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Daste C, Mihoubi F, Roren A, Dumitrache A, Carlier N, Benghanem S, Ruttimann A, Mira JP, Pène F, Roche N, Seror P, Nguyen C, Rannou F, Drapé JL, Lefèvre-Colau MM. Early shoulder-girdle MRI findings in severe COVID-19-related intensive care unit-acquired weakness: a prospective cohort study. Eur Radiol 2023:10.1007/s00330-023-09468-5. [PMID: 36912923 PMCID: PMC10010198 DOI: 10.1007/s00330-023-09468-5] [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: 05/07/2022] [Revised: 12/23/2022] [Accepted: 01/22/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To describe clinical and early shoulder-girdle MR imaging findings in severe COVID-19-related intensive care unit-acquired weakness (ICU-AW) after ICU discharge. METHODS A single-center prospective cohort study of all consecutive patients with COVID-19-related ICU-AW from November 2020 to June 2021. All patients underwent similar clinical evaluations and shoulder-girdle MRI within the first month and then 3 months (± 1 month) after ICU discharge. RESULTS We included 25 patients (14 males; mean [SD] age 62.4 [12.5]). Within the first month after ICU discharge, all patients showed severe proximal predominant bilateral muscular weakness (mean Medical Research Council total score = 46.5/60 [10.1]) associated with bilateral, peripheral muscular edema-like MRI signals of the shoulder girdle in 23/25 (92%) patients. At 3 months, 21/25 (84%) patients showed complete or quasi-complete resolution of proximal muscular weakness (mean Medical Research Council total score > 48/60) and 23/25 (92%) complete resolution of MRI signals of the shoulder girdle, but 12/20 (60%) patients experienced shoulder pain and/or shoulder dysfunction. CONCLUSIONS Early shoulder-girdle MRI findings in COVID-19-related ICU-AW included muscular edema-like peripheral signal intensities, without fatty muscle involution or muscle necrosis, with favorable evolution at 3 months. Precocious MRI can help clinicians distinguish critical illness myopathy from alternative, more severe diagnoses and can be useful in the care of patients discharged from intensive care with ICU-AW. KEY POINTS • We describe the clinical and shoulder-girdle MRI findings of COVID-19-related severe intensive care unit-acquired weakness. • This information can be used by clinicians to achieve a nearly specific diagnosis, distinguish alternative diagnoses, assess functional prognosis, and select the more appropriate health care rehabilitation and shoulder impairment treatment.
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Affiliation(s)
- Camille Daste
- Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.,AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur Et Des Pathologies du Rachis, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France.,INSERM UMR-S 1153, Centre de Recherche Épidémiologie Et Statistique Paris (CRESS), ECaMO Team, 75004, Paris, France
| | - Fadila Mihoubi
- INSERM UMR-S 1153, Centre de Recherche Épidémiologie Et Statistique Paris (CRESS), ECaMO Team, 75004, Paris, France.,AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Radiologie Ostéo-Articulaire, 75014, Paris, France
| | - Alexandra Roren
- AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur Et Des Pathologies du Rachis, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France.,INSERM UMR-S 1153, Centre de Recherche Épidémiologie Et Statistique Paris (CRESS), ECaMO Team, 75004, Paris, France
| | - Alina Dumitrache
- AP-HP. Centre-Université de Paris Cité, Hôpital Corentin Celton, Service de Rééducation Et de Réadaptation, 92130, Issy-Les-Moulineaux, France
| | - Nicolas Carlier
- AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Pneumologie, 75014, Paris, France
| | - Sarah Benghanem
- Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.,AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Médecine Intensive Et Réanimation, 75014, Paris, France.,Neurophysiology Department, GHU Psychiatrie Et Neurosciences, Sainte Anne Hospital, 75014, Paris, France
| | - Aude Ruttimann
- AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Médecine Intensive Et Réanimation, 75014, Paris, France
| | - Jean-Paul Mira
- Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.,AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Médecine Intensive Et Réanimation, 75014, Paris, France
| | - Frédéric Pène
- Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.,AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Médecine Intensive Et Réanimation, 75014, Paris, France.,Institut Cochin, INSERM U1016, CNRS UMR8104, 75006, Paris, France
| | - Nicolas Roche
- Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.,AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Pneumologie, 75014, Paris, France
| | - Paul Seror
- Laboratoire d'électroneuromyographie, 146 Av Ledru Rollin, 75011, Paris, France
| | - Christelle Nguyen
- Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.,AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur Et Des Pathologies du Rachis, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France.,INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire Et Biomarqueurs (T3S), Centre Universitaire Des Saints-Pères, 75006, Paris, France
| | - François Rannou
- Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.,AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur Et Des Pathologies du Rachis, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France.,INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire Et Biomarqueurs (T3S), Centre Universitaire Des Saints-Pères, 75006, Paris, France
| | - Jean-Luc Drapé
- Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France.,INSERM UMR-S 1153, Centre de Recherche Épidémiologie Et Statistique Paris (CRESS), ECaMO Team, 75004, Paris, France.,AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Radiologie Ostéo-Articulaire, 75014, Paris, France
| | - Marie-Martine Lefèvre-Colau
- Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France. .,AP-HP. Centre-Université de Paris Cité, Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur Et Des Pathologies du Rachis, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France. .,INSERM UMR-S 1153, Centre de Recherche Épidémiologie Et Statistique Paris (CRESS), ECaMO Team, 75004, Paris, France.
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Lupi A, Spolaor S, Favero A, Bello L, Stramare R, Pegoraro E, Nobile MS. Muscle magnetic resonance characterization of STIM1 tubular aggregate myopathy using unsupervised learning. PLoS One 2023; 18:e0285422. [PMID: 37155641 PMCID: PMC10166478 DOI: 10.1371/journal.pone.0285422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/21/2023] [Indexed: 05/10/2023] Open
Abstract
PURPOSE Congenital myopathies are a heterogeneous group of diseases affecting the skeletal muscles and characterized by high clinical, genetic, and histological variability. Magnetic Resonance (MR) is a valuable tool for the assessment of involved muscles (i.e., fatty replacement and oedema) and disease progression. Machine Learning is becoming increasingly applied for diagnostic purposes, but to our knowledge, Self-Organizing Maps (SOMs) have never been used for the identification of the patterns in these diseases. The aim of this study is to evaluate if SOMs may discriminate between muscles with fatty replacement (S), oedema (E) or neither (N). METHODS MR studies of a family affected by tubular aggregates myopathy (TAM) with the histologically proven autosomal dominant mutation of the STIM1 gene, were examined: for each patient, in two MR assessments (i.e., t0 and t1, the latter after 5 years), fifty-three muscles were evaluated for muscular fatty replacement on the T1w images, and for oedema on the STIR images, for reference. Sixty radiomic features were collected from each muscle at t0 and t1 MR assessment using 3DSlicer software, in order to obtain data from images. A SOM was created to analyze all datasets using three clusters (i.e., 0, 1 and 2) and results were compared with radiological evaluation. RESULTS Six patients with TAM STIM1-mutation were included. At t0 MR assessments, all patients showed widespread fatty replacement that intensifies at t1, while oedema mainly affected the muscles of the legs and appears stable at follow-up. All muscles with oedema showed fatty replacement, too. At t0 SOM grid clustering shows almost all N muscles in Cluster 0 and most of the E muscles in Cluster 1; at t1 almost all E muscles appear in Cluster 1. CONCLUSION Our unsupervised learning model appears to be able to recognize muscles altered by the presence of edema and fatty replacement.
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Affiliation(s)
- Amalia Lupi
- Institute of Radiology, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Simone Spolaor
- Microsystems, Department of Mechanical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Alessandro Favero
- Institute of Radiology, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Luca Bello
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Roberto Stramare
- Clinical and Translational Advanced Imaging Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Elena Pegoraro
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Marco Salvatore Nobile
- Department of Environmental Sciences, Informatics and Statistics (DAIS), Ca' Foscari University of Venice, Venice, Italy
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Matsuda N, Kobayashi S, Hasegawa O, Yoshida K, Kubo H, Ugawa Y, Kanai K. Subclinical involvement of the trunk muscles in idiopathic inflammatory myopathies. Acta Radiol Open 2022; 11:20584601221075796. [PMID: 35251701 PMCID: PMC8891869 DOI: 10.1177/20584601221075796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/09/2022] [Indexed: 12/03/2022] Open
Abstract
Background Whole-body magnetic resonance imaging (WB-MRI) is a useful tool for revealing the disease-specific distribution of affected muscles and clinically asymptomatic muscle involvements in idiopathic inflammatory myopathies (IIMs). Purpose To examine inflammatory changes in the systemic skeletal muscles, including the thoracoabdominal trunk, in IIMs using WB-MRI. Material and Methods We prospectively obtained WB-MRI axial images from 10 patients with IIMs, including antisynthetase syndrome (ASS), immune-mediated necrotizing myopathy (IMNM), sporadic inclusion body myositis, and myopathy associated with antimitochondrial antibody. We evaluated 108 systemic skeletal muscles in short-tau inversion recovery (STIR) images and rated changes in signal intensity using a semiquantitative scale. Correlations between STIR sum score, peak creatine kinase (CK) and muscle strength were examined. We also investigated the correlation between STIR sum score within the thoracoabdominal trunk and forced vital capacity. Results High STIR signal changes were frequently identified in asymptomatic and routinely unexamined muscles. Thoracoabdominal trunk muscles were frequently involved in ASS and IMNM. Peak CK was positively correlated with the STIR sum score (R2 = 0.62, p < .01). There was no significant correlation between the STIR sum score within the thoracoabdominal trunk and forced vital capacity. Conclusion WB-MRI can detect subclinical muscle inflammation in the systemic muscles including the trunk muscles. STIR sum score is positively correlated with serum peak CK level; therefore, it could be a biomarker of overall muscle inflammation.
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Affiliation(s)
- Nozomu Matsuda
- Department of Neurology, Fukushima Medical University, Fukushima, Japan
| | - Shunsuke Kobayashi
- Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan
| | - Osamu Hasegawa
- Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kenji Yoshida
- Department of Neurology, Fukushima Medical University, Fukushima, Japan
| | - Hitoshi Kubo
- Advanced Clinical Research Center, Fukushima Medical University, Fukushima, Japan
- Department of Radiological Sciences, School of Health Sciences, Fukushima Medical University, Fukushima, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
| | - Kazuaki Kanai
- Department of Neurology, Fukushima Medical University, Fukushima, Japan
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Decreased Muscular Perfusion in Dermatomyositis: Initial Results Detected by Inflow-Based Vascular-Space-Occupancy MRI. AJR Am J Roentgenol 2021; 216:1588-1595. [PMID: 33787295 DOI: 10.2214/ajr.20.23045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. This study aimed to determine whether inflow-based vascular-space-occupancy (iVASO) MRI could reproducibly quantify skeletal muscle perfusion and differentiate patients with dermatomyositis (DM) from healthy subjects. MATERIALS AND METHODS. A total of 25 patients with DM and 22 healthy volunteers underwent iVASO MRI in a 3-T MRI scanner. Maximum and mean arteriolar muscle blood volume (MBV) values of four subgroups of muscles (normal muscles, morphologically normal-appearing muscles, edematous muscles, and atrophic or fat-infiltrated muscles) were obtained. Maximum and mean arteriolar MBV values were compared among the different subgroups, and repeat testing was performed in 20 subjects to assess reproducibility. RESULTS. Compared with normal muscles in healthy subjects, morphologically normal-appearing muscles, edematous muscles, and atrophic or fat-infiltrated muscles in patients with DM showed a significant decrease of both maximum and mean arteriolar MBV (p < .001). Both parameters were significantly lower in atrophic or fat-infiltrated muscles than in morphologically normal-appearing and edematous muscles (p < .001). ROC AUCs for discriminating patients with DM from healthy volunteers were 0.842 and 0.812 for maximum and mean arteriolar MBV values, respectively. As a measure of test-retest studies, the intraclass correlation coefficients (ICCs) were 0.990 (95% CI, 0.986-0.993) and 0.990 (95% CI, 0.987-0.993) for maximum and mean arteriolar MBV, respectively. For interobserver reproducibility, the ICCs were 0.989 (95% CI, 0.986-0.991) and 0.980 (95% CI, 0.975-0.983), respectively. CONCLUSION. iVASO MRI can reproducibly quantify arteriolar MBV in the thigh and discriminate between healthy volunteers and patients with DM.
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Carroll LS, Walker M, Allen D, Marini-Bettolo C, Ditchfield A, Pinto AA, Hammans SR. Desminopathy presenting as late onset bilateral facial weakness, with diagnosis supported by lower limb MRI. Neuromuscul Disord 2021; 31:249-252. [PMID: 33546848 DOI: 10.1016/j.nmd.2020.12.013] [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: 09/30/2020] [Revised: 12/12/2020] [Accepted: 12/30/2020] [Indexed: 11/29/2022]
Abstract
A 63 year old male presented with a 20 year history of facial weakness and several years of nasal regurgitation and dysphonia. Examination revealed bilateral facial weakness with nasal speech. Serum creatine kinase was 918 U/L. Neurophysiological studies suggested a myopathy and biopsy of the left vastus lateralis showed serpentine basophilic inclusions in the sarcoplasm and strong oxidative enzyme activity suggesting mitochondria accumulation. The muscle MRI showed selective fatty replacement within semitendinosus, gastrocnemius and soleus indicative of a desminopathy. A heterozygous missense variant c.17C>G (p.Ser6Trp) was identified within DES, predicted to be pathogenic in silico and previously described in a family with distal limb weakness. There are no previous case reports of desminopathy presenting with facial weakness, to our knowledge. Diagnosis was suggested following myoimaging of clinically unaffected muscles. Our study highlights the importance of muscle MRI in the diagnostic evaluation of muscle disease and further expands the known phenotypic heterogeneity of desminopathies.
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Affiliation(s)
- Liam S Carroll
- Wessex Neurological Centre, Southampton General Hospital, Southampton SO16 6YD, UK.
| | - Mark Walker
- Wessex Neurological Centre, Southampton General Hospital, Southampton SO16 6YD, UK
| | - David Allen
- Wessex Neurological Centre, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Ciara Marini-Bettolo
- John Walton Muscular Dystrophy Research Centre, Newcastle University and The Newcastle Hospitals NHS Foundation Trust, NE1 3BZ, UK
| | - Adam Ditchfield
- Wessex Neurological Centre, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Ashwin A Pinto
- Wessex Neurological Centre, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Simon R Hammans
- Wessex Neurological Centre, Southampton General Hospital, Southampton SO16 6YD, UK
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Muscle Imaging. IDKD SPRINGER SERIES 2021. [DOI: 10.1007/978-3-030-71281-5_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AbstractEvaluation and characterization of skeletal muscle pathology is a frequently encountered indication for musculoskeletal imaging. Causes of muscle pathology are diverse and include traumatic, autoimmune, infectious, inflammatory, neurologic, and neoplastic. Each etiology while dramatically different in the pathophysiology may present with similar imaging features. An understanding of the subtle differences in imaging features between the pathologic conditions may serve to guide diagnosis and treatment in these often complex cases. In this section, we will discuss the various skeletal muscle pathologies and the imaging features associated with each.
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Sudoł-Szopińska I, Jacques T, Gietka P, Cotten A. Imaging in dermatomyositis in adults and children. J Ultrason 2020; 20:e36-e42. [PMID: 32320164 PMCID: PMC7266069 DOI: 10.15557/jou.2020.0007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/02/2020] [Indexed: 11/29/2022] Open
Abstract
Dermatomyositis is a rare autoimmune disorder in which an abnormal immune reaction against vascular endothelial antigens and endomysium leads to obstructive inflammatory changes of blood vessels within muscles, skin and other tissues. The disease is characterized by involvement of muscles, and less frequently of other systems, including the gastrointestinal tract, heart and lungs. Dermatomyositis may be diagnosed based on a detailed patient history, through clinical examination, detection of characteristic physical findings and certain specialized tests. Additional imaging studies may be performed to aid in the diagnosis. These include magnetic resonance imaging and ultrasound of the affected muscles. Magnetic resonance imaging is the modality of choice in the diagnostic work-up and monitoring of dermatomyositis affecting muscles, fasciae, and the subcutis. It may recognize acute inflammatory edematous changes in the affected muscles as well fatty replacement and atrophy. The role of ultrasound to diagnose and follow up muscle echogenicity, vascularity, elasticity and volume during treatment has increased over the last years in both adults and children. Ultrasound is used to discriminate between high and low disease activity, may show features of subclinical disease and may be used to confirm remission.
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Affiliation(s)
- Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation , Warsaw , Poland
| | - Thibaut Jacques
- Department of Musculoskeletal Radiology, Lille University Hospital , Lille , France
| | - Piotr Gietka
- Department of Pediatric Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation , Warsaw , Poland
| | - Anne Cotten
- Department of Musculoskeletal Radiology, Lille University Hospital , Lille , France
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Abstract
Members of the International Skeletal Society compiled a glossary of terms for musculoskeletal radiology. The authors also represent national radiology or pathology societies in Asia, Australia, Europe, and the USA. We provide brief descriptions of musculoskeletal structures, disease processes, and syndromes and address their imaging features. Given the abundance of musculoskeletal disorders and derangements, we chose to omit most terms relating to neoplasm, spine, intervention, and pediatrics. Consensus agreement was obtained from 19 musculoskeletal radiology societies worldwide.
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Tomas X, Milisenda JC, Garcia-Diez AI, Prieto-Gonzalez S, Faruch M, Pomes J, Grau-Junyent JM. Whole-body MRI and pathological findings in adult patients with myopathies. Skeletal Radiol 2019; 48:653-676. [PMID: 30377729 DOI: 10.1007/s00256-018-3107-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/12/2018] [Accepted: 10/22/2018] [Indexed: 02/08/2023]
Abstract
Magnetic resonance imaging (MRI) is considered the most sensitive and specific imaging technique for the detection of muscle diseases related to myopathies. Since 2008, the use of whole-body MRI (WBMRI) to evaluate myopathies has improved due to technical advances such as rolling table platform and parallel imaging, which enable rapid assessment of the entire musculoskeletal system with high-quality images. WBMRI protocols should include T1-weighted and short-tau inversion recovery (STIR), which provide the basic pulse sequences for studying myopathies, in order to detect fatty infiltration/muscle atrophy and muscle edema, respectively. High signal intensity in T1-weighted images shows chronic disease with fatty infiltration, whereas high signal intensity in STIR indicates an acute stage with muscle edema. Additional sequences such as diffusion-weighted imaging (DWI) can be readily incorporated into routine WBMRI study protocols. Contrast-enhanced sequences have not been done. This article reviews WBMRI as an imaging method to evaluate different myopathies (idiopathic inflammatory, dystrophic, non-dystrophic, metabolic, and channelopathies). WBMRI provides a comprehensive estimate of the total burden with a single study, seeking specific distribution patterns, including clinically silent involvement of muscle areas. Furthermore, WBMRI may help to select the "target muscle area" for biopsy during patient follow-up. It may be also be used to detect related and non-related pathological conditions, such as tumors.
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Affiliation(s)
- Xavier Tomas
- Department of Radiology (CDIC), Hospital Clinic, Universitat de Barcelona (UB), Villarroel 170, 08036, Barcelona, Spain.
| | - Jose Cesar Milisenda
- Department of Internal Medicine, Hospital Clinic, Universitat de Barcelona (UB) and CIBERER, Villarroel 170, 08036, Barcelona, Spain
| | - Ana Isabel Garcia-Diez
- Department of Radiology (CDIC), Hospital Clinic, Universitat de Barcelona (UB), Villarroel 170, 08036, Barcelona, Spain
| | - Sergio Prieto-Gonzalez
- Department of Autoimmune Diseases, Hospital Clinic, Universitat de Barcelona (UB), Villarroel 170, 08036, Barcelona, Spain
| | - Marie Faruch
- Department of Radiology, Hopital Purpan, Centre Hospitalier Universitaire (CHU), Place du Docteur Baylac TSA 40031, 31059, Toulouse cedex 9, France
| | - Jaime Pomes
- Department of Radiology (CDIC), Hospital Clinic, Universitat de Barcelona (UB), Villarroel 170, 08036, Barcelona, Spain
| | - Josep Maria Grau-Junyent
- Department of Internal Medicine, Hospital Clinic, Universitat de Barcelona (UB) and CIBERER, Villarroel 170, 08036, Barcelona, Spain
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Paoletti M, Pichiecchio A, Cotti Piccinelli S, Tasca G, Berardinelli AL, Padovani A, Filosto M. Advances in Quantitative Imaging of Genetic and Acquired Myopathies: Clinical Applications and Perspectives. Front Neurol 2019; 10:78. [PMID: 30804884 PMCID: PMC6378279 DOI: 10.3389/fneur.2019.00078] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022] Open
Abstract
In the last years, magnetic resonance imaging (MRI) has become fundamental for the diagnosis and monitoring of myopathies given its ability to show the severity and distribution of pathology, to identify specific patterns of damage distribution and to properly interpret a number of genetic variants. The advances in MR techniques and post-processing software solutions have greatly expanded the potential to assess pathological changes in muscle diseases, and more specifically of myopathies; a number of features can be studied and quantified, ranging from composition, architecture, mechanical properties, perfusion, and function, leading to what is known as quantitative MRI (qMRI). Such techniques can effectively provide a variety of information beyond what can be seen and assessed by conventional MR imaging; their development and application in clinical practice can play an important role in the diagnostic process and in assessing disease course and treatment response. In this review, we briefly discuss the current role of muscle MRI in diagnosing muscle diseases and describe in detail the potential and perspectives of the application of advanced qMRI techniques in this field.
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Affiliation(s)
- Matteo Paoletti
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Anna Pichiecchio
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Stefano Cotti Piccinelli
- Unit of Neurology, Center for Neuromuscular Diseases, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Giorgio Tasca
- Neurology Department, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Alessandro Padovani
- Unit of Neurology, Center for Neuromuscular Diseases, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Massimiliano Filosto
- Unit of Neurology, Center for Neuromuscular Diseases, ASST Spedali Civili and University of Brescia, Brescia, Italy
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Arrigoni F, De Luca A, Velardo D, Magri F, Gandossini S, Russo A, Froeling M, Bertoldo A, Leemans A, Bresolin N, D'angelo G. Multiparametric quantitative MRI assessment of thigh muscles in limb-girdle muscular dystrophy 2A and 2B. Muscle Nerve 2018; 58:550-558. [PMID: 30028523 DOI: 10.1002/mus.26189] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 05/29/2018] [Accepted: 06/03/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The aim of this study was to apply quantitative MRI (qMRI) to assess structural modifications in thigh muscles of subjects with limb girdle muscular dystrophy (LGMD) 2A and 2B with long disease duration. METHODS Eleven LGMD2A, 9 LGMD2B patients and 11 healthy controls underwent a multi-parametric 3T MRI examination of the thigh. The protocol included structural T1-weighted images, DIXON sequences for fat fraction calculation, T2 values quantification and diffusion MRI. Region of interest analysis was performed on 4 different compartments (anterior compartment, posterior compartment, gracilis, sartorius). RESULTS Patients showed high levels of fat infiltration as measured by DIXON sequences. Sartorius and anterior compartment were more infiltrated in LGMD2B than LGMD2A patients. T2 values were mildly reduced in both disorders. Correlations between clinical scores and qMRI were found. CONCLUSIONS qMRI measures may help to quantify muscular degeneration, but careful interpretation is needed when fat infiltration is massive. Muscle Nerve 58: 550-558, 2018.
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Affiliation(s)
- Filippo Arrigoni
- Neuroimaging Lab, Scientific Institute, IRCCS E. Medea, Via don L. Monza 20, Bosisio Parini, Italy
| | - Alberto De Luca
- Image Sciences Institute, University Medical Center Utrecht and University Utrecht, Utrecht, The Netherlands
| | - Daniele Velardo
- NeuroMuscular Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy
| | - Francesca Magri
- Neurology Unit, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Sandra Gandossini
- NeuroMuscular Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy
| | - Annamaria Russo
- NeuroMuscular Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy
| | - Martijn Froeling
- NeuroMuscular Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy
| | | | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht and University Utrecht, Utrecht, The Netherlands
| | - Nereo Bresolin
- Neurology Unit, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Grazia D'angelo
- NeuroMuscular Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy
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12
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Figueroa-Bonaparte S, Llauger J, Segovia S, Belmonte I, Pedrosa I, Montiel E, Montesinos P, Sánchez-González J, Alonso-Jiménez A, Gallardo E, Illa I, Díaz-Manera J. Quantitative muscle MRI to follow up late onset Pompe patients: a prospective study. Sci Rep 2018; 8:10898. [PMID: 30022036 PMCID: PMC6052002 DOI: 10.1038/s41598-018-29170-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 07/03/2018] [Indexed: 12/13/2022] Open
Abstract
Late onset Pompe disease (LOPD) is a slow, progressive disorder characterized by skeletal and respiratory muscle weakness. Enzyme replacement therapy (ERT) slows down the progression of muscle symptoms. Reliable biomarkers are needed to follow up ERT-treated and asymptomatic LOPD patients in clinical practice. In this study, 32 LOPD patients (22 symptomatic and 10 asymptomatic) underwent muscle MRI using 3-point Dixon and were evaluated at the time of the MRI with several motor function tests and patient-reported outcome measures, and again after one year. Muscle MRI showed a significant increase of 1.7% in the fat content of the thigh muscles in symptomatic LOPD patients. In contrast, there were no noteworthy differences between muscle function tests in the same period of time. We did not observe any significant changes either in muscle MRI or in muscle function tests in asymptomatic patients over the year. We conclude that 3-point Dixon muscle MRI is a useful tool for detecting changes in muscle structure in symptomatic LOPD patients and could become part of the current follow-up protocol in daily clinics.
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Affiliation(s)
- Sebastian Figueroa-Bonaparte
- Neuromuscular Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Llauger
- Radiology department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sonia Segovia
- Neuromuscular Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación en Red en Enfermedades Raras (CIBERER), Madrid, Spain
| | - Izaskun Belmonte
- Rehabilitation and physiotherapy department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Irene Pedrosa
- Rehabilitation and physiotherapy department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Montiel
- Rehabilitation and physiotherapy department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Alicia Alonso-Jiménez
- Neuromuscular Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eduard Gallardo
- Neuromuscular Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación en Red en Enfermedades Raras (CIBERER), Madrid, Spain
| | - Isabel Illa
- Neuromuscular Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación en Red en Enfermedades Raras (CIBERER), Madrid, Spain
| | | | - Jordi Díaz-Manera
- Neuromuscular Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Centro de Investigación en Red en Enfermedades Raras (CIBERER), Madrid, Spain.
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13
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Rider LG, Aggarwal R, Machado PM, Hogrel JY, Reed AM, Christopher-Stine L, Ruperto N. Update on outcome assessment in myositis. Nat Rev Rheumatol 2018; 14:303-318. [PMID: 29651119 PMCID: PMC6702032 DOI: 10.1038/nrrheum.2018.33] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The adult and juvenile myositis syndromes, commonly referred to collectively as idiopathic inflammatory myopathies (IIMs), are systemic autoimmune diseases with the hallmarks of muscle weakness and inflammation. Validated, well-standardized measures to assess disease activity, known as core set measures, were developed by international networks of myositis researchers for use in clinical trials. Composite response criteria using weighted changes in the core set measures of disease activity were developed and validated for adult and juvenile patients with dermatomyositis and adult patients with polymyositis, with different thresholds for minimal, moderate and major improvement in adults and juveniles. Additional measures of muscle strength and function are being validated to improve content validity and sensitivity to change. A health-related quality of life measure, which incorporates patient input, is being developed for adult patients with IIM. Disease state criteria, including criteria for inactive disease and remission, are being used as secondary end points in clinical trials. MRI of muscle and immunological biomarkers are promising approaches to discriminate between disease activity and damage and might provide much-needed objective outcome measures. These advances in the assessment of outcomes for myositis treatment, along with collaborations between international networks, should facilitate further development of new therapies for patients with IIM.
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Affiliation(s)
- Lisa G. Rider
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD
| | - Rohit Aggarwal
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA
| | - Pedro M. Machado
- Centre for Rheumatology & MRC Centre for Neuromuscular Diseases, University College London, London, UK
| | | | - Ann M. Reed
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Lisa Christopher-Stine
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nicolino Ruperto
- Istituto Giannina Gaslini, Clinica Pediatria e Reumatologia, PRINTO, Genoa, Italy
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14
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Abstract
Necrotizing autoimmune myopathy (NAM) is a relatively newly recognized subgroup of idiopathic inflammatory myopathies. The common histopathologic features are myocyte necrosis without significant inflammation. Necrotizing autoimmune myopathy can be associated with connective tissue disorders but can also be triggered by viral infections such as human immunodeficiency virus or malignancy, be statin-induced NAM, or be idiopathic. Here, the authors present the case of a 58-year-old man who was referred to our PET unit for a suspected paraneoplastic syndrome in a context of NAM. Complementary contrast-enhanced CT and 3-dimensional T1-weighted MRI were carried out subsequently in order to resolve the PET/CT abnormalities.
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