern but is nonspecific, with a broad differential diagnosis. Autoimmune, paraneoplastic, and drug-induced myositis tend to be symmetric, whereas infection, radiation-induced injury, and myonecrosis are focal asymmetric processes. Architectural distortion in the setting of muscle edema suggests one of these latter processes. Intramuscular masses include primary neoplasms, metastases, and several benign masslike lesions that simulate malignancy. Some lesions, such as lipomas, low-flow vascular malformations, fibromatoses, and subacute hematomas, are distinctive, but many intramuscular masses ultimately require a biopsy for definitive diagnosis. Atrophy is the irreversible end result of any muscle disease of sufficient severity and is the dominant finding in disorders such as the muscular dystrophies, denervation myopathy, and sarcopenia. This imaging-based classification, in correlation with clinical and laboratory data, will aid the radiologist in interpreting MR imaging findings in patients with atraumatic muscle disorders. ©RSNA, 2018.
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Affiliation(s)
- Edward Smitaman
- From the Department of Radiology, UCSD Medical Center, San Diego, Calif (E.S., M.N.P.); Department of Radiology, Philippine Orthopedic Center, Quezon City, Maria Clara Street, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); and Department of Radiology, Hospital Pablo Tobón Uribe, Medellín, Colombia (C.M.G.)
| | - Dyan V Flores
- From the Department of Radiology, UCSD Medical Center, San Diego, Calif (E.S., M.N.P.); Department of Radiology, Philippine Orthopedic Center, Quezon City, Maria Clara Street, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); and Department of Radiology, Hospital Pablo Tobón Uribe, Medellín, Colombia (C.M.G.)
| | - Catalina Mejía Gómez
- From the Department of Radiology, UCSD Medical Center, San Diego, Calif (E.S., M.N.P.); Department of Radiology, Philippine Orthopedic Center, Quezon City, Maria Clara Street, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); and Department of Radiology, Hospital Pablo Tobón Uribe, Medellín, Colombia (C.M.G.)
| | - Mini N Pathria
- From the Department of Radiology, UCSD Medical Center, San Diego, Calif (E.S., M.N.P.); Department of Radiology, Philippine Orthopedic Center, Quezon City, Maria Clara Street, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); and Department of Radiology, Hospital Pablo Tobón Uribe, Medellín, Colombia (C.M.G.)
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Onishi A, Otsuka Y, Morita N, Morinobu A. Focal myositis diffusely involving multiple masticatory muscles. Scand J Rheumatol 2018; 47:513-514. [DOI: 10.1080/03009742.2017.1397740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A Onishi
- Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Y Otsuka
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - N Morita
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - A Morinobu
- Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan
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12
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Gallay L, Streichenberger N, Benveniste O, Allenbach Y. [Focal myositis: An unknown disease]. Rev Med Interne 2017; 38:679-684. [PMID: 28947258 DOI: 10.1016/j.revmed.2017.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/12/2017] [Indexed: 11/29/2022]
Abstract
Focal myositis are inflammatory muscle diseases of unknown origin. At the opposite from the other idiopathic inflammatory myopathies, they are restricted to a single muscle or to a muscle group. They are not associated with extramuscular manifestations, and they have a good prognosis without any treatment. They are characterized by a localized swelling affecting mostly lower limbs. The pseudo-tumor can be painful, but is not associated with a muscle weakness. Creatine kinase level is normal. Muscle MRI shows an inflammation restricted to a muscle or a muscle group. Muscle biopsy and pathological analysis remain necessary for the diagnosis, showing inflammatory infiltrates composed by macrophages and lymphocytes without any specific distribution within the muscle. Focal overexpression of HLA-1 by the muscle fibers is frequently observed. The muscle biopsy permits to rule out differential diagnosis such a malignancy (sarcoma). Spontaneous remission occurs within weeks or months after the first symptoms, relapse is unusual.
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Affiliation(s)
- L Gallay
- Centre de pathologie et neuropathologie Est, hospices civils de Lyon, 69004 Lyon, France; Institut neuromyogène, CNRS UMR 5310, Inserm U1217, 69622 Villerbanne, France
| | - N Streichenberger
- Centre de pathologie et neuropathologie Est, hospices civils de Lyon, 69004 Lyon, France; Institut neuromyogène, CNRS UMR 5310, Inserm U1217, 69622 Villerbanne, France; Université Claude-Bernard-Lyon 1, 69622 Villerbanne, France
| | - O Benveniste
- Département de médecine interne et immunologie clinique, groupe hospitalier Pitié-Salpêtrière, centre de référence des maladies neuromusculaires Paris-Est, hôpital Pitié-Salpêtrière, Sorbonne universités, UPMC université Paris 06, AP-HP, 80, boulevard de l'Hôpital, 75013 Paris, France; UMR974, centre de recherche en myologie, Inserm, université Pierre-et-Marie-Curie, Sorbonnes universités, 75013 Paris, France
| | - Y Allenbach
- Département de médecine interne et immunologie clinique, groupe hospitalier Pitié-Salpêtrière, centre de référence des maladies neuromusculaires Paris-Est, hôpital Pitié-Salpêtrière, Sorbonne universités, UPMC université Paris 06, AP-HP, 80, boulevard de l'Hôpital, 75013 Paris, France; UMR974, centre de recherche en myologie, Inserm, université Pierre-et-Marie-Curie, Sorbonnes universités, 75013 Paris, France.
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Devic P, Gallay L, Streichenberger N, Petiot P. Focal myositis: A review. Neuromuscul Disord 2016; 26:725-733. [PMID: 27726926 DOI: 10.1016/j.nmd.2016.08.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 12/27/2022]
Abstract
Amongst the heterogeneous group of inflammatory myopathies, focal myositis stands as a rare and benign dysimmune disease. Although it can be associated with root and/or nerve lesions, traumatic muscle lesions and autoimmune diseases, its triggering factors remain poorly understood. Defined as an isolated inflammatory pseudotumour usually restricted to one skeletal muscle, clinical presentation of focal myositis is that of a rapidly growing solitary mass within a single muscle, usually in the lower limbs. Electromyography shows spontaneous activity associated with a myopathic pattern. MRI reveals a contrast enhanced enlarged muscle appearing hyper-intense on FAT-SAT T2 weighted images. Adjacent structures are spared and there are no calcifications. Serum creatine kinase (CK) levels are usually moderately augmented and biological markers of systemic inflammation are absent in most cases. Pathological histological features include marked variation in fibre size, inflammatory infiltrates mostly composed of T CD4+ lymphocytes and macrophages, degenerating/regenerating fibres and interstitial fibrosis. Differential diagnoses are numerous and include myositis of other origin with focal onset. Steroid treatment should be reserved for patients who present with major pain, nerve lesions, associated autoimmune disease, or elevated C reactive protein or CK.
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Affiliation(s)
- P Devic
- Department of Functional Neurology and Epileptology, Pierre Wertheimer Neurology University Hospital, 69 Bdv Pinel, 69677 Bron-Cedex, France; University Claude Bernard Lyon-I, France.
| | - L Gallay
- University Claude Bernard Lyon-I, France; Department of Clinical Immunology, Pavillon O, Edouard Herriot University Hospital, 5 place d'Arsonval, 69437 Lyon Cedex 03, France; NeuroMyoGen Institute, CNRS UMR 5310 - INSERM U1217, France
| | - N Streichenberger
- University Claude Bernard Lyon-I, France; NeuroMyoGen Institute, CNRS UMR 5310 - INSERM U1217, France; Department of Pathology, Lyon East University Hospital, 69 Bdv Pinel, 69677 Bron-Cedex, France
| | - P Petiot
- Department of Neurology, Croix-Rousse University Hospital, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
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14
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Laurent PE, Larribe M, Guenoun D, Champsaur P, Le Corroller T. Focal myositis: Sonographic findings. Muscle Nerve 2015; 52:306-7. [DOI: 10.1002/mus.24649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 03/03/2015] [Accepted: 03/05/2015] [Indexed: 11/08/2022]
Affiliation(s)
| | - Maud Larribe
- Service de Radiologie, Hôpital Sainte Marguerite; Marseille France
| | - Daphné Guenoun
- Laboratoire d'Anatomie, Faculté de Médecine de Marseille; Marseille France
| | - Pierre Champsaur
- Laboratoire d'Anatomie, Faculté de Médecine de Marseille; Marseille France
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15
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Intramuscular leukemic relapse: clinical signs and imaging findings. A multicentric analysis. Skeletal Radiol 2015; 44:491-6. [PMID: 25256752 DOI: 10.1007/s00256-014-2009-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/08/2014] [Accepted: 09/11/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Leukemia is a group of malignant diseases involving peripheral blood and bone marrow. Extramedullary tumor manifestation in leukemia can also occur. They more often involve lymph nodes, skin, and bones. Intramuscular leukemic relapse (ILR) is very unusual. The aim of this analysis was to summarize the reported data regarding clinical signs and radiological features of ILR. MATERIAL AND METHODS The PubMed database was searched for publications related to ILR. After an analysis of all identified articles, 20 publications matched the inclusion criteria. The authors of the 20 publications were contacted and provided imaging of their cases for review. The following were recorded: age, gender, primary diagnosis, clinical signs, pattern, localization and size of the intramuscular leukemic relapse. Images of 16 patients were provided [8 computer tomographic (CT) images and 15 magnetic resonance images, MRI]. Furthermore, one patient with ILR was identified in our institutional database. Therefore, images of 17 patients were available for further analysis. RESULTS Overall, 32 cases with ILR were included in the analysis. In most cases acute myeloid leukemia was diagnosed. Most ILRs were localized in the extremities (44 %) and in the extraocular muscles (44 %). Clinically, ILR manifested as local pain, swelling and muscle weakness. Radiologically, ILR presented most frequently with diffuse muscle infiltration. On postcontrast CT/MRI, most lesions demonstrated homogeneous enhancement. ILRs were hypo-/isointense on T1w and hyperintense on T2w images. CONCLUSION ILR manifests commonly as focal pain, swelling and muscle weakness. ILR predominantly involved the extraocular musculature and the extremities. Radiologically, diffuse muscle infiltration was the most common imaging finding.
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Shemesh S, Sidon E, Tobar A, Sheinis D, Velkes S, Ohana N. Primary Pyomyositis of the Paravertebral Muscles Involving the Adjacent Facet Joint: The Diagnostic Yield of Positron Emission Tomography-Computed Tomography: A Case Report. JBJS Case Connect 2012; 2:e84-4. [PMID: 34571696 DOI: 10.2106/jbjs.cc.l.00137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- S Shemesh
- Department of Orthopedics (S.S., E.S., and S.V.), Department of Orthopedics, Spine Unit (D.S. and N.O), and Department of Pathology (A.T.), Rabin Medical Center, Beilinson Campus, 39 Jabotinsky Street, Petach Tikva 49100, Israel.
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17
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Tantisricharoenkul G, Tan EW, Fayad LM, McCarthy EF, McFarland EG. Malignant soft tissue tumors of the biceps muscle mistaken for proximal biceps tendon rupture. Orthopedics 2012; 35:e1548-52. [PMID: 23027496 DOI: 10.3928/01477447-20120919-28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Tears of the proximal long head of the biceps tendon are among the most common tendon tears in the body. In most cases, the diagnosis is easily determined based on the history and physical examination. However, malignant soft tissue tumors can simulate proximal biceps tendon tears. Although tumors simulating tears of the distal biceps tendon at the elbow have been reported, to the authors' knowledge, no previous cases of tumors simulating or being mistaken for proximal biceps tendon tears have been reported.This article describes 2 cases of malignant sarcomas initially mistaken for tears of the long head of the biceps tendon. In the first case, a 62-year-old woman developed swelling in her arm after feeling a twinge in her shoulder. A magnetic resonance imaging scan was misread as a biceps tendon tear and not treated by the examining physician. In the second case, a mass appeared with little trauma in the brachium of a 70-year-old man. On physical examination, the mass was hard to palpation. In each case, biopsy revealed a soft tissue sarcoma. Both patients underwent wide excision with radiation and are currently disease free. These 2 cases emphasize the importance of obtaining a good history and of performing a thorough shoulder and arm examination in patients with deformities consistent with tears of the long head of the biceps tendon.
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Affiliation(s)
- Gof Tantisricharoenkul
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland 21224-2780 ., USA
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18
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Jun J, Im S, Park JH, Yoo SH, Park GY. Focal myositis of unilateral leg. Ann Rehabil Med 2011; 35:944-8. [PMID: 22506226 PMCID: PMC3309372 DOI: 10.5535/arm.2011.35.6.944] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 09/16/2010] [Indexed: 11/12/2022] Open
Abstract
Focal myositis is a rare, benign inflammatory pseudotumor of the skeletal muscle of unknown etiology. In Korea, there is no case report of focal myositis, which is not combined with connective tissue disease. We present an unusual case of focal myositis with ankle contracture, involving more than two muscles. A 26-year-old man visited our clinic complaining of right ankle contracture and leg muscle pain. Physical examination revealed no muscle weakness or any other neurological abnormality. T2-weighted magnetic resonance imaging of the right leg demonstrated diffuse high signal intensity of the right gastrocnemius, flexor digitorum longus, and tibialis anterior muscles. Needle electromyography showed profuse denervation potentials with motor unit action potentials of short duration and small amplitude from the involved muscles. All these findings suggested a diagnosis of focal inflammatory myositis and the patient was put under oral prednisolone and physical therapy.
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Affiliation(s)
- Jin Jun
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Bucheon 420-717, Korea
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19
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Schäfer CN, Hvolris J, Karlsmark T, Plambech M. Muscle enhancement using intramuscular injections of oil in bodybuilding: review on epidemiology, complications, clinical evaluation and treatment. Eur Surg 2011. [DOI: 10.1007/s10353-011-0033-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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20
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MRI findings of neutrophilic fasciitis in a patient with acute febrile neutrophilic dermatosis (Sweet's syndrome). Skeletal Radiol 2011; 40:779-82. [PMID: 21298430 DOI: 10.1007/s00256-011-1104-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 12/19/2010] [Accepted: 01/13/2011] [Indexed: 02/02/2023]
Abstract
Acute febrile neutrophilic dermatosis (Sweet's syndrome) is a clinical condition that is histopathologically characterized by infiltration of the dermis with mature neutrophils with or without vessel wall destruction. Frequently, an extracutaneous systemic disease can be seen. We report magnetic resonance imaging (MRI) findings of neutrophilic fasciitis in a 62-year-old man with Sweet's syndrome and musculoskeletal involvement. The musculoskeletal system is rarely involved in Sweet's syndrome and, to our knowledge, no previous report of MRI findings of neutrophilic fasciitis with myofascial involvement exists in the literature.
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21
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Surov A, Fiedler E, Voigt W, Wienke A, Holzhausen HJ, Spielmann RP, Behrmann C. Magnetic resonance imaging of intramuscular metastases. Skeletal Radiol 2011; 40:439-46. [PMID: 20697708 DOI: 10.1007/s00256-010-1018-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 07/27/2010] [Accepted: 07/28/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of the present study was to analyse magnetic resonance findings of intramuscular metastases (IM) in a relatively large series. MATERIALS AND METHODS From January 2000 to January 2010, 28 patients (207 metastases) were retrospectively identified in the radiological database of the Martin-Luther-University. Several different scanning protocols were used depending on the localisation of IM. In 12 patients diffusion-weighted (DW) images were obtained with a multi-shot SE-EPI sequence. Apparent diffusion coefficient (ADC) maps were also calculated. Furthermore, fusion images were manually generated between the DW and half-Fourier acquisition single-shot turbo spin echo (HASTE) images. RESULTS On T2-weighted images, 97% of the recognised IM were hyperintense in comparison to unaffected musculature, and 3% were mixed iso- to hyperintense. On T1-weighted images most IM (91%) were homogeneously isointense in comparison to muscle tissue, whereas 4% were hypointense, and 5% lightly hyperintense. ADC maps were calculated for 91 metastases ranging from 0.99 to 4.00 mm(2)s(-1) (mean value 1.99 ± 0.66). ADC values of low (<1.5) signal intensity (SI) were identified in 26%, moderate SI (from 1.5 to 3.0) in 68%, and high SI (>3.0) in 6%. Of the IM that were investigated with contrast medium, 88.5% showed marked enhancement. It was homogeneous in 88% and heterogenous in 6%. Rim enhancement with central low attenuation was seen in 6%. There was no difference in enhancement characteristics with respect to ADC values or fusion patterns. Peritumoral enhancement was identified in 2.4%. CONCLUSION Magnetic resonance features of muscle metastases are relatively typical and consist of round or oval intramuscular masses with well-defined margins, marked enhancement, low or moderate ADC values, and moderate to high signal intensity on fusion images.
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Affiliation(s)
- Alexey Surov
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
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22
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Kim SY, Park JS, Ryu KN, Jin W, Park SY. Various tumor-mimicking lesions in the musculoskeletal system: causes and diagnostic approach. Korean J Radiol 2011; 12:220-31. [PMID: 21430940 PMCID: PMC3052614 DOI: 10.3348/kjr.2011.12.2.220] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 07/06/2010] [Indexed: 01/02/2023] Open
Abstract
Tumor-mimicking lesions in the musculoskeletal system can be defined as lesions mistaken as tumors due to the presence of palpation upon physical examination or a tumor-like appearance upon radiological examination. Moreover, tumor-mimicking lesions show diverse etiologies and anatomic locations. We illustrated the various tumor-mimicking lesions involving bone and soft tissue. In this review, the tumor-mimicking lesions were classified into those based on clinical examination and those based on radiological examination in musculoskeletal radiology. Awareness of the various causes of tumor-mimicking lesions, correctly obtaining clinical information, and the proper selection of imaging modality are important for the differentiation of tumor-mimicking lesions from true neoplasms.
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Affiliation(s)
- Sue Yon Kim
- Department of Radiology, Kyung Hee University Medical Center, Seoul 130-702, Korea
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23
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Mileto A, Gaeta M. Calcific tendonitis of supraspinatus simulating acute brachial neuritis (Parsonage-Turner syndrome). Clin Radiol 2011; 66:578-81. [PMID: 21353212 DOI: 10.1016/j.crad.2011.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 12/25/2010] [Accepted: 01/06/2011] [Indexed: 11/17/2022]
Affiliation(s)
- A Mileto
- Dipartimento di Scienze Radiologiche, Policlinico G. Martino, Messina, Italy.
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Bradshaw AR, Sandow MJ, Clayer MT. Distal biceps tendon partial tear presenting as a pseudotumor. J Shoulder Elbow Surg 2011; 20:e14-7. [PMID: 20869267 DOI: 10.1016/j.jse.2010.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 08/02/2010] [Accepted: 08/07/2010] [Indexed: 02/01/2023]
Affiliation(s)
- Anthony R Bradshaw
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
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25
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Schroeder AS, Ertl-Wagner B, Britsch S, Schröder JM, Nikolin S, Weis J, Müller-Felber W, Koerte I, Stehr M, Berweck S, Borggraefe I, Heinen F. Muscle biopsy substantiates long-term MRI alterations one year after a single dose of botulinum toxin injected into the lateral gastrocnemius muscle of healthy volunteers. Mov Disord 2009; 24:1494-503. [PMID: 19489066 DOI: 10.1002/mds.22661] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Despite numerous clinical and experimental studies on botulinum toxin type A (BoNT/A), long-term alterations of muscle texture and fine structure following BoNT/A treatment have thus far not been studied in normal human skeletal muscle. After obtaining institutional review board approval, we performed a prospective, placebo-controlled, double-blinded follow-up study on two healthy adults using magnetic resonance imaging (MRI) and muscle biopsy to visualize long-term alterations after a single BoNT/A injection into the lateral head of the gastrocnemius muscle. MRI disclosed a high-signal-intensity pattern in short tau inversion recovery sequences, and a reduction of the cross-sectional area in the BoNT/A-injected, but not in the saline-injected contralateral control muscle (at 6 to 9 months in volunteer A: 73%, in B: 62%; at 12 months in A: 88%, and in B: 78%). Enzyme histochemistry, 12 months after injection, confirmed neurogenic atrophy of muscle fibers only in the BoNT/A-injected muscle. Electron microscopy revealed additional degenerative changes at the neuromuscular junction. The data confirm that MRI is a suitable tool to monitor the long-term effect of BoNT/A on skeletal muscle. Neurogenic muscle atrophy following a single BoNT/A injection should be taken into consideration when repeated BoNT/A injections into the same muscles are proposed.
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Affiliation(s)
- A Sebastian Schroeder
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner's Children's Hospital, University of Munich, Munich, Germany.
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