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Tan JY, Tan CY, Yahya MA, Shahrizaila N, Goh KJ. Evaluating disease status in idiopathic inflammatory myopathies with quantitative muscle ultrasound. Muscle Nerve 2024; 69:597-603. [PMID: 38488306 DOI: 10.1002/mus.28081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/22/2024] [Accepted: 03/02/2024] [Indexed: 04/07/2024]
Abstract
INTRODUCTION/AIMS Muscle strength, functional status, and muscle enzymes are conventionally used to evaluate disease status in idiopathic inflammatory myopathies (IIM). This study aims to investigate the role of quantitative muscle ultrasound in evaluating disease status in IIM patients. METHODS Patients with IIM, excluding inclusion body myositis, were recruited along with age- and sex-matched healthy controls (HC). All participants underwent muscle ultrasound and clinical assessments. Six limb muscles were unilaterally scanned using a standardized protocol, measuring muscle thickness (MT) and echo intensity (EI). Results were compared with HC, and correlations were made with outcome measures. RESULTS Twenty IIM patients and 24 HC were recruited. The subtypes of IIM were dermatomyositis (6), necrotizing myositis (6), polymyositis (3), antisynthetase syndrome (3), and nonspecific myositis (2). Mean disease duration was 8.7 ± 6.9 years. There were no significant differences in demographics and anthropometrics between patients and controls. MT of rectus femoris in IIM patients was significantly lower than HC. Muscle EI of biceps brachii and vastus medialis in IIM patients were higher than HC. There were moderate correlations between MT of rectus femoris and modified Rankin Scale, Physician Global Activity Assessment, and Health Assessment Questionnaire, as well as between EI of biceps brachii and Manual Muscle Testing-8. DISCUSSION Muscle ultrasound can detect proximal muscle atrophy and hyperechogenicity in patients with IIM. The findings correlate with clinical outcome measures, making it a potential tool for evaluating disease activity of patients with IIM in the late phase of the disease.
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Affiliation(s)
- Jie Ying Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Cheng Yin Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Azly Yahya
- Neurophysiology Laboratory, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khean Jin Goh
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Chen Y, Zhang W, Lv H, Wang Z, Hao H, Yuan Y, Zheng Y. Pathological findings with vacuoles in anti-mitochondrial antibody-positive inflammatory myopathy. BMC Musculoskelet Disord 2024; 25:257. [PMID: 38566087 PMCID: PMC10985968 DOI: 10.1186/s12891-023-06941-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 10/06/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND A few patients with inflammatory myopathy showed anti-mitochondrial antibody (AMA) positivity. This study aimed to report the clinical and pathological findings with vacuoles in 3 cases of such patients. METHODS Three cases with myositis from the Myositis Clinical Database of Peking University First Hospital were identified with AMA positivity. Their clinical records were retrospectively reviewed and the data was extracted. All the 3 cases underwent muscle biopsy. RESULTS Three middle-aged patients presented with chronic-onset weakness of proximal limbs, marked elevation of creatine kinase, and AMA-positivity. Two of the 3 cases meet the criteria of primary biliary cholangitis. All the 3 cases presented with cardiac involvement and proteinuria. Two cases developed type 2 respiratory failure. MRI of the thigh muscle showed multiple patches of edema bilaterally in both cases, mostly in the adductor magnus. Pathological findings include degeneration of muscle fibers, diffused MHC-I positivity, and complement deposits on cell membranes. Vacuoles without rims of different sizes were discovered under the membrane of the muscle fibers. A few RBFs were discovered in case 1, while a diffused proliferation of endomysium and perimysium was shown in case 2. CONCLUSIONS AMA-positive inflammatory myopathy is a disease that could affect multiple systems. Apart from inflammatory changes, the pathological findings of muscle can also present vacuoles.
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Affiliation(s)
- Yuanchong Chen
- Department of Neurology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
- Department of Radiology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - He Lv
- Department of Neurology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Hongjun Hao
- Department of Neurology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yiming Zheng
- Department of Neurology, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
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Marth AA, Hosse C, Yamamura J, Went S, Al Shinibr R, Gebert P, Kolck J, Keresztyen O, Krusche M, Keller S, Can E. The value of non-enhanced MRI in the evaluation of patients with suspected idiopathic inflammatory myopathy. Muscle Nerve 2024; 69:334-339. [PMID: 38197490 DOI: 10.1002/mus.28036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION/AIMS The performance of magnetic resonance imaging (MRI) for diagnosing suspected idiopathic inflammatory myopathy (IIM) remains controversial. Furthermore, the role of contrast-enhanced magnetic resonance imaging (CE-MRI) sequences is unclear. The aim of this study was to evaluate the sensitivity and specificity of a non-enhanced magnetic resonance imaging (NE-MRI) protocol compared to a CE-MRI protocol in adult patients with confirmed IIM. METHODS This study retrospectively enrolled patients with suspected IIM who underwent MRI of the upper thigh between 2008 and 2020. The protocol consisted of a T1-weighted (T1w) sequence, a turbo inversion recovery magnitude (TIRM) sequence and a contrast-enhanced T1-weighted sequence (CE-T1w). After randomly stratifying patients into a group with only the T1w and TIRM sequences available and another group with additional availability of CE-T1w, three blinded readers assessed the presence of IIM based on characteristic imaging features. Confirmation of the diagnosis was determined based on the 2017 ACR/EULAR criteria. RESULTS Of the 80 patients (mean age 49.0 ± 21.1 years; 42 female, 38 male) included, 54 (67.5%) had a positive diagnosis of IIM. Cumulated sensitivity and specificity for MRI to detect IIM was 87.1% and 83.3% in the NE-MRI group versus 87.0% and 63.0% in the CE-MRI group. The group differences for sensitivity and specificity were non-significant for each of the three readers, respectively (p ≥ .081). DISCUSSION NE-MRI detects suspected IIM with high diagnostic accuracy and performs equivalently to CE-MRI. Therefore, it may be appropriate to omit the use of contrast agents in MRI scans performed for suspected IIM.
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Affiliation(s)
| | - Clarissa Hosse
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jin Yamamura
- Department of Radiology, Universitätsklinikum Eppendorf, Hamburg, Germany
| | - Simone Went
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Raid Al Shinibr
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Pimrapat Gebert
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Kolck
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Keresztyen
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Krusche
- Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sarah Keller
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Elif Can
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Paramalingam S, Needham M, Bulsara M, Mastaglia FL, Keen HI. The longitudinal study of muscle changes with ultrasound: differential changes in idiopathic inflammatory myopathy subgroups. Rheumatology (Oxford) 2024; 63:490-497. [PMID: 37225404 DOI: 10.1093/rheumatology/kead239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/21/2023] [Accepted: 05/13/2023] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVES We investigated shear wave elastography (SWE), B mode US and power Doppler (PDUS) as imaging biomarkers for longitudinal follow-up in idiopathic inflammatory myopathy (IIM), with a particular focus on immune-mediated necrotizing myopathy (IMNM) and DM. METHODS Participants had serial SWE, PDUS on the deltoid (D) and vastus lateralis (VL) muscles on four occasions at intervals of 3-6 months. Clinical assessments included manual muscle testing, and patient- and physician-reported outcome scales. RESULTS Thirty-three participants were included: IMNM = 17, DM = 12, overlap myositis = 3, PM = 1. Twenty were in a prevalent clinic group, and 13 were recently treated cases in an incident group. Differential changes in SWS and US domains occurred with time in both the prevalent and incident groups. In the VL-prevalent subgroup, echogenicity increased over time (P = 0.040), while in the incident cases there was a trend for reduction to normal over time (P = 0.097) with treatment. Muscle bulk reduced in the D-prevalent subgroup over time (P = 0.096), suggesting atrophy. SWS also reduced in the VL-incident subgroup over time (P = 0.096), suggesting a trend towards improvement in muscle stiffness with treatment. CONCLUSION SWE and US appear promising as imaging biomarkers for patient follow-up in IIM and indicate changes over time, especially with echogenicity, muscle bulk and SWS in the VL. Due to the limitations of the participant numbers, additional studies with a larger cohort are needed to help evaluate these US domains further and outline specific characteristics within the IIM subgroups.
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Affiliation(s)
- Shereen Paramalingam
- University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Department of Rheumatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Merrilee Needham
- University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
- Department of Neurology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Frank L Mastaglia
- Perron Institute for Neurological and Translational Science, University of Western Australia, Australia
| | - Helen I Keen
- Department of Rheumatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- School of Medicine, University of Western Australia, Australia
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Gil-Vila A, Burcet-Rodriguez G, Trallero-Araguás E, Cuellar-Calabria H, Selva-O'Callaghan A. Subclinical myocardial involvement in a cohort of patients with antisynthetase syndrome. Clin Exp Rheumatol 2024; 42:309-315. [PMID: 38488096 DOI: 10.55563/clinexprheumatol/tgcrtf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 02/21/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES There is an increasing interest in knowing whether patients with antisynthetase syndrome (ASSD) may have silent myocardial interstitial involvement. Mapping techniques in cardiac magnetic resonance (CMR) can detect subclinical myocardial involvement. The purpose of this study was to identify alterations in multiparametric CMR in ASSD patients without overt cardiac involvement. METHODS Patients diagnosed with ASSD underwent a CMR along with the standard clinical workup, investigation of specific and associated myositis antibodies, and high-resolution chest CT. The CMR protocol includes routine morphologic, functional, and late gadolinium enhancement sequences in standard cardiac planes, as well as native T1 and T2 mapping sequences and extracellular volume (ECV) calculation. RESULTS Twenty-five patients were included in this study (56% women; median age 56.3 years). Three patients were considered in the acute phase at the time of inclusion. Eight patients (32%) showed pathological findings in CMR (6 stable disease, 2 acute phase). Elevated T1, T2 and ECV mapping values were found in 20% (5/25), 17% (4/25) and 24% (6/25) of the group, respectively. Two patients in the acute phase had increased values of both T2 and ECV. CONCLUSIONS Subclinical myocardial involvement in ASSD is not rare (32%) although its clinical significance is uncertain. Myocardial oedema (T2) was the most frequent finding, followed by increased T1 and/or ECV values likely signalling interstitial fibrosis. Of note, patients in the acute phase showed elevated T2 values.
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Affiliation(s)
- Albert Gil-Vila
- Systemic Autoimmune Diseases Unit, Vall d'Hebron General Hospital, Barcelona, and Department of Medicine, Universitat Autònoma de Barcelona, Spain.
| | - Gemma Burcet-Rodriguez
- Cardiovascular Imaging Area, Diagnostic Imaging Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Hug Cuellar-Calabria
- Department of Medicine, Universitat Autònoma de Barcelona; and Cardiovascular Imaging Area, Diagnostic Imaging Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Albert Selva-O'Callaghan
- Systemic Autoimmune Diseases Unit, Vall d'Hebron General Hospital, Barcelona, and Department of Medicine, Universitat Autònoma de Barcelona, Spain
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Fujita Y, Mori H, Kuwashima S, Suzuki S, Yoshihara S. Bilateral idiopathic orbital myositis: A pediatric case. Int J Rheum Dis 2024; 27:e15012. [PMID: 38140845 DOI: 10.1111/1756-185x.15012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/01/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Yuji Fujita
- Department of Paediatrics, Dokkyo Medical University, Tochigi, Japan
| | - Haruki Mori
- Department of Ophthalmology, Dokkyo Medical University, Tochigi, Japan
| | | | - Shigenari Suzuki
- Department of Ophthalmology, Dokkyo Medical University, Tochigi, Japan
| | - Shigemi Yoshihara
- Department of Paediatrics, Dokkyo Medical University, Tochigi, Japan
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7
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Liang F, Li G, Guo J, Zhang W, Chang X. Assessing PET/CT's diagnostic accuracy in idiopathic myopathies. Hell J Nucl Med 2024; 27:46-54. [PMID: 38678384 DOI: 10.1967/s002449912711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/17/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE Recent studies have utilized fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) specifically to diagnose cases of idiopathic inflammatory myopathies (IIM), excluding inclusion body myositis (IBM). Conversely, carbon-11 (11C) labeled Pittsburgh compound B (PIB)-PET imaging is exclusively used for the detection of IBM. This research is designed to evaluate the diagnostic accuracy of PET/CT in identifying IIM by employing rigorous diagnostic accuracy testing methodologies. MATERIALS AND METHODS A systematic review and meta-analysis were conducted across multiple databases including PubMed, and Embase. We focused on the diagnostic utility of PET/CT in IIM, assessing sensitivities, specificities, and deriving likelihood ratios (LR+ and LR-). The study was registered with PROSPERO (CRD42022343222). RESULTS This systematic review identified 635 citations, of which 10 eligible trials were included, with a total of 419 participants. The results indicated a sensitivity of 0.86 (0.81-0.90), and a specificity of 0.93 (0.88-0.96). The synthesis of LR revealed the LR+ of 10.35 (6.31-16.98), and LR-of 0.15 (0.07-0.32). The summary receiver operating characteristic curve (SROC) showed an area under the curve (AUC) of 0.9658. Regarding IBM, the sensitivity was 0.84 (0.60-0.97), and the specificity was 1 (0.69-1). The synthesis of LR showed the LR+ of 9.61 (1.46-63.15) and an LR- of 0.21 (0.09-0.51). For disease activity, the sensitivity was 0.96 (0.92-0.99), and the specificity was 0.91 (0.084-0.96). The synthesis of LR showed an LR+ of 9.43 (5.39-16.51) and an LR- of 0.05 (0.02-0.11). CONCLUSION Positron emission tomography/CT has great potential for accurately diagnosing and monitoring patients with IIM, and may have implications for their clinical management.
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Affiliation(s)
- Feng Liang
- Department of Neurology, The first Hospital of Shanxi Medical University, Taiyuan, People's Republic of China.
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Biso GM, Mangla R, Eldokla AM. Orbital Myositis as an Initial Presentation of Lyme Disease. Neurology 2023; 101:914-915. [PMID: 37648535 PMCID: PMC10662990 DOI: 10.1212/wnl.0000000000207742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/20/2023] [Indexed: 09/01/2023] Open
Affiliation(s)
- Grace M Biso
- From the Department of Neurology (G.M.B., A.M.E.), Department of Radiology (R.M.), and Department of Pathology (A.M.E.), State University of New York, Upstate Medical University, Syracuse
| | - Rajiv Mangla
- From the Department of Neurology (G.M.B., A.M.E.), Department of Radiology (R.M.), and Department of Pathology (A.M.E.), State University of New York, Upstate Medical University, Syracuse
| | - Ahmed M Eldokla
- From the Department of Neurology (G.M.B., A.M.E.), Department of Radiology (R.M.), and Department of Pathology (A.M.E.), State University of New York, Upstate Medical University, Syracuse.
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Yeo J, Yoon SH, Kim JY, Lee JS, Lee EY, Goo JM, Pourzand L, Goldin JG, Kim GJ, Ha Y. Quantitative interstitial lung disease scores in idiopathic inflammatory myopathies: longitudinal changes and clinical implications. Rheumatology (Oxford) 2023; 62:3690-3699. [PMID: 36929924 PMCID: PMC10629794 DOI: 10.1093/rheumatology/kead122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 02/01/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES To investigate computer-aided quantitative scores from high-resolution CT (HRCT) images and determine their longitudinal changes and clinical significance in patients with idiopathic inflammatory myopathies (IIMs)-related interstitial lung disease (IIMs-ILD). METHODS The clinical data and HRCT images of 80 patients with IIMs who underwent serial HRCT scans at least twice were retrospectively analysed. Quantitative ILD (QILD) scores (%) were calculated as the sum of the extent of lung fibrosis, ground-glass opacity, and honeycombing. The individual time-estimated ΔQILD between two consecutive scans was derived using a linear approximation of yearly changes. RESULTS The baseline median QILD (interquartile range) scores in the whole lung were 28.1% (19.1-43.8). The QILD was significantly correlated with forced vital capacity (r = -0.349, P = 0.002) and diffusing capacity for carbon monoxide (r = -0.381, P = 0.001). For ΔQILD between the first two scans, according to the visual ILD subtype, QILD aggravation was more frequent in patients with usual interstitial pneumonia (UIP) than non-UIP (80.0% vs 44.4%, P = 0.013). Multivariable logistic regression analyses identified UIP was significantly related to radiographic ILD progression (ΔQILD >2%, P = 0.015). Patients with higher baseline QILD scores (>28.1%) had a higher risk of lung transplantation or death (P = 0.015). In the analysis of three serial HRCT scans (n = 41), dynamic ΔQILD with four distinct patterns (improving, worsening, convex and concave) was observed. CONCLUSION QILD changes in IIMs-ILD were dynamic, and baseline UIP patterns seemed to be related to a longitudinal progression in QILD. These may be potential imaging biomarkers for lung function, changes in ILD severity and prognosis in IIMs-ILD.
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Affiliation(s)
- Jina Yeo
- Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ju Yeon Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong Seok Lee
- Clinic Pappalardo Center, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
- GENOME INSIGHT Inc, Daejeon, Republic of Korea
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Lila Pourzand
- Department of Radiological Sciences, David-Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jonathan G Goldin
- Department of Radiological Sciences, David-Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Grace‐Hyun J Kim
- Department of Radiological Sciences, David-Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - You‐Jung Ha
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi‐Do, Republic of Korea
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Tan AL, Di Matteo A, Wakefield RJ, Biglands J. Update on muscle imaging in myositis. Curr Opin Rheumatol 2023; 35:395-403. [PMID: 37656661 PMCID: PMC10552815 DOI: 10.1097/bor.0000000000000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
PURPOSE OF REVIEW Imaging techniques such as MRI, ultrasound and PET/computed tomography (CT) have roles in the detection, diagnosis and management of myositis or idiopathic inflammatory myopathy (IIM). Imaging research has also provided valuable knowledge in the understanding of the pathology of IIM. This review explores the latest advancements of these imaging modalities in IIM. RECENT FINDINGS Recent advancements in imaging of IIM have seen a shift away from manual and qualitative analysis of the images. Quantitative MRI provides more objective, and potentially more sensitive characterization of fat infiltration and inflammation in muscles. In addition to B-mode ultrasound changes, shearwave elastography offers a new dimension to investigating IIM. PET/CT has the added advantage of including IIM-associated findings such as malignancies. SUMMARY It is evident that MRI, ultrasound and PET/CT have important roles in myositis. Continued technological advancement and a quest for more sophisticated applications help drive innovation; this has especially been so of machine learning/deep learning using artificial intelligence and the developing promise of texture analysis.
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Affiliation(s)
- Ai Lyn Tan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital
| | - Andrea Di Matteo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital
| | - Richard J. Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital
| | - John Biglands
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital
- Department of Medical Physics & Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Machado LSG, Oliveira ACD, Mancuso FJN, Sato EI. First study demonstrating speckle tracking echocardiography has prognostic value in patients with idiopathic inflammatory myopathies. Int J Cardiovasc Imaging 2023; 39:2163-2171. [PMID: 37592086 DOI: 10.1007/s10554-023-02925-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 07/31/2023] [Indexed: 08/19/2023]
Abstract
To measure left ventricular (LV) global longitudinal strain (GLS) using speckle tracking echocardiography in idiopathic inflammatory myopathy (IIM) patients and to determine whether the LV GLS predicts outcomes in those patients. Prospective study consisted of a cross-sectional phase with 61 IIM patients and 32 individuals without IIM and longitudinal phase, in which patients were divided into two subgroups: 26 with reduced LV GLS and 35 with normal LV GLS; patients were followed for a mean of 25 months, and the occurrence of cardiovascular events and criteria for IIM activity were compared. The mean LV GLS (18.5 ± 2.9% vs. 21.6 ± 2.5%; p < 0.001) and right ventricle free wall strain (21.9 ± 6.1% vs. 27.5 ± 4.7%; p < 0.001) were lower in patients than in controls. The mean N-terminal pro B-type natriuretic peptide level was higher in patients than in controls. There were no differences regarding other cardiac involvement. Anti-Jo1 antibody was associated with general electrocardiographic abnormality and LV diastolic dysfunction. The subgroup with reduced GLS progressed with higher mean creatine phosphokinase, myositis disease activity assessment visual analogue scales, the physician's and patient's visual analogue scales, the health assessment questionnaire, and a higher proportion of relapses than the subgroup with normal GLS. There was no difference between the subgroups regarding cardiovascular events. The LV GLS appears to be useful for evaluating patients with IIM. Abnormal values are associated with more frequent relapses and increased disease activity during follow-up.
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Affiliation(s)
- Luiz S G Machado
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, São Paulo, CEP 04023 900, Brazil
| | - Ana C D Oliveira
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, São Paulo, CEP 04023 900, Brazil
| | - Frederico J N Mancuso
- Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Emilia I Sato
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, São Paulo, CEP 04023 900, Brazil.
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Shah M, Shinjo SK, Day J, Gupta L. Cardiovascular manifestations in idiopathic inflammatory myopathies. Clin Rheumatol 2023; 42:2557-2575. [PMID: 37148365 PMCID: PMC10497702 DOI: 10.1007/s10067-023-06599-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/04/2023] [Accepted: 04/09/2023] [Indexed: 05/08/2023]
Abstract
Cardiovascular involvement in idiopathic inflammatory myopathies (IIM) is an understudied area which is gaining increasing recognition in recent times. Recent advances in imaging modalities and biomarkers have allowed the detection of subclinical cardiovascular manifestations in IIM. However, despite the availability of these tools, the diagnostic challenges and underestimated prevalence of cardiovascular involvement in these patients remain significant. Notably, cardiovascular involvement remains one of the leading causes of mortality in patients with IIM. In this narrative literature review, we outline the prevalence and characteristics of cardiovascular involvement in IIM. Additionally, we explore investigational modalities for early detection of cardiovascular involvement, as well as newer approaches in screening to facilitate timely management. Key points • Cardiac involvement in IIM in majority cases is subclinical and a major cause of mortality. • Cardiac magnetic resonance imaging is sensitive for detection of subclinical cardiac involvement.
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Affiliation(s)
- Meera Shah
- Department of Rheumatology, Indraprastha Apollo Hospital, New Delhi, Delhi, 110076, India
| | - Samuel Katsuyuki Shinjo
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jessica Day
- Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, WV10 0QP, UK.
- Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK.
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Mecoli CA, Chee B, Chen M, Wang X, Albayda J, Paik JJ, Tiniakou E, Adler B, Kelly W, Mammen AL, Platz EA, Casciola-Rosen L, Christopher-Stine L, Shah AA. Diagnostic Yield of Computed Tomography for Cancer Detection in a Tertiary Referral Population of Idiopathic Inflammatory Myositis Patients. Arthritis Care Res (Hoboken) 2023; 75:2142-2150. [PMID: 36913182 PMCID: PMC10497706 DOI: 10.1002/acr.25114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/21/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To inform guidance for cancer detection in patients with idiopathic inflammatory myopathy (IIM), we evaluated the diagnostic yield of computed tomography (CT) imaging for cancer screening/surveillance within distinct IIM subtypes and myositis-specific autoantibody strata. METHODS We conducted a single-center, retrospective cohort study in IIM patients. Overall diagnostic yield (number of cancers diagnosed/number of tests performed), percentage of false positives (number of biopsies performed not leading to cancer diagnosis/number of tests performed), and test characteristics were determined on CT of the chest and abdomen/pelvis. RESULTS Within the first 3 years since IIM symptom onset, a total of 9 of 1,011 (0.9%) chest CT scans and 12 of 657 (1.8%) abdomen/pelvis CT scans detected cancer. Diagnostic yields for both CT of the chest and CT of the abdomen/pelvis were highest in dermatomyositis, specifically anti-transcription intermediary factor 1γ (2.9% and 2.4% for CT of the chest and abdomen/pelvis, respectively). The highest percentage of false positives was in patients with antisynthetase syndrome (ASyS) (4.4%) and immune-mediated necrotizing myopathy (4.4%) on CT of the chest, and ASyS (3.8%) on CT of the abdomen/pelvis. Patients ages <40 years old at IIM onset had both low diagnostic yields (0% and 0.5%) and high false-positive rates (1.9% and 4.4%) for CT of the chest and abdomen/pelvis, respectively. CONCLUSION In a tertiary referral cohort of IIM patients, CT imaging has a wide range of diagnostic yield and frequency of false positives for contemporaneous cancer. These findings suggest that cancer detection strategies targeted according to IIM subtype, autoantibody positivity, and age may maximize cancer detection while minimizing the harms and costs of over-screening.
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Affiliation(s)
| | - Brant Chee
- Johns Hopkins University School of Medicine, Baltimore, Maryland, and Johns Hopkins University Applied Physics Laboratory, Laurel, Maryland
| | - Mengkun Chen
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - XingYao Wang
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jemima Albayda
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julie J Paik
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eleni Tiniakou
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brittany Adler
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Will Kelly
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew L Mammen
- Johns Hopkins University School of Medicine, Baltimore, Maryland, and the NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland
| | - Elizabeth A Platz
- Johns Hopkins Bloomberg School of Public Health and Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland
| | | | | | - Ami A Shah
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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14
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Ono S, Nakamura M, Morise S, Kunieda T, Yakushiji Y. [A case of atezolizumab- and bevacizumab-induced myositis showing high intensity in the pterygoid muscles, soft palate, and tongue on STIR-MRI]. Rinsho Shinkeigaku 2023; 63:582-587. [PMID: 37648475 DOI: 10.5692/clinicalneurol.cn-001876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
A 61-year-old woman was treated with atezolizumab plus bevacizumab for hepatocellular carcinoma with peritoneal dissemination. Blood tests revealed elevated creatine kinase (CK) that peaked at 2,657 U/l. After two cycles of atezolizumab plus bevacizumab combination therapy, she complained of progressive dysarthria and dysphagia. Needle electromyography showed myopathic changes. Initial MRI showed high signal intensity in the orbicularis oris muscle, soft palate, tongue, pterygoid muscles, and paravertebral muscles on STIR images. Myositis-specific autoantibodies were not detected. Based on these findings, the patient was diagnosed with immune checkpoint inhibitor-associated myositis. The clinical symptoms improved after administration of oral prednisone, and follow-up MRI showed reduced extent of areas of high signal intensity and almost complete resolution of signal abnormality in the paravertebral muscles. The CK level normalized after 1 months of oral steroid administration. MRI of the head and neck, including the tongue and soft palate, may be useful in diagnosis and for evaluating therapeutic efficiency in cases of bulbar symptoms that occur following the introduction of immune checkpoint inhibitors.
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Affiliation(s)
- Shohei Ono
- Department of Neurology, Kansai Medical University
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15
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Nomiya H, Hamano T, Takaku N, Sasaki H, Usui K, Sanada S, Yamaguchi T, Kitazaki Y, Endo Y, Kamisawa T, Enomoto S, Shirafuji N, Matsunaga A, Ueno A, Ikawa M, Yamamura O, Hasegawa M, Kimura H, Nishino I, Nakamoto Y. Magnetic resonance imaging findings of the lower limb muscles in anti-mitochondrial M2 antibody-positive myositis. Neuromuscul Disord 2023; 33:74-80. [PMID: 37652755 DOI: 10.1016/j.nmd.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/19/2023] [Accepted: 07/21/2023] [Indexed: 09/02/2023]
Abstract
Anti-mitochondrial M2 antibody (AMA-M2)-positive myositis is an idiopathic inflammatory myopathy (IIM). Of all patients with myositis, 2.5-19.5% have AMA-M2 antibodies. However, the detailed distribution of muscles affected in AMA-positive myositis is unknown. Therefore, we examined lower muscle magnetic resonance imaging (MRI) findings of patients with AMA-positive myositis. Among the 63 patients with IIM at our institute, 5 (7.9%) were positive for AMA-M2 antibodies. However, one was also positive for anti-Jo1 antibodies; therefore, four patients were finally participated in this study. All patients had high-intensity MRI signals in the proximal muscles, including the gluteus maximus and iliopsoas muscles, and in the thigh muscles, including the vastus lateralis, vastus medialis, adductor magnus, and semimembranosus muscles. Lower leg muscles were relatively spared. Fascial edema was observed in all patients and was also present in the lower leg muscles. Subcutaneous edema was observed, particularly in the proximal portion of the lower limbs. In AMA-positive myositis, proximal muscles, including the gluteus maximus, vastus lateralis, adductor magnus, and the semimembranosus, were markedly affected, while the lower leg muscles were relatively preserved. Additionally, fascial edema was evident even in lower leg muscles. Therefore, muscle MRI can be a useful diagnostic aid for AMA-positive myositis.
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Affiliation(s)
- Hirotaka Nomiya
- Clinical Training Center, University of Fukui Hospital, Fukui, Japan; Department of Cell Biology and Biochemistry, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan; Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Tadanori Hamano
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan; Department of Aging and Dementia, Faculty of Medical Sciences, University of Fukui, Japan; Life Science Innovation Center, University of Fukui, Fukui, Japan.
| | - Naoko Takaku
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Hirohito Sasaki
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Kojiro Usui
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Sayaka Sanada
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Tomohisa Yamaguchi
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Yuki Kitazaki
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Yoshinori Endo
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Tomoko Kamisawa
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Soichi Enomoto
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Norimichi Shirafuji
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Akiko Matsunaga
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Asako Ueno
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Masamichi Ikawa
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Osamu Yamamura
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Minoru Hasegawa
- Department of Dermatology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yasunari Nakamoto
- Second Department of Internal Medicine, Faculty of Medical Science, University of Fukui, Fukui, Japan
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16
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Kim S, Eun MY, Seok HY. Myasthenia gravis-myositis association: is it an overlap myositis or a distinct entity? Neurol Sci 2023; 44:3345-3346. [PMID: 37178215 DOI: 10.1007/s10072-023-06846-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Sohyeon Kim
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea
| | - Mi-Yeon Eun
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Hung Youl Seok
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea.
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17
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Shah V, Young L, Husain H, Kazmi T, Bankole A. A case of immune mediated necrotizing myositis. Am J Med Sci 2023; 366:e42-e43. [PMID: 37094630 DOI: 10.1016/j.amjms.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/27/2023] [Accepted: 04/12/2023] [Indexed: 04/26/2023]
Affiliation(s)
- Viraj Shah
- Virginia Tech Carilion Clinic, Rheumatology Fellowship Program, Roanoke, VA, USA.
| | - Lena Young
- University of Virginia, Neuropathology Fellowship Program, VA, USA
| | - Hyder Husain
- Virginia Tech Carilion Clinic, Rheumatology Fellowship Program, Roanoke, VA, USA
| | - Taskeen Kazmi
- Virginia Tech Carilion Clinic, Rheumatology Fellowship Program, Roanoke, VA, USA
| | - Adegbenga Bankole
- Virginia Tech Carilion Clinic, Rheumatology Fellowship Program, Roanoke, VA, USA
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18
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Erfani S, Vahedi M, Mohammadzadeh H, Malek A, Aghaee A. Generalized ossificant myositis with intensive diffuse muscle uptake in whole body bone scan of a 13-year-old boy. Rev Esp Med Nucl Imagen Mol 2023; 42:341-342. [PMID: 37172932 DOI: 10.1016/j.remnie.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Soheila Erfani
- Nuclear medicine research center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdieh Vahedi
- Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran; Clinical Research Development Unit of Akbar Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadis Mohammadzadeh
- Nuclear medicine research center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abdolreza Malek
- Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran; Clinical Research Development Unit of Akbar Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Atena Aghaee
- Nuclear medicine research center, Mashhad University of Medical Sciences, Mashhad, Iran.
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19
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Wang F, Fang S, Li J, Yuan L, Hou B, Zhu J, Jiao Y, Liu Z, Qian M, Santini F, Wang Q, Chen L, Feng F. Correlation analysis of quantitative MRI measurements of thigh muscles with histopathology in patients with idiopathic inflammatory myopathy. Eur Radiol Exp 2023; 7:51. [PMID: 37589922 PMCID: PMC10435435 DOI: 10.1186/s41747-023-00350-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 04/29/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES To validate the correlation between histopathological findings and quantitative magnetic resonance imaging (qMRI) fat fraction (FF) and water T2 mapping in patients with idiopathic inflammatory myopathy (IIM). METHODS The study included 13 patients with histopathologically confirmed IIM who underwent dedicated thigh qMRI scanning within 1 month before open muscle biopsy. For the biopsied muscles, FF derived from the iterative decomposition of water and fat with echo asymmetry and least-squares estimation quantitation (IDEAL-IQ) and T2 time from T2 mapping with chemical shift selective fat saturation were measured using a machine learning software. Individual histochemical and immunohistochemical slides were evaluated using a 5-point Likert score. Inter-reader agreement and the correlation between qMRI markers and histopathological scores were analyzed. RESULTS Readers showed good to perfect agreement in qMRI measurements and most histopathological scores. FF of the biopsied muscles was positively correlated with the amount of fat in histopathological slides (p = 0.031). Prolonged T2 time was associated with the degree of variation in myofiber size, inflammatory cell infiltration, and amount of connective tissues (p ≤ 0.008 for all). CONCLUSIONS Using the machine learning-based muscle segmentation method, a positive correlation was confirmed between qMRI biomarkers and histopathological findings of patients with IIM. This finding provides a basis for using qMRI as a non-invasive tool in the diagnostic workflow of IIM. RELEVANCE STATEMENT By using ML-based muscle segmentation, a correlation between qMRI biomarkers and histopathology was found in patients with IIM: qMRI is a potential non-invasive tool in this clinical setting. KEY POINTS • Quantitative magnetic resonance imaging measurements using machine learning-based muscle segmentation have good consistency and reproductivity. • Fat fraction of idiopathic inflammatory myopathy (IIM) correlated with the amount of fat at histopathology. • Prolonged T2 time was associated with muscle inflammation in IIM.
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Affiliation(s)
- Fengdan Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Shiyuan Fang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ling Yuan
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthineers Ltd., Beijing, China
| | - Yang Jiao
- Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Qian
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Francesco Santini
- Department of Research and Analytic Services, University Hospital Basel, Basel, Switzerland.
- Radiological Physics, University Hospital Basel, Basel, Switzerland.
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.
| | - Qian Wang
- Department of Rheumatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Chen
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Gupta H, Bhavsar SV, Lu JQ. Unusual features of myositis with amyloid myopathy. Neurol Sci 2023; 44:1457-1459. [PMID: 36480118 DOI: 10.1007/s10072-022-06538-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Himanshu Gupta
- Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Jian-Qiang Lu
- Neuropathology Section, Department of Pathology and Molecular Medicine, Hamilton General Hospital, McMaster University, 237 Barton Street, Hamilton, Ontario, L8L 2X2, Canada.
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21
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Wang F, Zhou S, Hou B, Santini F, Yuan L, Guo Y, Zhu J, Hilbert T, Kober T, Zhang Y, Wang Q, Zhao Y, Jin Z. Assessment of idiopathic inflammatory myopathy using a deep learning method for muscle T2 mapping segmentation. Eur Radiol 2023; 33:2350-2357. [PMID: 36396791 PMCID: PMC9672653 DOI: 10.1007/s00330-022-09254-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/19/2022] [Accepted: 10/09/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the utility of an automatic deep learning (DL) method for segmentation of T2 maps in patients with idiopathic inflammatory myopathy (IIM) against healthy controls, and also the association of quantitative T2 values in patients with laboratory and pulmonary findings. METHODS Structural MRI and T2 mapping of bilateral thigh muscles from patients with IIM and healthy volunteers were segmented using dedicated software based on a pre-trained convolutional neural network. Incremental and federated learning were implemented for continuous adaptation and improvement. Muscle T2 values derived from DL segmentation were compared between patients and healthy controls, and T2 values of patients were further analyzed with serum muscle enzymes, and interstitial lung disease (ILD) which was diagnosed and graded based on chest HRCT. RESULTS Overall, 64 patients (27 patients with dermatomyositis, 29 with polymyositis, and 8 with antisynthetase syndrome (ASS)) and 10 healthy controls were included. By using DL-based muscle segmentation, T2 values generated from T2 maps accurately differentiated patients from those of controls (p < 0.001) with a cutoff value of 36.4 ms (sensitivity 96.9%, and specificity 100%). In patients with IIM, muscle T2 values positively correlated with all the serum muscle enzymes (all p < 0.05). ILD score of patients with ASS was markedly higher than that of those without ASS (p = 0.011), while dissociation between the severity of muscular involvement and ILD was observed (p = 0.080). CONCLUSION Automatic DL could be used to segment thigh muscles and help quantitatively assess muscular inflammation of IIM through T2 mapping. KEY POINTS • Muscle T2 mapping automatically segmented by deep learning can differentiate IIM from healthy controls. • T2 value, an indicator of active muscle inflammation, positively correlates with serum muscle enzymes. • T2 mapping can detect muscle disease in patients with normal muscle enzyme levels.
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Affiliation(s)
- Fengdan Wang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shuang Zhou
- Department of Rheumatology and Clinical Immunology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Bo Hou
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Francesco Santini
- Department of Research & Analytic Services, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland.
- Radiological Physics, University Hospital Basel, Basel, Switzerland.
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.
| | - Ling Yuan
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ye Guo
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthcare Ltd., Beijing, China
| | - Tom Hilbert
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Yan Zhang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qian Wang
- Department of Rheumatology and Clinical Immunology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yan Zhao
- Department of Rheumatology and Clinical Immunology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
- Department of Radiology, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China.
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22
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Wang R, Zhao Y, Qi F, Wu X, Wang Y, Xu Y, Wu Y, Zhang N, Hou H, Sun W, Li X, Wei W. Analysis of the clinical features of antisynthetase syndrome: a retrospective cohort study in China. Clin Rheumatol 2023; 42:703-709. [PMID: 36308573 DOI: 10.1007/s10067-022-06404-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 09/21/2022] [Accepted: 10/04/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To summarize the clinical, serological, and radiological characteristics of anti-synthetase syndrome (ASS) patients with different anti-aminoacyl-tRNA synthase antibody. METHODS Retrospective analysis was performed based on the clinical data of 88 patients diagnosed with ASS in Tianjin Medical University General Hospital from January 2015 to December 2020. The clinical data included general conditions, serological indexes, high-resolution CT (HRCT) characteristics, and pulmonary function manifestations. RESULTS Among the 88 patients, there were 17 males and 71 females. The anti-synthetase antibodies included anti-Jo-1 (n = 42), anti-PL-7 (n = 14), anti-PL-12 (n = 9), anti-EJ (n = 20), and anti-OJ (n = 3) antibodies. The most common clinical manifestations of ASS patients were interstitial lung disease (ILD) (90%, 79/88), followed by myositis (79.5%, 70/88), arthritis (50%, 44/88), and rash (50%, 44/88). The frequency of arthritis in the anti-Jo-1 antibody-positive group was higher than that of the anti-PL-7 and anti-EJ antibody groups (P = 0.004, P = 0.002, respectively). The frequency of Gottron's sign in the anti-PL-7 antibody positive group was higher than that of the anti-Jo-1 and anti-PL-12 antibody-positive groups (P = 0.006, P = 0.04). Isolated arthritis was the most frequent initial symptoms in anti-Jo-1 antibody-positive group (47.6%, 20/42), while isolated ILD was most frequent in patients with anti-EJ antibody (50%, 10/20), and isolated myositis in patients carrying anti-OJ (66.7%, 2/3). There were only 32 cases (36.4%) with the typical clinical triad (myositis, arthritis, ILD). In our cohort, 79 patients (90%) were complicated with ILD. Meanwhile, 7 out of 79 cases were classified into rapid progressive group with 6 cases (85.7%) carrying anti-Ro-52 antibody. The probability of reticular and honeycombing shadow in HRCT of patients with anti-EJ antibody positive was higher than that of other groups (P < 0.05). CONCLUSION ILD, myositis, and arthritis were the most common clinical manifestations in patients with ASS. Different antibody-positive patients have different initial symptoms. Patients with isolated arthritis, myositis, and ILD should be vigilant of ASS. The complication of anti-Ro-52 antibody in ASS patients was associated with rapidly progressive pulmonary interstitial disease. Patients with positive anti-EJ antibodies tend to have ILD as the first symptom, and with high occurrence of ILD, the HRCT showed more serious patterns, suggesting the correlation between anti-EJ antibodies and ILD. Key Points • Analyzing specific clinical manifestations in ASS patients with different ARS antibodies can raise awareness of the disease and reduce misdiagnosis. • Anti-EJ antibodies were correlated with ILD. • Anti-Ro-52 antibodies may correlate with RP-ILD in ASS patients.
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Affiliation(s)
- Ruoming Wang
- Department of Rheumatology and Immunology, Tianjin First Central Hospital, Tianjin, 300192, People's Republic of China
| | - Yin Zhao
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, 300052, Tianjin, People's Republic of China
| | - Fumin Qi
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, 300052, Tianjin, People's Republic of China
| | - Xiuhua Wu
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, 300052, Tianjin, People's Republic of China
| | - Yingai Wang
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, 300052, Tianjin, People's Republic of China
| | - Yong Xu
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, 300052, Tianjin, People's Republic of China
| | - Yanan Wu
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, 300052, Tianjin, People's Republic of China
| | - Na Zhang
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, 300052, Tianjin, People's Republic of China
| | - Hou Hou
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, 300052, Tianjin, People's Republic of China
| | - WenWen Sun
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, 300052, Tianjin, People's Republic of China
| | - Xin Li
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, 300052, Tianjin, People's Republic of China
| | - Wei Wei
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, 300052, Tianjin, People's Republic of China.
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Zhang W, Zheng Y, Wang Y, Xiong H, Que C, Zhang X, Zhu Y, Zhao Y, Yu M, Meng L, Lv H, Zhang W, Hao H, Xiao J, Yuan Y, Wang Z. Thigh MRI in antisynthetase syndrome, and comparisons with dermatomyositis and immune-mediated necrotizing myopathy. Rheumatology (Oxford) 2022; 62:310-320. [PMID: 35512205 DOI: 10.1093/rheumatology/keac269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To evaluate MRI changes to define muscle-lesion specific patterns in patients with antisynthetase syndrome (ASS), and compare them with those in other common idiopathic inflammatory myopathy subtypes. METHODS Qualitative and semi-quantitative thigh MRI evaluations were conducted in patients with ASS, DM and immune-mediated necrotizing myopathy (IMNM). RESULTS This study included 51 patients with ASS, 56 with DM and 61 with IMNM. Thigh MRI revealed muscle oedema (62.7%), myofascial oedema (90.2%), subcutaneous-tissue oedema (60.8%) and fatty infiltration of muscles (68.6%) in patients with ASS. Compared with IMNM, ASS and DM were associated with more frequent adductor-muscle relative sparing (40.6% vs 3.6%, P<0.001, and 25.6% vs 3.6%, P<0.001) and subcutaneous-tissue oedema (60.8% vs 23.0%, P<0.001, and 57.1% vs 23.0%, P<0.001). Although ASS and DM exhibited similar oedema patterns, there were certain subtle differences between them. The ASS group was less frequently symmetric (60.6% vs 88.4%, P=0.005, and 60.6% vs 80.0%, P=0.048), but more frequently showed myofascial oedema of the tensor fasciae latae (80.4% vs 48.2%, P<0.001, and 80.4% vs 31.1%, P<0.001) than either the DM or IMNM groups. The receiver operating characteristic curve analysis showed an optimal combination of thigh MRI findings had an area under the curve with 0.893 for diagnosing ASS. CONCLUSION Thigh MRI in ASS exhibited frequent myofascial oedema. ASS oedema patterns resembled those of DM more than those of IMNM. Bilateral asymmetry, adductor-muscle relative sparing and remarkable myofascial oedema of tensor fasciae latae were the most characteristic ASS imaging findings.
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Affiliation(s)
- Wenhao Zhang
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
| | - Yiming Zheng
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
| | - Yikang Wang
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
| | | | | | | | - Ying Zhu
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Yawen Zhao
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
| | - Meng Yu
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
| | - Lingchao Meng
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
| | - He Lv
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
| | - Hongjun Hao
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
| | - Jiangxi Xiao
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital
- Beijing Key Laboratory of Neurovascular Disease Discovery
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Rus T, Gregorič Kramberger M, Brecl Jakob G, Leonardis L, Meznaric M. Life-threatening myositis after one dose of nivolumab in a patient with nonmetastatic completely resected cutaneous melanoma. Acta Neurol Belg 2022; 122:1637-1639. [PMID: 34331257 DOI: 10.1007/s13760-021-01760-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Tomaž Rus
- Department of Neurology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia
| | - Milica Gregorič Kramberger
- Department of Neurology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia
| | - Gregor Brecl Jakob
- Department of Neurology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia
| | - Lea Leonardis
- Clinical Institute of Clinical Neurophysiology, University Medical Centre Ljubljana, Zaloška cesta 7, 1000, Ljubljana, Slovenia
| | - Marija Meznaric
- Faculty of Medicine, Institute of Anatomy, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia.
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25
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Al-Khudairi N, Dulay GS, Witham F. Covid-19 associated shoulder girdle calcific myositis: a novel entity. Br J Radiol 2022; 95:20220411. [PMID: 35867893 PMCID: PMC10996957 DOI: 10.1259/bjr.20220411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/28/2022] [Accepted: 07/08/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the prevalence, describe the radiological features, and consider the clinical sequelae of COVID-19- associated shoulder girdle calcific myositis. METHODS All patients who underwent a CT pulmonary angiogram study at our institution (Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom) in April and May 2020, January 2021, and July 2021 were included. A total of 1239 CT pulmonary angiogram studies for 1201 patients were reviewed. Patients with COVID-19 and associated shoulder girdle calcific myositis were identified. Their electronic patient records were reviewed. The patients' demographics, serum inflammatory markers, and proning history were recorded. RESULTS Of the 364 patients in Wave 1, 71 patients (19.5%) had COVID-19, and of those, 2 patients (2.8%) had shoulder girdle calcific myositis. Of the 521 patients in Wave 2, 354 patients (67.9%) had COVID-19, and of those, 3 patients (0.8%) had shoulder girdle calcific myositis. Of the 316 patients in Wave 3, 37 patients (11.7%) had COVID-19, and of those, 1 patient (2.7%) had shoulder girdle calcific myositis. The overall prevalence was 1.3%. The most common site of calcific myositis was within the subscapularis muscle. CONCLUSION COVID-19-associated shoulder girdle calcific myositis is a rare extrapulmonary musculoskeletal manifestation of COVID-19. Early recognition and increased awareness of this disease entity, in our experience, aids in reducing patient morbidity and improving long-term functional outcome. ADVANCES IN KNOWLEDGE We have reported a novel disease entity associated with COVID-19, in the form of shoulder girdle calcific myositis. We have described the common imaging features and discussed our experience of management and clinical sequelae.
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Affiliation(s)
- Naji Al-Khudairi
- Queen Alexandra Hospital, Portsmouth Hospitals University NHS
Trust, Portsmouth, United
Kingdom
| | - Gurdeep S Dulay
- Queen Alexandra Hospital, Portsmouth Hospitals University NHS
Trust, Portsmouth, United
Kingdom
| | - Fiona Witham
- Queen Alexandra Hospital, Portsmouth Hospitals University NHS
Trust, Portsmouth, United
Kingdom
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Abstract
ABSTRACT Sunitinib is one of the most commonly used multikinase inhibitors for metastatic renal cell carcinoma. Myositis is one of the rarest known adverse effects of sunitinib. Presenting herewith one such case with its relevant imaging findings on FDG PET/CT and ultrasound.
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Affiliation(s)
- Ritesh R Suthar
- From the Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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27
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EKŞİOĞLU AS, AKCA ÇAĞLAR A, KAYNAK ŞAHAP S, KARACAN CD, TUYGUN N. Value of strain-wave sonoelastography as an imaging modality in assessment of benign acute myositis in children. Turk J Med Sci 2021; 51:2951-2958. [PMID: 34365785 PMCID: PMC10734879 DOI: 10.3906/sag-2103-290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 12/13/2021] [Accepted: 08/07/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim Although sonoelastography is applied in assessment of many organs, studies for evaluation of muscles are very few in number and are mostly limited to adults. With this prospective study, we aimed to evaluate the value of sonoelastography in assessment of influenza related benign acute myositis in children. Materials and methods This study enrolled 25 patients with a clinical diagnosis of benign acute childhood myositis (BACM) and 25 age and sex-matched healthy controls. All patients presented to our emergency department with the complaint of inability to walk and had increased serum creatine kinase (CK) levels. All patients underwent strain elastography of the gastrocnemius muscle, and an elastography score was assigned to each patient by using a previously published 5 point-color scoring system. The findings were compared with those of the control group. Results No statistically significant difference was detected regarding age, weight, height, or body mass index (BMI) between patient and control groups. A statistically significant difference was found between the final elastography scores of the patient and control groups, mean values being 4.16 ± 0.75 versus 3.08 ±0.40, respectively (p < 0.001). Sonoelastography yielded a sensitivity of 80%, positive predictive value of 87%, specificity 88%, negative predictive value of 81.5%, and an overall accuracy of 84 %. Conclusion Sonoelastography proves to be a valuable tool for diagnosis of BACM. It is one of the available ultrasound techniques in a radiology department and may particularly evolve to become a useful routine ancillary technique for investigation and follow-up in these cases.
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Affiliation(s)
- Ayşe Seçil EKŞİOĞLU
- Division of Pediatric Radiology, Department of Radiology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara,
Turkey
| | - Ayla AKCA ÇAĞLAR
- Division of Pediatric Emergency Care, Department of Pediatrics, Dr Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, University of Health Sciences, Ankara,
Turkey
| | - Seda KAYNAK ŞAHAP
- Division of Pediatric Radiology, Department of Radiology, Pediatric Radiology, Dr Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, University of Health Sciences, Ankara,
Turkey
| | - Can Demir KARACAN
- Division of Pediatric Emergency Care, Department of Pediatrics, Dr Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, University of Health Sciences, Ankara,
Turkey
| | - Nilden TUYGUN
- Division of Pediatric Emergency Care, Department of Pediatrics, Dr Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, University of Health Sciences, Ankara,
Turkey
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28
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Kolb M, Ekert K, Schneider L, Fritz J, Ioanoviciu SD, Henes J, Horger M. The Utility of Shear-Wave Elastography in the Evaluation of Myositis. Ultrasound Med Biol 2021; 47:2176-2185. [PMID: 34030894 DOI: 10.1016/j.ultrasmedbio.2021.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 06/12/2023]
Abstract
Changes in muscle elasticity are expected in patients with untreated myositis. The purpose of this study was to define the accuracy of shear-wave elastography (SWE) in diagnosing myositis. This case control study included 21 patients (mean age, 49.4 y; 12 women) with myositis who underwent SWE, magnetic resonance imaging (MRI) and biopsy of the involved muscle group. SWE was performed accordingly in a control group (n = 24; mean age, 51.2 y; 8 women). Blood tests consisted of creatine kinase (CK) and aldolase. Two operators performed SWE in longitudinal and transverse planes of muscular fibers, quantifying the mean shear-wave velocity (SWV) and the pattern of stiffness. On MRI, short-TI inversion recovery (STIR) signal hyperintensity and T1 contrast enhancement of muscle was considered diagnostic for myositis. The patient group suffered from different types of myositis (nine patients with polymyositis, eight with dermatomyositis and four with other types of myositis). Blood tests showed significantly increased CK and aldolase values in patients with myositis (p < 0.001 and p < 0.0001). MRI showed a sensitivity of 0.95. In the patient group, the mean SWVs of longitudinal and transverse measurements were 2.8 ± 1.4 m/s and 3.1 ± 1.2 m/s, respectively. In the control group, SWVs were 2.3 ± 0.5 m/s and 2.4 ± 0.5 m/s, respectively. The difference between transverse measurements was significant (p = 0.02). Increased heterogeneity as a marker for myositis in transverse SWE showed a sensitivity of 0.8, specificity of 0.79, positive predictive value (PPV) of 0.76 and negative predictive value (NPV) of 0.82. Inter-observer difference was very low (κ = 0.92). Increased heterogeneity in both planes compared with histologic results showed a sensitivity of 0.56, specificity of 0.93, PPV of 0.91 and NPV of 0.62. Spearman correlation between CK <1000 U/L and SWE was 0.54. In conclusion, transverse orientation SWE may serve as an imaging biomarker for the diagnosis of myositis through the display of a heterogeneous pattern and increased absolute SWV values of inflamed muscles.
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Affiliation(s)
- Manuel Kolb
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany.
| | - Kaspar Ekert
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Luisa Schneider
- Department of Internal Medicine II, Eberhard-Karls-University, Tübingen, Germany
| | - Jan Fritz
- Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, Maryland, USA
| | | | - Jörg Henes
- Department of Internal Medicine II, Eberhard-Karls-University, Tübingen, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
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29
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Egashira R. High-Resolution CT Findings of Myositis-Related Interstitial Lung Disease. Medicina (Kaunas) 2021; 57:medicina57070692. [PMID: 34356972 PMCID: PMC8304263 DOI: 10.3390/medicina57070692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/17/2021] [Accepted: 07/01/2021] [Indexed: 12/21/2022]
Abstract
Myositis-related interstitial lung disease presents with a wide variety of lesions, ranging from chronic to acute. It can be divided into two main forms by the types of onsets, namely, chronic to subacute type showing nonspecific interstitial pneumonia (NSIP) or NSIP with an organizing pneumonia (OP)/fibrosing OP (FOP) pattern and acute type showing acute lung injury (ALI) to diffuse alveolar damage (DAD) pattern. Anti-aminoacyl tRNA Synthetase antibody-positive cases mainly show an NSIP or FOP pattern, whereas anti-melanoma differentiation-associated gene 5 antibody-positive cases show ALI to DAD pattern. Bilateral consolidation with or without ground-glass opacification with lower lobe predominance is common as a major pattern in all types, but the distribution or extent is sometimes different. The early detection of findings that indicate a rapid progressive course is vital. Diffuse cranio-caudal distribution and multiple ground-glass opacifications with random distribution might indicate a poorer prognosis.
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Affiliation(s)
- Ryoko Egashira
- Department of Radiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
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30
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Ran J, Yin C, Liu C, Li Y, Hou B, Morelli JN, Dai B, Li X. The Diagnostic Value of MR IVIM and T2 Mapping in Differentiating Autoimmune Myositis From Muscular Dystrophy. Acad Radiol 2021; 28:e182-e188. [PMID: 32417032 DOI: 10.1016/j.acra.2020.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/11/2020] [Accepted: 04/12/2020] [Indexed: 01/15/2023]
Abstract
RATIONALE AND OBJECTIVES To confirm the feasibility and compare the accuracy of magnetic resonance imaging intravoxel incoherent motion (IVIM) and T2 mapping models for the differentiation of autoimmune myositis from muscular dystrophy. MATERIALS AND METHODS Fourty-two autoimmune myositis and 11 muscular dystrophy patients proven by diagnostic criteria were enrolled in the study. Conventional MR sequences, IVIM, and T2 mapping through the bilateral thighs were obtained as well as blood samples for all patients. IVIM and T2 mapping parameters as well as serum markers were compared between the autoimmune myositis and muscular dystrophy groups. Mann-Whitney U tests were performed for statistical analysis along with receiver operating characteristic curves. Spearman correlation coefficient models were constructed to analyze the correlation between IVIM and T2 mapping with serological parameters. RESULTS The intramuscular apparent diffusion coefficient, tissue diffusivity (D), perfusion fraction (fp), and T2 relaxation time values were statistically significantly different between the autoimmune myositis and muscular dystrophy groups (p < 0.05). Pseudo diffusivity (Dp) values showed no statistical difference between the groups (p > 0.05). D parameter of IVIM sequences differentiated autoimmune and muscular dystrophy with a higher specificity of 75.60%. T2 values within the thighs were correlated with serum creatine kinase and lactate dehydrogenase levels (p < 0.05). CONCLUSION Thigh muscle IVIM and T2 mapping parameters are useful in differentiating autoimmune myositis from muscular dystrophy, particularly the IVIM parameters.
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Affiliation(s)
- Jun Ran
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan 430030, Hubei Province, People's Republic of China
| | - Cuilin Yin
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan 430030, Hubei Province, People's Republic of China
| | - Chanyuan Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan 430030, Hubei Province, People's Republic of China
| | - Yitong Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan 430030, Hubei Province, People's Republic of China
| | - Bowen Hou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan 430030, Hubei Province, People's Republic of China
| | - John N Morelli
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bin Dai
- Department of General Surgery, General Hospital of the Central Theater Command of the People's Liberation Army, Wuhan, People's Republic of China
| | - Xiaoming Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095, Jiefang Road, Wuhan 430030, Hubei Province, People's Republic of China.
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31
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Adams RA, Fernandes-Cerqueira C, Notarnicola A, Mertsching E, Xu Z, Lo WS, Ogilvie K, Chiang KP, Ampudia J, Rosengren S, Cubitt A, King DJ, Mendlein JD, Yang XL, Nangle LA, Lundberg IE, Jakobsson PJ, Schimmel P. Serum-circulating His-tRNA synthetase inhibits organ-targeted immune responses. Cell Mol Immunol 2021; 18:1463-1475. [PMID: 31797905 PMCID: PMC8166958 DOI: 10.1038/s41423-019-0331-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/29/2019] [Indexed: 12/13/2022] Open
Abstract
His-tRNA synthetase (HARS) is targeted by autoantibodies in chronic and acute inflammatory anti-Jo-1-positive antisynthetase syndrome. The extensive activation and migration of immune cells into lung and muscle are associated with interstitial lung disease, myositis, and morbidity. It is unknown whether the sequestration of HARS is an epiphenomenon or plays a causal role in the disease. Here, we show that HARS circulates in healthy individuals, but it is largely undetectable in the serum of anti-Jo-1-positive antisynthetase syndrome patients. In cultured primary human skeletal muscle myoblasts (HSkMC), HARS is released in increasing amounts during their differentiation into myotubes. We further show that HARS regulates immune cell engagement and inhibits CD4+ and CD8+ T-cell activation. In mouse and rodent models of acute inflammatory diseases, HARS administration downregulates immune activation. In contrast, neutralization of extracellular HARS by high-titer antibody responses during tissue injury increases susceptibility to immune attack, similar to what is seen in humans with anti-Jo-1-positive disease. Collectively, these data suggest that extracellular HARS is homeostatic in normal subjects, and its sequestration contributes to the morbidity of the anti-Jo-1-positive antisynthetase syndrome.
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Affiliation(s)
- Ryan A Adams
- aTyr Pharma, 3545 John Hopkins Court, Suite 250, San Diego, CA, 92121, USA
| | - Cátia Fernandes-Cerqueira
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Antonella Notarnicola
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | | | - Zhiwen Xu
- aTyr Pharma, 3545 John Hopkins Court, Suite 250, San Diego, CA, 92121, USA
- IAS HKUST- Scripps R&D Laboratory, Institute for Advanced Study, Hong Kong University of Science and Technology, and Pangu Biopharma, Hong Kong, China
| | - Wing-Sze Lo
- IAS HKUST- Scripps R&D Laboratory, Institute for Advanced Study, Hong Kong University of Science and Technology, and Pangu Biopharma, Hong Kong, China
| | - Kathleen Ogilvie
- aTyr Pharma, 3545 John Hopkins Court, Suite 250, San Diego, CA, 92121, USA
| | - Kyle P Chiang
- aTyr Pharma, 3545 John Hopkins Court, Suite 250, San Diego, CA, 92121, USA
| | - Jeanette Ampudia
- aTyr Pharma, 3545 John Hopkins Court, Suite 250, San Diego, CA, 92121, USA
| | - Sanna Rosengren
- aTyr Pharma, 3545 John Hopkins Court, Suite 250, San Diego, CA, 92121, USA
| | - Andrea Cubitt
- aTyr Pharma, 3545 John Hopkins Court, Suite 250, San Diego, CA, 92121, USA
| | - David J King
- aTyr Pharma, 3545 John Hopkins Court, Suite 250, San Diego, CA, 92121, USA
| | - John D Mendlein
- aTyr Pharma, 3545 John Hopkins Court, Suite 250, San Diego, CA, 92121, USA
| | - Xiang-Lei Yang
- The Scripps Laboratories for tRNA Synthetase Research, 10650 North Torrey Pines Road, La Jolla, CA, 92037, USA
| | - Leslie A Nangle
- aTyr Pharma, 3545 John Hopkins Court, Suite 250, San Diego, CA, 92121, USA
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Per-Johan Jakobsson
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Paul Schimmel
- The Scripps Laboratories for tRNA Synthetase Research, 10650 North Torrey Pines Road, La Jolla, CA, 92037, USA.
- The Scripps Laboratories for tRNA Synthetase Research, Scripps Florida, 130 Scripps Way, Jupiter, FL, 33458, USA.
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Mehan WA, Yoon BC, Lang M, Li MD, Rincon S, Buch K. Paraspinal Myositis in Patients with COVID-19 Infection. AJNR Am J Neuroradiol 2020; 41:1949-1952. [PMID: 32763902 DOI: 10.3174/ajnr.a6711] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/12/2020] [Indexed: 01/07/2023]
Abstract
Myalgia is a previously reported symptom in patients with COVID-19 infection; however, the presence of paraspinal myositis has not been previously reported. We report MR imaging findings of the spine obtained in a cohort of 9 patients with COVID-19 infection who presented to our hospital between March 3, 2020 and May 6, 2020. We found that 7 of 9 COVID-19 patients (78%) who underwent MR imaging of the spine had MR imaging evidence of paraspinal myositis, characterized by intramuscular edema and/or enhancement. Five of these 7 patients had a prolonged hospital course (greater than 25 days). Our knowledge of the imaging manifestations of COVID-19 infection is expanding. It is important for clinicians>a to be aware of the relatively high frequency of paraspinal myositis in this small cohort of patients with COVID-19 infection.
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Affiliation(s)
- W A Mehan
- From the Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - B C Yoon
- From the Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - M Lang
- From the Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - M D Li
- From the Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - S Rincon
- From the Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - K Buch
- From the Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
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Wang Y, Chen S, Lin J, Xie X, Hu S, Lin Q, Zheng K, Du G, Huang X, Zhang G, Gargani L, Matucci-Cerinic M, Furst DE. Lung ultrasound B-lines and serum KL-6 correlate with the severity of idiopathic inflammatory myositis-associated interstitial lung disease. Rheumatology (Oxford) 2020; 59:2024-2029. [PMID: 31794028 PMCID: PMC7382590 DOI: 10.1093/rheumatology/kez571] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/25/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Idiopathic inflammatory myositis-associated interstitial lung disease (IIM-ILD) significantly increases morbidity and mortality. Lung ultrasound B-lines and Krebs von den Lungen-6 (KL-6) are identified as new sonographic and serum markers of ILD, respectively. The aim of our work was to assess the role of B-lines and KL-6 as markers of the severity of IIM-ILD. For this purpose, the correlation among B-lines score, serum KL-6 levels, high-resolution CT (HRCT) score, and pulmonary function tests were investigated in IIM-ILD patients. METHODS Thirty-eight patients with IIM-ILD underwent chest HRCT scans, lung ultrasound and pulmonary function tests (independently performed within 1 week) examination. To assess severity and extent of ILD at HRCT, the Warrick score was used. The B-lines score denoting the extension of ILD was calculated by summing the number of B-lines on a total of 50 scanning sites. Serum KL-6 levels (U/ml) was measured by chemiluminescent enzyme immunoassay. RESULTS A significant correlation was found between the B-lines score and serum KL-6 levels (r = 0.43, P < 0.01), and between the Warrick score and serum KL-6 levels (r = 0.45, P < 0.01). A positive correlation between B-lines score and the Warrick score (r = 0.87, P < 0.0001) was also confirmed. Both B-lines score and KL-6 levels inversely correlated to diffusion capacity for carbon monoxide (r = -0.77, P < 0.0001 and r = -0.42, P < 0.05, respectively) and total lung capacity (r = -0.73, P < 0.0001 and r = -0.36, P < 0.05, respectively). Moreover, B-lines correlated inversely with forced vital capacity (r = -0.73, P < 0.0001), forced expiratory volume in 1 s (r = -0.69, P < 0.0001). CONCLUSION B-lines score and serum KL-6 levels correlate with HRCT findings and pulmonary function tests, supporting their use as measures of IIM-ILD severity.
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Affiliation(s)
- Yukai Wang
- Department of Rheumatology and Immunology, Shantou Central Hospital, Shantou, Guangdong, China
- Division of Rheumatology AOUC, Department of Geriatric Medicine, University of Florence, Florence, Italy
- Correspondence to: Yukai Wang, Department of Rheumatology and Immunology, Shantou Central Hospital, No. 114 Wai Ma Road, Shantou, Guangdong 515031, China. E-mail:
| | - Shaoqi Chen
- Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College
| | - Jianqun Lin
- Department of Rheumatology and Immunology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Xuezhen Xie
- Department of Rheumatology and Immunology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Shijian Hu
- Department of Rheumatology and Immunology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Qisheng Lin
- Department of Rheumatology and Immunology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Kedi Zheng
- Department of Rheumatology and Immunology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Guangzhou Du
- Department of Radiology, Shantou Central Hospital, Shantou, Guangdong
| | - Xiufeng Huang
- Department of Respiratory Medicine, Shantou Central Hospital, Shantou, Guangdong
| | - Guohong Zhang
- Department of Pathology, Shantou University Medical College, Shantou, China
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Marco Matucci-Cerinic
- Division of Rheumatology AOUC, Department of Geriatric Medicine, University of Florence, Florence, Italy
| | - Daniel E Furst
- Division of Rheumatology AOUC, Department of Geriatric Medicine, University of Florence, Florence, Italy
- Division of Rheumatology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
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Nakamura K, Sugai A, Saji E, Kasuga K, Onodera O. Refractory Myositis Affecting the Intrinsic Muscles of the Hand. Intern Med 2020; 59:1211-1214. [PMID: 31956201 PMCID: PMC7270759 DOI: 10.2169/internalmedicine.3773-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Myositis generally affects the proximal muscles. However, we herein report a case of a 48-year-old woman with intractable myositis affecting the intrinsic muscles of the hands. Her myositis, which developed in childhood, was refractory to treatment with steroids and several immunosuppressants, causing walking disability. After experiencing pain and swelling in the hands for six months, she was diagnosed with myositis of the intrinsic muscles of the hands and tested positive for the anti-signal recognition particle antibody. Intravenous immunoglobulin therapy improved the myositis of the hands. This case suggests that inflammation caused by intractable myositis can extend to the hands.
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Affiliation(s)
- Kosei Nakamura
- Department of Neurology, Brain Research Institute, Niigata University, Japan
| | - Akihiro Sugai
- Department of Neurology, Brain Research Institute, Niigata University, Japan
| | - Etsuji Saji
- Department of Neurology, Brain Research Institute, Niigata University, Japan
| | - Kensaku Kasuga
- Department of Molecular Genetics, Center for Bioresources, Brain Research Institute, Niigata University, Japan
| | - Osamu Onodera
- Department of Neurology, Brain Research Institute, Niigata University, Japan
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Xu Y, Sun J, Wan K, Yu L, Wang J, Li W, Yang F, Sun J, Cheng W, Mui D, Zhang Q, Xie Q, Chen Y. Multiparametric cardiovascular magnetic resonance characteristics and dynamic changes in myocardial and skeletal muscles in idiopathic inflammatory cardiomyopathy. J Cardiovasc Magn Reson 2020; 22:22. [PMID: 32272936 PMCID: PMC7147024 DOI: 10.1186/s12968-020-00616-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 03/16/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Idiopathic inflammatory myopathy (IIM) manifest as systematic muscle involvement. Multiparametric cardiovascular magnetic resonance (CMR) could be a useful technique to detect systemic involvement and disease progression in IIM patients. This study aimed to describe the tissue characteristics and dynamic changes in myocardial and skeletal muscles after treatment in IIM patients. METHODS Forty-four consecutively recruited IIM patients (49.0 ± 12.0 years; 22 males) underwent 3 T CMR at first diagnosis, and 28 patients underwent follow-up scan after receiving standard treatment for more than 1 year. Thirty age- and sex-matched healthy subjects served as controls. The CMR protocol included: cines, T2-weighted (T2w), late gadolinium enhancement (LGE), T1 and T2 mapping, and extracellular volume (ECV) evaluated for the myocardium, and T1 and T2 mapping and ECV evaluated for skeletal muscles. Correlations between laboratory biomarkers and myocardial and skeletal tissue characteristics were analyzed. Comparisons between baseline and follow-up scans were performed using paired t-tests. RESULTS At baseline, IIM patients showed significantly decreased hematocrit, higher left ventricular (LV) mass index, right ventricular (RV) volume index, myocardial and skeletal native T1, T2 mapping, and ECV than healthy controls. Significant correlations were found among myocardial native T1, T2 mapping, and ECV values and N-terminal pro b-type natriuretic peptide (NT-proBNP) levels, and significant correlations between skeletal T2 mapping and inflammatory biomarkers in IIM patients. During the follow-up, 28 patients underwent repeated CMR scan (median interval, 14.5 months, interquartile range: 13.2-15.5 months). Significant relief from clinical symptoms and decreased inflammatory biomarkers levels were observed. Significant reduction in myocardial native T1, T2, ECV, and skeletal native T1, T2, and ECV were observed during the follow-up assessment. CONCLUSIONS Both myocardial and skeletal muscles in newly diagnosed IIM patients show distinct characteristics on multiparametric CMR. In addition, significant changes were observed in patients showing clinical remission after effective treatment, which suggests that quantitative T1, T2, and ECV techniques may have potential clinical value in IIM patients.
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Affiliation(s)
- Yuanwei Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Jianhong Sun
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Ke Wan
- Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Liuyu Yu
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Wuhan province, China
| | - Jie Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Weihao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Fuyuao Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Wei Cheng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - David Mui
- Department of Medicine, Cardiovascular Division, University of Pennsylvania, Philadelphia, USA
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Qibing Xie
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China.
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China.
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Zlitni A, Gowrishankar G, Steinberg I, Haywood T, Sam Gambhir S. Maltotriose-based probes for fluorescence and photoacoustic imaging of bacterial infections. Nat Commun 2020; 11:1250. [PMID: 32144257 PMCID: PMC7060353 DOI: 10.1038/s41467-020-14985-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/13/2020] [Indexed: 11/09/2022] Open
Abstract
Currently, there are no non-invasive tools to accurately diagnose wound and surgical site infections before they become systemic or cause significant anatomical damage. Fluorescence and photoacoustic imaging are cost-effective imaging modalities that can be used to noninvasively diagnose bacterial infections when paired with a molecularly targeted infection imaging agent. Here, we develop a fluorescent derivative of maltotriose (Cy7-1-maltotriose), which is shown to be taken up in a variety of gram-positive and gram-negative bacterial strains in vitro. In vivo fluorescence and photoacoustic imaging studies highlight the ability of this probe to detect infection, assess infection burden, and visualize the effectiveness of antibiotic treatment in E. coli-induced myositis and a clinically relevant S. aureus wound infection murine model. In addition, we show that maltotriose is an ideal scaffold for infection imaging agents encompassing better pharmacokinetic properties and in vivo stability than other maltodextrins (e.g. maltohexose).
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Affiliation(s)
- Aimen Zlitni
- Molecular Imaging Program at Stanford, Stanford University, Stanford, CA, 94305, USA
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Gayatri Gowrishankar
- Molecular Imaging Program at Stanford, Stanford University, Stanford, CA, 94305, USA
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Idan Steinberg
- Molecular Imaging Program at Stanford, Stanford University, Stanford, CA, 94305, USA
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Tom Haywood
- Molecular Imaging Program at Stanford, Stanford University, Stanford, CA, 94305, USA
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Sanjiv Sam Gambhir
- Molecular Imaging Program at Stanford, Stanford University, Stanford, CA, 94305, USA.
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA.
- Department of Bioengineering, Department of Materials Science & Engineering, Stanford University, Stanford, CA, 94305, USA.
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Abstract
A 57-year-old woman with a history of uterine endometrial carcinoma underwent PET/CT examinations for initial staging and posttreatment survey. Multiple patchy accumulations were noted in the muscles, particularly in both thighs. These accumulations resolved spontaneously 6 months after the follow-up examination. However, 3.5 years after the surgery, the multiple patchy accumulations reappeared in the muscle of the upper and lower extremities showing an increase in signal intensity from previous examination. A biopsy of the right thigh revealed epithelioid cell granuloma without necrosis. We therefore consider that this case might be "idiopathic" granulomatous myositis.
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Affiliation(s)
| | | | | | - Yoshiya Sugiura
- Division of Pathology, The Cancer Institute Hospital of JFCR, Tokyo, Japan
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Abstract
A 69-year-old Japanese woman presented with mild muscle weakness of the neck and symmetrical proximal parts of the upper and lower limbs. Laboratory tests, needle electromyography, and a muscle biopsy revealed inflammatory myopathy with an apparent clinical classification of polymyositis and positive findings for anti-PM/Scl-75 antibody. This antibody is rare among Japanese populations, and most Japanese patients with the antibody are not classified with the inflammatory myopathy seen in polymyositis. The muscle biopsy also showed marked necrotic and regenerative fibers. We need to collectively investigate patients with the potential to develop this disease, and to identify any unique characteristics for Asian populations, including Japanese.
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Affiliation(s)
- Yuki Nakamura
- Department of Neurology, Sapporo Kosei General Hospital, Japan
| | - Rei Miyanaga
- Department of Neurology, Sapporo Kosei General Hospital, Japan
| | | | - Shun Shimohama
- Department of Neurology, Sapporo Medical University School of Medicine, Japan
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Dhital R, Basnet S, Poudel DR. Acute Proximal Myopathy in a Young Male—A Case of Infectious Myositis. Medicina (B Aires) 2019; 55:medicina55010019. [PMID: 30658484 PMCID: PMC6359648 DOI: 10.3390/medicina55010019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 01/14/2019] [Indexed: 11/21/2022] Open
Abstract
Background and objectives: Acute proximal muscle weakness has a broad differential. Infectious myositis is difficult to differentiate clinically from inflammatory myopathy, often causing a delayed diagnosis. Infectious myositis should be thought of as a differential for proximal muscle pain and weakness in the right context. Case Presentation: A 40-year-old male with diabetes presented with exquisite pain and weakness of proximal extremities. He denied trauma, recent travel, new medications, or substance use. He denied prior rheumatologic, thyroid, or musculoskeletal disorders. The urine culture revealed staphylococcal infection with negative blood cultures. Rheumatologic and endocrine workups were negative. Random muscle biopsy was negative for inflammatory infiltrate. MRI of thighs and arms showed innumerable foci of nodular and ring enhancement in the proximal muscle groups. The patient noted improvement after about 10 days of antibiotics with complete resolution at 2 months. Discussion and Conclusion: Bacterial myositis is most often due to Staphylococcus aureus (70%) and affects a single muscle. Multifocal abscesses are rare and strongly suggest transient bacteremia. Our patient most likely had transient initiating staphylococcal bacteremia leading to diffuse myositis and hematogenous urinary tract infection (UTI). A delay in treatment can be life-threatening.
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Affiliation(s)
- Rashmi Dhital
- Reading Hospital, Tower Health System, West Reading, PA 19611, USA.
| | - Sijan Basnet
- Reading Hospital, Tower Health System, West Reading, PA 19611, USA.
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Boinpally H, Howell RS, Ram B, Donovan V, Castellano M, Woods JS, Gorenstein S. Necrotizing Myositis: A Rare Necrotizing Soft Tissue Infection Involving Muscle. Wounds 2018; 30:E116-E120. [PMID: 30561371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Necrotizing myositis (NM) is an extremely rare necrotizing soft tissue infection involving muscle. Unlike similar infections (eg, necrotizing fasciitis, clostridial myonecrosis) that can be more readily diagnosed, NM can have a benign presentation then rapidly progress into a life-threatening condition with a mortality rate of 100% without surgical intervention. CASE REPORT A 74-year-old man with a history of prostate cancer with radiation therapy, seed implants, and 2 transurethral resection procedures presented to the emergency department after a fall. He was initially diagnosed and treated for urosepsis. Sixteen hours after presentation, he complained of pain and swelling of his right groin. Computed tomography of the abdomen and pelvis showed gas findings suspicious for necrotizing infection of the bilateral thighs. Surgical exploration revealed NM. Separate cultures from the left thigh and bladder grew Streptococcus intermedius, Clostridium clostridioforme, and Peptostreptococcus, suggesting a possible common source of infection from the prostate gland or the osteomyelitic pubic symphysis, which subsequently spread to the bilateral thighs. CONCLUSIONS To the best of the authors' knowledge, this is the first reported case of S intermedius and C clostridioforme causing NM. A high index of suspicion is required for extremely rare conditions like NM, because early diagnosis and surgical intervention significantly reduce mortality.
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Affiliation(s)
| | | | - Bebu Ram
- Department of Pathology, NYU Winthrop Hospital, Mineola, NY
| | | | | | - John S Woods
- Department of Surgery, NYU Winthrop Hospital, Mineola, NY
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Marasco E, Cioffi E, Cometi L, Valentini V, Zanframundo G, Neri R, Cavagna L, Barsotti S. One year in review 2018: idiopathic inflammatory myopathies. Clin Exp Rheumatol 2018; 36:937-947. [PMID: 30526764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 08/27/2018] [Indexed: 06/09/2023]
Abstract
Idiopathic inflammatory myopathies (IIMs) are a group of chronic autoimmune systemic diseases affecting the skeletal muscle and other organs. IIMs are also a complex group of diseases, in some cases, difficult to manage. Literature on IIMs has been growing fairly rapidly and keeping up-to-date on such a topic is of utmost importance for any rheumatologist who looks after IIM patients. Thus, the aim of this review is to summarise the most relevant literature contributions published over the last year on the pathogenesis, serology, diagnosis and treatment of IIMs.
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Affiliation(s)
- Emiliano Marasco
- Division of Rheumatology, Hospital IRCCS Policlinico S. Matteo Foundation of Pavia, Italy
| | | | - Laura Cometi
- Department of Experimental and Clinical Medicine, Rheumatology Unit, University of Florence, Italy
| | | | - Giovanni Zanframundo
- Division of Rheumatology, Hospital IRCCS Policlinico S. Matteo Foundation of Pavia, Italy
| | | | - Lorenzo Cavagna
- Division of Rheumatology, Hospital IRCCS Policlinico S. Matteo Foundation of Pavia, Italy
| | - Simone Barsotti
- Rheumatology Unit, University of Pisa, and Department of Medical Biotechnologies, University of Siena, Italy
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Kubínová K, Dejthevaporn R, Mann H, Machado PM, Vencovský J. The role of imaging in evaluating patients with idiopathic inflammatory myopathies. Clin Exp Rheumatol 2018; 36 Suppl 114:74-81. [PMID: 30296982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/30/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To describe imaging modalities for diagnosing and monitoring of patients with idiopathic inflammatory myopathies. METHODS A detailed literature search summarising recent data documenting the contribution of different imaging techniques to current management of idiopathic inflammatory myopathies was performed. RESULTS An overview of methods most frequently used for evaluation of inflammatory myopathies and the description of their role in the diagnostic and monitoring process is presented. CONCLUSIONS MRI is currently the most useful method capable of demonstrating both inflammatory and post-inflammatory changes in the muscles and surrounding soft tissue. Several studies have documented potential usefulness of other imaging techniques, such as ultrasonography, positron emission tomography, scintigraphy, and dual-energy x-ray absorptiometry.
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Affiliation(s)
- Katerina Kubínová
- Institute of Rheumatology, Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - R Dejthevaporn
- MRC Centre for Neuromuscular Diseases, University College London, UK
| | - Herman Mann
- Institute of Rheumatology, Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, University College London; Rheumatology Department, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Jiří Vencovský
- Institute of Rheumatology, Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
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Moon JS, Shin SY. Superior oblique myositis causing acquired Brown's syndrome as the first manifestation of primary Sjögren's syndrome. Clin Exp Rheumatol 2018; 36 Suppl 112:237-238. [PMID: 29465361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/09/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Ji-Sun Moon
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Young Shin
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea.
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Hurtado García R, Hurtado Oliver B, Nortes Cañizares E, Cepeda Rodrigo JM. Antisynthetase syndrome and influenza B, characteristic pulmonary involvement. Reumatol Clin (Engl Ed) 2018; 14:173-174. [PMID: 28063779 DOI: 10.1016/j.reuma.2016.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/10/2016] [Accepted: 11/24/2016] [Indexed: 06/06/2023]
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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] [What about the content of this article? (0)] [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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Pervaiz MH, Durga S, Janoudi A, Berger K, Abela GS. PET/CTA detection of muscle inflammation related to cholesterol crystal emboli without arterial obstruction. J Nucl Cardiol 2018; 25:433-440. [PMID: 28224451 DOI: 10.1007/s12350-017-0826-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/06/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND PET/CTA was used to evaluate the effect of cholesterol crystal emboli (CCE) on muscle injury. Cholesterol crystals (CCs) released during plaque rupture travel downstream and lodge in muscle triggering inflammation and tissue injury. METHODS Thigh muscles in three groups of rabbits (n = 22) were studied after intra-arterial injection of CCs, Group I (n = 10); polystyrene microspheres, Group II (n = 5); or normal saline, Group III (n = 7). After 48 hours, muscle inflammation and injury were measured by fluorodeoxy-glucose uptake using PET/CTA, serum tissue factor (TF), and creatinine phosphokinase (CPK). Macrophages were stained with RAM11 and CCs with Bodipy. RESULTS SUVmax of thigh muscles was greater for Group I vs Group II and III (0.40 ± 0.16 vs 0.21 ± 0.11, P = .038 and 0.23 ± 0.06, P = .036). CPK levels rose significantly in Group I vs Group II and III (6.7 ± 6.0 vs 0.6 ± 0.4, P = .007 and 0.9 ± 0.4 mg·dL-1, P = .023). No arterial thrombosis was detected by CTA or histology of embolized arteries and TF did not rise significantly. There were extensive macrophage infiltrates surrounding muscle necrosis in Group I only. CONCLUSIONS Cholesterol crystal emboli triggered muscle inflammation and necrosis with an intact circulation. PET/CTA may help in the early detection of inflammation caused by CCs.
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Affiliation(s)
- M Hassan Pervaiz
- Division of Cardiology, Department of Medicine, Michigan State University, East Lansing, MI, USA
| | - Sridevi Durga
- Division of Cardiology, Department of Medicine, Michigan State University, East Lansing, MI, USA
| | - Abed Janoudi
- Division of Cardiology, Department of Medicine, Michigan State University, East Lansing, MI, USA
| | - Kevin Berger
- Department of Radiology, Michigan State University, East Lansing, MI, USA
| | - George S Abela
- Division of Cardiology, Department of Medicine, Michigan State University, East Lansing, MI, USA.
- Division of Pathology, Department of Physiology, Michigan State University, East Lansing, MI, USA.
- Michigan State University, B208 Clinical Center, East Lansing, MI, 48824, USA.
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Huber AT, Bravetti M, Lamy J, Bacoyannis T, Roux C, de Cesare A, Rigolet A, Benveniste O, Allenbach Y, Kerneis M, Cluzel P, Kachenoura N, Redheuil A. Non-invasive differentiation of idiopathic inflammatory myopathy with cardiac involvement from acute viral myocarditis using cardiovascular magnetic resonance imaging T1 and T2 mapping. J Cardiovasc Magn Reson 2018; 20:11. [PMID: 29429407 PMCID: PMC5808400 DOI: 10.1186/s12968-018-0430-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 01/23/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Idiopathic inflammatory myopathy (IIM) is a group of autoimmune diseases with systemic myositis which may involve the myocardium. Cardiac involvement in IIM, although often subclinical, may mimic clinical manifestations of acute viral myocarditis (AVM). Our aim was to investigate the usefulness of the combined analysis of cardiovascular magnetic resonance (CMR) T1 and T2 mapping parameters measured both in the myocardium and in the thoracic skeletal muscles to differentiate AVM from IIM cardiac involvement. METHODS Sixty subjects were included in this retrospective study (36 male, age 45 ± 16 years): twenty patients with AVM, twenty patients with IIM and cardiac involvement and twenty healthy controls. Study participants underwent CMR imaging with modified Look-Locker inversion-recovery (MOLLI) T1 mapping and 3-point balanced steady-state-free precession T2 mapping. Relaxation times were quantified after endocardial and epicardial delineation on basal and medial short-axis slices, as well as in different thoracic skeletal muscle groups present in the CMR field-of-view. ROC-Analysis was performed to assess the ability of mapping indices to discriminate the study groups. RESULTS Mapping parameters in the thoracic skeletal muscles were able to discriminate between AVM and IIM patients. Best skeletal muscle parameters to identify IIM from AVM patients were reduced post-contrast T1 and increased extracellular volume (ECV), resulting in an area under the ROC curve (AUC) of 0.95 for post-contrast T1 and 0.96 for ECV. Conversely, myocardial mapping parameters did not discriminate IIM from AVM patients but increased native T1 (AUC 0.89 for AVM; 0.84 for IIM) and increased T2 (AUC 0.82 for AVM; 0.88 for IIM) could differentiate both patient groups from healthy controls. CONCLUSION CMR myocardial mapping detects cardiac inflammation in AVM and IIM compared to normal myocardium in healthy controls but does not differentiate IIM from AVM. However, thoracic skeletal muscle mapping was able to accurately discern IIM from AVM.
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Affiliation(s)
- Adrian T. Huber
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d’Imagerie Biomédicale (LIB), Faculté de Médecine, 91, Boulevard de l’hôpital, 75013 Paris, France
- Department of Cardiovascular Imaging, Interventional and Thoracic Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière, Paris, France
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marine Bravetti
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d’Imagerie Biomédicale (LIB), Faculté de Médecine, 91, Boulevard de l’hôpital, 75013 Paris, France
- Department of Cardiovascular Imaging, Interventional and Thoracic Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jérôme Lamy
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d’Imagerie Biomédicale (LIB), Faculté de Médecine, 91, Boulevard de l’hôpital, 75013 Paris, France
- Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Tania Bacoyannis
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d’Imagerie Biomédicale (LIB), Faculté de Médecine, 91, Boulevard de l’hôpital, 75013 Paris, France
| | - Charles Roux
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d’Imagerie Biomédicale (LIB), Faculté de Médecine, 91, Boulevard de l’hôpital, 75013 Paris, France
- Department of Cardiovascular Imaging, Interventional and Thoracic Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière, Paris, France
| | - Alain de Cesare
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d’Imagerie Biomédicale (LIB), Faculté de Médecine, 91, Boulevard de l’hôpital, 75013 Paris, France
- Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Aude Rigolet
- Department of Internal Medicine, Hôpital Pitié-Salpêtrière, Paris, France
| | - Olivier Benveniste
- Department of Internal Medicine, Hôpital Pitié-Salpêtrière, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, INSERM UMR974, Centre de Recherche en Myologie, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine, Hôpital Pitié-Salpêtrière, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, INSERM UMR974, Centre de Recherche en Myologie, Paris, France
| | - Mathieu Kerneis
- Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Department of Cardiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière, Paris, France
| | - Philippe Cluzel
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d’Imagerie Biomédicale (LIB), Faculté de Médecine, 91, Boulevard de l’hôpital, 75013 Paris, France
- Department of Cardiovascular Imaging, Interventional and Thoracic Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière, Paris, France
- Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Nadjia Kachenoura
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d’Imagerie Biomédicale (LIB), Faculté de Médecine, 91, Boulevard de l’hôpital, 75013 Paris, France
- Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Alban Redheuil
- Sorbonne Universités, UPMC Univ Paris 06, INSERM 1146, CNRS 7371, Laboratoire d’Imagerie Biomédicale (LIB), Faculté de Médecine, 91, Boulevard de l’hôpital, 75013 Paris, France
- Department of Cardiovascular Imaging, Interventional and Thoracic Radiology, Institute of Cardiology, Hôpital Pitié-Salpêtrière, Paris, France
- Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
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Aoun Sebaiti M, Kauv P, Charles-Nelson A, Van Der Gucht A, Blanc-Durand P, Itti E, Gherardi RK, Bachoud-Levi AC, Authier FJ. Cognitive dysfunction associated with aluminum hydroxide-induced macrophagic myofasciitis: A reappraisal of neuropsychological profile. J Inorg Biochem 2017; 181:132-138. [PMID: 29079320 DOI: 10.1016/j.jinorgbio.2017.09.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/15/2017] [Accepted: 09/19/2017] [Indexed: 01/12/2023]
Abstract
Patients with macrophagic myofasciitis (MMF) present with diffuse arthromyalgias, chronic fatigue, and cognitive disorder. Representative features of MMF-associated cognitive dysfunction include attentional dysfunction, dysexecutive syndrome, visual memory deficit and left ear extinction. Our study aims to reevaluate the neuropsychological profile of MMF. 105 unselected consecutive MMF patients were subjected to a neuropsychological battery of screen short term and long-term memory, executive functions, attentional abilities, instrumental functions and dichotic listening. From these results, patients were classified in four different groups: Subsymptomatic patients (n=41) with performance above pathological threshold (-1.65 SD) in all tests; Fronto-subcortical patients (n=31) who showed pathological results at executive functions and selective attention tests; Papezian patients (n=24) who showed pathological results in storage, recognition and consolidation functions for episodic verbal memory, in addition to fronto-subcortical dysfunction; and Extinction patients (n=9) who had a left ear extinction at dichotic listening test in association to fronto-subcortical and papezian dysfunction. In addition, inter-test analysis showed that patients with apparently normal cognitive functions (Subsymptomatic group) performed significantly worse to attention tests compared to others. In conclusion, our study shows that (i) most patients have specific cognitive deficits; (ii) all patients with cognitive deficit have impairment of executive functions and selective attention; (iii) patients without measurable cognitive deficits display significant weakness in attention; (iv) episodic memory impairment affects verbal, but not visual, memory; (v) none of the patients show an instrumental dysfunction.
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Affiliation(s)
- Mehdi Aoun Sebaiti
- INSERM/UPEC U955 Team 10 'Biology of Neuromuscular System', Faculty of Médecine, 94000 Créteil, France; Department of Neurology, Henri Mondor University Hospital, 94000 Créteil, France
| | - Paul Kauv
- Neuroradiology, Henri Mondor University Hospital, 94000 Créteil, France
| | - Anaïs Charles-Nelson
- Cordeliers Research Center, UPMC, Team 'Information Sciences to Support Personalized Medicine', 75006 Paris, France
| | - Axel Van Der Gucht
- Nuclear Medicine, Henri Mondor University Hospital, 94000 Créteil, France
| | - Paul Blanc-Durand
- Nuclear Medicine, Henri Mondor University Hospital, 94000 Créteil, France
| | - Emmanuel Itti
- Nuclear Medicine, Henri Mondor University Hospital, 94000 Créteil, France
| | - Romain K Gherardi
- INSERM/UPEC U955 Team 10 'Biology of Neuromuscular System', Faculty of Médecine, 94000 Créteil, France; Expert Center for Neuromuscular Diseases, Department of Pathology, Henri Mondor University Hospital, 94000 Créteil, France
| | | | - François Jérôme Authier
- INSERM/UPEC U955 Team 10 'Biology of Neuromuscular System', Faculty of Médecine, 94000 Créteil, France; Expert Center for Neuromuscular Diseases, Department of Pathology, Henri Mondor University Hospital, 94000 Créteil, France.
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Skala SL, Hristov AC, Gudjonsson JE, Chan MP. Unsuspected lymphomatoid granulomatosis in a patient with antisynthetase syndrome. Cutis 2017; 100:E22-E26. [PMID: 29136066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Clinical diagnosis of lymphomatoid granulomatosis (LYG) often is difficult, especially in patients with multiple comorbidities. We present a 60-year-old woman with worsening fatigue, night sweats, unintentional weight loss, and dyspnea of 2 weeks' duration. Her medical history was remarkable for recent radiation therapy for recurrent breast cancer and antisynthetase syndrome complicated by interstitial lung disease and controlled with azathioprine. Computed tomography showed ground-glass opacities and nodular infiltrates in all lung lobes, raising concern for radiation pneumonitis and drug toxicity. Skin examination revealed erythematous and hemorrhagic papules, macules, and blisters on the lower leg. A diagnosis of LYG was made on a skin biopsy showing large angiocentric Epstein-Barr virus (EBV)-positive B cells. The patient soon progressed to develop nodal large B-cell lymphoma and died 6 weeks later. This rare report of LYG in a patient with antisynthetase syndrome highlights the diagnostic difficulty and aggressive course of LYG as well as the important role of skin biopsy in establishing the diagnosis.
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Affiliation(s)
| | - Alexandra C Hristov
- Department of Dermatology, Department of Pathology, University of Michigan, Ann Arbor, USA
| | | | - May P Chan
- Department of Dermatology, Department of Pathology, University of Michigan, Ann Arbor, USA
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50
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Aslam F, Fox M, Chang-Miller A. Ultrasound for the rheumatologist - focal myositis. Acta Reumatol Port 2017; 42:336-338. [PMID: 29231909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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