揭示特发性炎症性肌病的肌肉病理和临床特征的磁共振成像模式。

IF 4.7 2区医学 Q1 RHEUMATOLOGY Rheumatology Pub Date : 2024-10-01 DOI:10.1093/rheumatology/keae125

Takashi Shimoyama, Ken Yoshida, Yoshinao Muro, Haruyasu Ito, Takayuki Matsushita, Yohsuke Oto, Taro Ukichi, Kentaro Noda, Daitaro Kurosaka

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引用次数: 0

摘要

目的：特发性炎症性肌病（IIMs）是一种严重影响骨骼肌的自身免疫性疾病；然而，肌肉磁共振成像（MRI）结果、肌肉病理、疾病亚型和临床特征之间的精确相关性仍不确定。因此，我们研究了 IIM 患者肌肉磁共振成像结果与肌肉病理和临床特征之间的关联：新发 IIM 患者均接受了上肢和/或下肢近端肌肉 MRI 检查。MRI 上的肌肉水肿模式分为筋膜型、蜂窝型、周边型、雾状型、密集型或粗点型，并与相应肌肉活检中的炎性细胞浸润部位进行比较。利用肌炎特异性抗体（MSA）和2017 EULAR/ACR分类标准对患者亚组中MRI模式的发生率进行了研究。进行了单变量和多变量分析，以确定磁共振成像结果与临床特征的几率比（ORs）：85名患者中有56名接受了肌肉活检。活检部位的雾状、蜂窝状和筋膜状形态分别与肌内膜（OR 11.9，p= 0.005）、肌周（OR 6.0，p= 0.014）和筋膜（OR 16.9，p< 0.001）的炎性细胞浸润相关。抗TIF1γ或抗Mi2抗体和MSA阴性皮肌炎患者以及抗SRP或抗HMGCR抗体和MSA阴性多发性肌炎（PM）患者分别具有蜂窝状和雾状模式。蜂窝状图案与恶性肿瘤（OR 6.87，P< 0.001）和戈特龙征（OR 8.05，P= 0.002）呈正相关；雾状图案与肌无力（OR 11.24，P= 0.005）呈正相关。密点模式与吞咽困难（OR 6.27，p= 0.006）和恶性肿瘤（OR 8.49，p= 0.002）相关：肌肉磁共振成像有望预测IIM的肌肉病理、疾病亚型和临床表现。

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Magnetic resonance imaging patterns revealing muscle pathology and clinical features in idiopathic inflammatory myopathies.

Objective: Idiopathic inflammatory myopathies (IIMs) are autoimmune disorders significantly impacting skeletal muscles; however, the precise correlation between muscle magnetic resonance imaging (MRI) findings, muscle pathology, disease subtypes and clinical characteristics remains uncertain. Thus, we investigated the association of muscle MRI findings in IIMs with muscle pathology and clinical features.

Methods: New-onset IIM patients underwent proximal upper and/or lower limb muscle MRI. Patterns of muscle oedema on MRI were categorised into fascial, honeycomb, peripheral, foggy, dense, or coarse dot patterns and compared with inflammatory cell infiltration sites in corresponding muscle biopsies. The incidence of MRI patterns was examined in patient subgroups using myositis-specific antibodies (MSAs) and 2017 EULAR/ACR classification criteria. Univariate and multivariate analyses were conducted to determine the odds ratios (ORs) of MRI findings for clinical characteristics.

Results: Fifty-six of 85 patients underwent muscle biopsy. Foggy, honeycomb and fascial patterns at biopsy sites correlated with inflammatory cell infiltration in the endomysium (OR 11.9, P = 0.005), perimysium (OR 6.0, P = 0.014) and fascia (OR 16.9, P < 0.001), respectively. Honeycomb and foggy patterns were characteristic of patients with anti-TIF1γ or anti-Mi2 antibodies and MSA-negative dermatomyositis, and those with anti-SRP or anti-HMGCR antibodies and MSA-negative polymyositis (PM), respectively. The honeycomb pattern positively correlated with malignancy (OR 6.87, P < 0.001) and Gottron sign (OR 8.05, P = 0.002); the foggy pattern correlated with muscle weakness (OR 11.24, P = 0.005). The dense dot pattern was associated with dysphagia (OR 6.27, P = 0.006) and malignancy (OR 8.49, P = 0.002).

Conclusion: Muscle MRI holds promise in predicting muscle pathology, disease subtypes and clinical manifestations of IIMs.

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来源期刊

Rheumatology 医学-风湿病学

CiteScore

9.40

自引率

7.30%

发文量

1091

审稿时长

2 months

期刊介绍： Rheumatology strives to support research and discovery by publishing the highest quality original scientific papers with a focus on basic, clinical and translational research. The journal’s subject areas cover a wide range of paediatric and adult rheumatological conditions from an international perspective. It is an official journal of the British Society for Rheumatology, published by Oxford University Press. Rheumatology publishes original articles, reviews, editorials, guidelines, concise reports, meta-analyses, original case reports, clinical vignettes, letters and matters arising from published material. The journal takes pride in serving the global rheumatology community, with a focus on high societal impact in the form of podcasts, videos and extended social media presence, and utilizing metrics such as Altmetric. Keep up to date by following the journal on Twitter @RheumJnl.