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Hashiba J, Yokota H, Abe K, Sekiguchi Y, Ikeda S, Sugiyama A, Kuwabara S, Uno T. Ultrasound-based radiomic analysis of the peripheral nerves for differentiation between CIDP and POEMS syndrome. Acta Radiol 2023; 64:2627-2635. [PMID: 37376758 DOI: 10.1177/02841851231181680] [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: 06/29/2023]
Abstract
BACKGROUND Demyelinating peripheral neuropathy is characteristic of both polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes (POEMS) syndrome and chronic inflammatory demyelinating polyneuropathy (CIDP). We hypothesized that the different pathogeneses underlying these entities would affect the sonographic imaging features. PURPOSE To investigate whether ultrasound (US)-based radiomic analysis could extract features to describe the differences between CIDP and POEMS syndrome. MATERIAL AND METHODS In this retrospective study, we evaluated nerve US images from 26 with typical CIDP and 34 patients with POEMS syndrome. Cross-sectional area (CSA) and echogenicity of the median and ulnar nerves were evaluated in each US image of the wrist, forearm, elbow, and mid-arm. Radiomic analysis was performed on these US images. All radiomic features were examined using receiver operating characteristic analysis. Optimal features were selected using a three-step feature selection method and were inputted into XGBoost to build predictive machine-learning models. RESULTS The CSAs were more enlarged in patients with CIDP than in those with POEMS syndrome without significant differences, except for that of the ulnar nerve at the wrist. Nerve echogenicity was significantly more heterogeneous in patients with CIDP than in those with POEMS syndrome. The radiomic analysis yielded four features with the highest area under the curve (AUC) value of 0.83. The machine-learning model showed an AUC of 0.90. CONCLUSION US-based radiomic analysis has high AUC values in differentiating POEM syndrome from CIDP. Machine-learning algorithms further improved the discriminative ability.
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Affiliation(s)
- Jun Hashiba
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kota Abe
- Department of Radiation Oncology, MR Linac ART Division, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yukari Sekiguchi
- Department of Neurology, JR Tokyo General Hospital, Tokyo, Japan
| | - Shinobu Ikeda
- Devision of Laboratory Medicine, Chiba University Hospital, Chiba, Japan
| | - Atsuhiko Sugiyama
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takashi Uno
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Niu J, Ding Q, Fan J, Zhang L, Liu J, Guan Y, Wu S, Cui L, Liu M. Nerve Ultrasound Performances in Differentiating POEMS Syndrome from CIDP. Neurotherapeutics 2022; 19:455-463. [PMID: 35257327 PMCID: PMC9226218 DOI: 10.1007/s13311-022-01209-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Accepted: 02/19/2022] [Indexed: 10/18/2022] Open
Abstract
Chronic inflammatory demyelinating polyneuropathy (CIDP) and polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes (POEMS) syndrome are both acquired demyelinating polyneuropathies. We aim to explore the different features of ultrasonographic changes between CIDP and POEMS syndrome. Nerve ultrasonographic studies were performed in 120 patients with CIDP and 34 patients with POEMS syndrome. Cross-sectional areas (CSAs) were measured on the bilateral median nerve, ulnar nerve, and brachial plexus. Nerve conduction studies were performed on median and ulnar nerves to detect motor conduction blocks (CBs). CSAs at all sites were larger in patients with CIDP and POEMS syndrome than in healthy controls. Maximal CSA (median (min to max)) was 14 (6-194) mm2 for median nerve, 9 (4-92) mm2 for ulnar nerve, and 14 (7-199) mm2 for brachial plexus in CIDP and 11 (8-16) mm2 for median nerve, 8.5 (6-13) mm2 for ulnar nerve, and 14 (10-20) mm2 for brachial plexus in POEMS syndrome. The ratio of maximum/minimum CSA of the median nerve was significantly larger in CIDP (2.8 ± 2.8) than in POEMS syndrome (1.7 ± 0.3). CBs or probable CBs were detected in 60 out of 120 CIDP patients but in none of the POEMS syndromes. For distinguishing CIDP and POEMS syndrome, a two-step protocol using CB and maximum/minimum CSA of the median nerve yields a sensitivity of 93% and a specificity of 79%. In conclusion, compared with CIDP, nerve CSA enlargement was more homogeneous along the same nerve in individual POEMS patients, as well as among different POEMS patients. The addition of nerve ultrasound to nerve conduction studies significantly improves the differential diagnosis between the two diseases.
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Affiliation(s)
- Jingwen Niu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qingyun Ding
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Fan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Zhang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingwen Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuzhou Guan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuang Wu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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Takahashi Y, Iwano H, Nakano I, Fukushima A, Naya M, Shimizu A, Matsuno Y, Oyama-Manabe N, Anzai T. POEMS Syndrome Showing Left Ventricular Dysfunction and Extracellular Edema Assessed by Cardiac Magnetic Resonance Imaging. Intern Med 2019; 58:2539-2543. [PMID: 31118405 PMCID: PMC6761353 DOI: 10.2169/internalmedicine.2842-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/18/2023] Open
Abstract
Although cardiac involvement is rare in polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes (POEMS) syndrome, the clinical course becomes considerably worse on complication with cardiac lesions. The increased release of various cytokines has been observed in the pathogenesis of POEMS syndrome, and serum vascular endothelial growth factor (VEGF) levels are known to be associated with the disease activity. We herein report a patient with POEMS syndrome who showed left ventricular systolic dysfunction and was treated with lenalidmide therapy. Of note, the reduction in extracellular edema in the left ventricular wall was clearly visualized by changes in the native T1 values and extracellular volumes on cardiac magnetic resonance imaging.
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Affiliation(s)
- Yumi Takahashi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Ippei Nakano
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Arata Fukushima
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Masanao Naya
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Ai Shimizu
- Department of Surgical Pathology, Hokkaido University Hospital, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Japan
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
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Lopes C, Costa T, Mateus M, Branco JC. POEMS Syndrome: a puzzling case. Acta Reumatol Port 2019; 44:84-85. [PMID: 31249280] [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: 06/09/2023]
Affiliation(s)
- Carina Lopes
- Hospital de Egas Moniz, CHLO, Lisbon, Portugal; CEDOC, NOVA Medical School | Faculdade de Ciências Médicas - NOVA University of Lisbon, Lisbon, Portugal
| | - Tiago Costa
- Hospital de Egas Moniz, CHLO, Lisbon, Portugal; CEDOC, NOVA Medical School | Faculdade de Ciências Médicas - NOVA University of Lisbon, Lisbon, Portugal
| | | | - Jaime Cunha Branco
- CEDOC, NOVA Medical School | Faculdade de Ciências Médicas - NOVA University of Lisbon, Lisbon, Portugal; Hospital de Egas Moniz, CHLO, Lisbon, Portugal
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Liapis K, Vlachou S, Markou A, Kakiopoulos G, Kounadi T, Anagnostopoulos NI, Piaditis GP. As white as ivory: sclerotic vertebra in POEMS syndrome. Lancet 2017; 389:2261-2262. [PMID: 28589896 DOI: 10.1016/s0140-6736(17)31374-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 03/10/2017] [Accepted: 03/29/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Konstantinos Liapis
- Department of Clinical Haematology, Georgios Gennimatas Hospital, Athens, Greece.
| | - Sophia Vlachou
- Department of Endocrinology and Diabetes Centre, Georgios Gennimatas Hospital, Athens, Greece
| | - Athina Markou
- Department of Endocrinology and Diabetes Centre, Georgios Gennimatas Hospital, Athens, Greece
| | | | - Theodora Kounadi
- Department of Endocrinology and Diabetes Centre, Georgios Gennimatas Hospital, Athens, Greece
| | | | - George P Piaditis
- Department of Endocrinology and Diabetes Centre, Georgios Gennimatas Hospital, Athens, Greece
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Ozawa Y, Yamamoto H, Yasuo M, Takahashi H, Tateishi K, Ushiki A, Kawakami S, Fujinaga Y, Asaka S, Sano K, Takayama H, Imamura H, Hanaoka M. Two patients with TAFRO syndrome exhibiting strikingly similar anterior mediastinal lesions with predominantly fat attenuation on chest computed tomography. Respir Investig 2017; 55:176-180. [PMID: 28274535 DOI: 10.1016/j.resinv.2016.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 07/21/2016] [Revised: 09/29/2016] [Accepted: 10/18/2016] [Indexed: 06/06/2023]
Abstract
We herein report on two middle-aged men with TAFRO (thrombocytopenia, anasarca, fever, reticulin fibrosis or renal failure, and organomegaly) syndrome, a unique clinicopathological variant of multicentric Castleman׳s disease recently proposed in Japan. Strikingly similar anterior mediastinal fat swellings with soft tissue density were observed in the patients on chest computed tomography. In TAFRO syndrome, bilateral pleural effusion and slight lymph node swelling are common in the thoracic region; however, anterior mediastinal lesions have not been previously observed. Although the mechanisms of anterior mediastinal lesions have not been defined, these lesions seem to have a close relationship with TAFRO syndrome.
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Affiliation(s)
- Yoko Ozawa
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Hiroshi Yamamoto
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Masanori Yasuo
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Hidekazu Takahashi
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Kazunari Tateishi
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Atsuhito Ushiki
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Satoshi Kawakami
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Shiho Asaka
- Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Kenji Sano
- Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Hiroshi Takayama
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Hiroshi Imamura
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
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Pruvost E, Gatfossé M, Calzada MC, Mekinian A, Fain O. [POEMS syndrome]. Rev Prat 2015; 65:606. [PMID: 26165089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Chandrashekaran S, Dispenzieri A, Cha SS, Kennedy CC. Pulmonary morbidity improves after autologous stem cell transplantation in POEMS syndrome. Respir Med 2014; 109:122-30. [PMID: 25433952 DOI: 10.1016/j.rmed.2014.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/29/2014] [Accepted: 11/05/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND POEMS syndrome is a plasma cell disorder manifested by Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy and Skin changes. Pulmonary morbidity includes restriction, decreased diffusing capacity for carbon monoxide (DLCO), respiratory muscle weakness, abnormal imaging, and pulmonary hypertension. Autologous peripheral blood stem cell transplantation (aPBSCT) is an effective treatment for POEMS syndrome. It is unknown if aPBSCT improves pulmonary morbidity. We hypothesize pulmonary morbidity will improve following aPBSCT. METHODS Retrospective cohort study of POEMS syndrome aPBSCT recipients from 2000 to 2010. Demographic, pulmonary function test (PFT), echocardiogram, cytokine, and imaging data at baseline and after aPBSCT were abstracted. Pre- and post-transplant data were compared using Wilcoxon signed-rank and McNemar's tests. RESULTS 53 patients met criteria. Median improvements in forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and total lung capacity (TLC) after transplant were 180, 315 and 350 ml respectively (median follow-up of 1.1 years). DLCO, maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) improved by a median of 11, 12.5 and 10% predicted respectively. RVSP and chest imaging also improved. Vascular endothelial growth factor and IL-6 decreased by a median of 334 and 2 pg/ml respectively. All comparisons were statistically significant. Longitudinal data demonstrated stability in FEV1, MEP, and TLC and continued improvement in FVC, MIP and DLCO on subsequent PFTs (median follow-up 26.5 months). CONCLUSION Patients with POEMS syndrome treated with aPBSCT have significant improvement in PFTs, respiratory muscle strength, imaging, and post-transplant IL-6. The improvement in PFTs persists during long-term follow-up.
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Affiliation(s)
- Satish Chandrashekaran
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55902, USA.
| | - Angela Dispenzieri
- Division of Hematology, Mayo Clinic, 200 First St. SW, Rochester, MN 55902, USA.
| | - Stephen S Cha
- Department of Biomedical Statistics and Informatics, Mayo Clinic, 200 First St. SW, Rochester, MN 55902, USA.
| | - Cassie C Kennedy
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55902, USA.
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Piradov MA, Suponeva NA, Ginzberg MA, Nikitin SS, Varlamova EI, Ryzhko VV, Semochkin SV, Merkulova DM. [POEMS-syndrome: a literature review and case reports]. Zh Nevrol Psikhiatr Im S S Korsakova 2014; 114:4-10. [PMID: 24874310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
POEMS-syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, M-protein, and Skin Changes) is a rare nosological form occurred in patients with paraproteinemic hemoblastosis. Chronic progressive sensory-motor polyneuropathy is a key syndrome of the disease and it is a common reason for referral to neurologist. The paper presents data about POEMS-syndrome and own case reports with the analysis of disease features and results of examination.
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Tanaka N, Yoshinaga K, Asano C, Kazama H, Okamura T, Shiseki M, Mori N, Teramura M, Kusakabe K, Sakai S, Motoji T. [Usefulness of (18)F-FDG PET/CT for detecting lesions in patients with POEMS syndrome]. Rinsho Ketsueki 2012; 53:2013-2017. [PMID: 23318968] [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: 06/01/2023]
Abstract
Many patients with POEMS syndrome have osteosclerotic plasmacytoma. Radiation therapy is useful for patients who have localized lesions, although chemotherapy is necessary for patients who have widespread lesions. Thus, evaluation of these lesions is important to determine the therapeutic strategy. We evaluated the activities of lesions in two patients with POEMS syndrome by (18)F-FDG positron emission tomography (PET)/computed tomography (CT) scan. In the first patient, PET/CT scan revealed osteosclerotic lesions, which were not detected by Ga-scintigraphy or plain X-ray. It also detected residual disease activity and relapse. In the second patient, lymph node involvement was suggested by (18)F-FDG uptake, and plasmacytoma was confirmed by subsequent biopsy. In the extramedullary lesions of this case, FDG uptake was as marked as in myeloma, whereas bone lesion was only detectable by CT scan. In POEMS syndrome, the PET and CT are complementary, and the combined PET/CT scan is considered to be very useful for evaluation of involved lesions.
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Affiliation(s)
- Norina Tanaka
- Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan
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Yanik B, Conkbayir I, Keyik B, Yoldas TK. Sonographic findings in a case of polyneuropathy associated with POEMS syndrome. J Clin Ultrasound 2011; 39:473-476. [PMID: 21626513 DOI: 10.1002/jcu.20838] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 03/22/2011] [Indexed: 05/30/2023]
Abstract
Polyneuropathy, organomegaly, endocrinopathy, M protein and skin changes (POEMS) syndrome is a rare multi-system disease. We describe the ultrasonography (US) and color Doppler ultrasonography (CDUS) findings of peripheral neuropathy in a patient with POEMS syndrome. In US examination, peripheral nerves were found to be diffusely thickned in both upper limbs. CDUS imaging showed arterial blood flow with low systolic peaks on the nerves.
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Affiliation(s)
- Bahar Yanik
- Ministry of Health Yildirim Beyazit Dişkapi Educational and Research Hospital, Department of Radiology, TR-06110, Dişkapi, Ankara, Turkey.
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Shibuya K, Misawa S, Horikoshi T, Kanai K, Isose S, Nasu S, Sekiguchi Y, Noto YI, Fujimaki Y, Nakaseko C, Kuwabara S. Detection of bone lesions by CT in POEMS syndrome. Intern Med 2011; 50:1393-6. [PMID: 21720058 DOI: 10.2169/internalmedicine.50.5263] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To study the utility of CT for detection of small bone lesions in POEMS (polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes) syndrome. For patients with a solitary bone lesion, irradiation is a first-line treatment, whereas systemic chemotherapy is indicated for patients with multiple bone lesions. Therefore it is important to correctly identify the number of bone lesions. METHODS We studied the sensitivity of chest/abdomen/pelvic CT to detect bone lesions in 28 patients with POEMS syndrome. (99m)Tc-HMDP bone scintigraphy was performed in 14 patients, and the results were compared with CT. RESULTS CT showed multiple bone lesions in 68% of the 28 patients, and 71% of the lesions had a diameter <10 mm. In 14 patients who underwent both CT and scintigraphy, bone lesions were detected in 57% by CT and in 79% by scintigraphy, but the location and nature of the identified lesions were considerably different; CT frequently showed small lesions (diameter <10 mm) in the vertebrae and pelvis, which were not detected by scintigraphy, whereas scintigraphy could show lesions in the skull and long bones. Overall, by using both examinations, multiple bone lesions were found for 86% of patients. CONCLUSION CT is particularly useful to detect small bone lesions. CT and bone scintigraphy are complementary, and therefore both should be performed for bone survey in POEMS syndrome.
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Affiliation(s)
- Kazumoto Shibuya
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
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Lanza C, Misericordia M, Fabrizzi G. POEMS syndrome in a 15-year-old boy: radiological findings. Pediatr Radiol 2007; 37:1147-50. [PMID: 17876573 DOI: 10.1007/s00247-007-0561-7] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 05/16/2007] [Accepted: 05/31/2007] [Indexed: 11/30/2022]
Abstract
POEMS syndrome is a multisystem disorder related to a plasma-cell dyscrasia. It is usually seen between the ages of 40 and 50 years and is very rare in childhood. Radiologically, this syndrome is characterized by sclerotic focal bone lesions with a normal radionuclide bone scan. We report a case of POEMS syndrome in a 15-year-old boy in whom plain radiographs and multidetector-row spiral CT (MDCT) provided information that was helpful in the clinical assessment.
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Affiliation(s)
- Cecilia Lanza
- Paediatric Radiology Department, Azienda Ospedaliero-Universitaria Ospedali Riuniti, via Corridoni 11, Ancona, 60123, Italy.
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Chen F, Zhang K, Tan X, Zuo X, Luo L, He L, Xiao H. Autologous peripheral blood stem cell transplantation in a patient with POEMS syndrome. Ann Hematol 2007; 87:247-8. [PMID: 17849116 DOI: 10.1007/s00277-007-0379-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Accepted: 08/27/2007] [Indexed: 10/22/2022]
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Maisonobe T, Jaccard A. [Chronic inflammatory demyelinating polyneuropathy (CIDP) revealing an associated disease diagnostic and therapeutic pitfalls]. Rev Neurol (Paris) 2007; 163 Spec No 1:3S61-3S67. [PMID: 18087232] [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: 05/25/2023]
Abstract
The objective of this case report is to illustrate the problem's diagnosis of a CIDP revealing a associated disease. The patient had initially a sensory CIDP wich respond to prednisone. After 2 years, he worsened with motor deficit, pain and atypical skin's lesions. The diagnosis of POEMS syndrome was made only in the fourth research of monoclonal gammopathy. A specific treatment was realised but too late and a important motor deficit with axonal loss unfortunately persisted.
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Affiliation(s)
- T Maisonobe
- Fédération de Neurophysiologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP et Université Paris VI, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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Chong ST, Beasley HS, Daffner RH. POEMS syndrome: radiographic appearance with MRI correlation. Skeletal Radiol 2006; 35:690-5. [PMID: 16247640 DOI: 10.1007/s00256-005-0941-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2004] [Revised: 03/31/2005] [Accepted: 04/01/2005] [Indexed: 02/02/2023]
Abstract
POEMS syndrome is a rare disorder in which patients present with the hallmark signs of polyneuropathy, organomegaly, endocrinopathy, M protein and skin changes. Many other clinical findings are also often present, most notably osseous lesions. The MRI appearance of the bony lesions in POEMS syndrome has been described in five cases, four of which are in the non-English literature. We report the MRI appearance of the osseous lesions in a patient with POEMS syndrome who presented with sciatic neuropathy.
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Affiliation(s)
- Suzanne T Chong
- Department of Diagnostic Radiology, The Western Pennsylvania Hospital, Pittsburgh, Pennsylvania, USA.
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Shiraki T, Satoh S, Sugiyama H, Kobayashi M, Takamura T, Kajiyama A, Saito D. [Highly concentrated vascular endothelial growth factor in Crow-Fukase syndrome with high output heart failure: a case report]. J Cardiol 2005; 45:75-80. [PMID: 15768610] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Crow-Fukase syndrome is a disease of plasma cell dyscrasia. Congestive heart failure is the biggest complication affecting the prognosis. A 57-year-old male was admitted with edema and low grade fever. Globe and stocking type polyneuropathy, increased levels of adrenocorticotropic hormone and thyroid-stimulating hormone, serum M-protein component of the immunoglobulin A-lambda type, skin polypoid lesion, and organomegaly including cardiomegaly were observed. The diagnosis was Crow-Fukase syndrome based on these clinical features. High output heart failure and pulmonary hypertension were determined with a cardiac catheter. Diuretics and angiotensin converting enzyme inhibitor were effective to control his overhydration. The level of serum vascular endothelial growth factor was markedly increased and might be responsible for the manifestation of this syndrome with cardiac involvement.
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Affiliation(s)
- Teruo Shiraki
- Department of Internal Medicine, National Hospital Organization, Iwakuni Medical Center, Yamaguchi
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18
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Abstract
A 31-year-old man was admitted to our hospital for further evaluation of heart failure symptoms. Crow-Fukase syndrome was diagnosed on the basis of findings of polyneuropathy, hepatomegaly, monoclonal hypergammaglobulinemia, and hypertrichosis. Dipyridamole-stress thallium-201 perfusion imaging, contrast left ventriculography, and coronary angiography revealed a markedly dilated and dysfunctioning left ventricle, extensive reversible ischemia with fixed defect, and multiple coronary lesions. Histopathology of myocardial biopsy specimens demonstrated ischemia-induced myocardial necrosis. These findings suggested that ischemic cardiomyopathy, probably due to inflammatory reactions of coronary arteries in Crow-Fukase syndrome, was responsible for the heart failure symptoms and left ventricular dysfunction in this patient.
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Affiliation(s)
- Y Ichikawa
- Second Department of Internal Medicine, Sapporo Medical University School of Medicine
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19
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Gandhi D, Vashisht S, Mahajan A, Kapoor A, Berry M. Proptosis with orbital soft tissue and bone changes and unilateral papilloedema: unusual presentation of POEMS syndrome. Clin Imaging 2000; 24:193-6. [PMID: 11274880 DOI: 10.1016/s0899-7071(00)00209-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
POEMS syndrome is a rare manifestation comprising of polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes. Orbital involvement in this syndrome is rare and manifestation with proptosis, even rarer. The imaging features in Poems syndrome and rarity of various features in our case are being highlighted here.
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Affiliation(s)
- D Gandhi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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20
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Soubrier M, Guillon R, Dubost JJ, Serre AF, Ristori JM, Boyer L, Sauvezie B. Arterial obliteration in POEMS syndrome: possible role of vascular endothelial growth factor. J Rheumatol 1998; 25:813-5. [PMID: 9558193] [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: 02/07/2023]
Abstract
Acute arterial obliteration is a newly acknowledged manifestation of the POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, M protein, skin changes), in which overproduction of proinflammatory cytokines has been implicated. We describe a case in which serum levels of proinflammatory cytokines were normal or slightly raised. In contrast, vascular endothelial growth factor (VEGF) was greatly increased. This angiogenic and vascular permeability factor is involved in the development of atheromatous and thrombotic lesions and may be responsible for the arterial complications of the disorder.
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Affiliation(s)
- M Soubrier
- Département de Rheumatologie; Faculté de Médecine et de Pharmacie, Hôpital Montpied, Clermont-Ferrand, France
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21
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Abstract
POEMS syndrome is a multisystemic disorder related to a plasma cell dyscrasia. Radiologically, this syndrome is characterized by sclerotic focal bone lesions with a normal radionuclide bone scan. We report a case of POEMS syndrome with an expansile lytic lesion in the sternum showing periosteal reaction and soft tissue mass, which revealed locally increased uptake of radiotracer in bone scintigraphy. These unusual findings and the differential diagnosis are discussed.
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Affiliation(s)
- J A Narváez
- Department of CT and MR Imaging, Institut de Diagnòstic per la Imatge, Hospital Duran i Reynals, Ciudad Sanitaria y Universitaria de Bellvitge, Autovia de Castelldefels km. 2'7, E-08907 L'Hospitalet de Llobregat, Barcelona, Spain
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22
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Lacy MQ, Gertz MA, Hanson CA, Inwards DJ, Kyle RA. Multiple myeloma associated with diffuse osteosclerotic bone lesions: a clinical entity distinct from osteosclerotic myeloma (POEMS syndrome). Am J Hematol 1997; 56:288-93. [PMID: 9395194 DOI: 10.1002/(sici)1096-8652(199712)56:4<288::aid-ajh16>3.0.co;2-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Multiple myeloma usually is characterized by the development of lytic bone lesions. Osteosclerotic myeloma is a rare entity characterized by a single or multiple osteosclerotic bone lesions and often accompanied by a demyelinating polyneuropathy. Multiple myeloma associated with widespread osteosclerotic lesions seen on radiographic studies is exceedingly rare. We describe 3 such cases and review 12 other cases described in the literature. Overall, the patients described herein had a clinical course that resembled multiple myeloma more than osteosclerotic myeloma. However, some patients had features of both diseases. Although rare, multiple myeloma should be included in the differential diagnosis of widespread osteosclerotic bone lesions.
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Affiliation(s)
- M Q Lacy
- Division of Hematology and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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23
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Affiliation(s)
- C F Kirsch
- Department of Radiology, University of California, San Francisco 94143-0628, USA
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24
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Dieckmann C, Nicolas V. [POEMS syndrome]. Radiologe 1995; 35:528-30. [PMID: 7568799] [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: 01/26/2023]
Abstract
The POEMS-syndrome is a very rare disorder, of which not much more than 100 cases are known worldwide, mostly in Japan. The following case report depicts the typical radiological changes to the skeletal system and inner organs.
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Affiliation(s)
- C Dieckmann
- Abteilung Röntgendiagnostik, Universitätskrankenhaus, Hamburg-Eppendorf
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25
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Abstract
A patient with a three year history of POEMS syndrome-polyneuropathy, hepatosplenomegaly M-protein, skin changes, optic disc edema, peripheral oedema, pleuritis, lymphadenopathy, and osteosclerotic myeloma is described. The patient had a twenty year history of psoriasis and impotence was the first sign of the disease. The pathophysiology of this multisystem disorder is unknown, although the M-protein is essential. No improvement was found after radiation, chemotherapy and steroid treatment.
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Affiliation(s)
- I Milanov
- University Hospital IV kilometer, III Neurological Clinic, Sofia, Bulgaria
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Souto FJ, Grzesiuk AK. [POEMS syndrome: report of a Brazilian case with fatal course]. Rev Assoc Med Bras (1992) 1994; 40:47-9. [PMID: 8061695] [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: 01/28/2023] Open
Abstract
The authors report a case of a 27 year old man with severe polyneuropathy, multiple endocrine and cutaneous disorders, ascites, edema and multiple osteosclerotic lesions. Clinical and laboratory diagnosis of POEMS syndrome was made. The patient condition worsened progressively and death followed. The literature search showed that this is the first Brazilian case report about such a syndrome.
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Affiliation(s)
- F J Souto
- Hospital Universitário Júlio Muller, Universidade Federal de Mato Grosso, Cuiabá
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Abstract
A patient with classical POEMS syndrome associated with a myeloproliferative disorder is presented, in whom extensive arterial calcification was seen at an early age in the absence of other predisposing factors. Radiographs also demonstrated several small discrete sclerotic foci elsewhere in the skeleton and areas of new bone formation around the spine which were described in previous cases. Histological studies in this patient demonstrated an osteosclerotic solitary plasmacytoma of bone and Castleman's disease of lymph nodes, both of which have previously been causally associated with POEMS syndrome. In addition, dermal infiltration by mast cells was demonstrated.
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Affiliation(s)
- A Jackson
- Department of Diagnostic Radiology, University of South Manchester, U.K
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28
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Affiliation(s)
- J Meding
- Department of Orthopedic Surgery, University of Cincinnati, Ohio
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