1
|
Alkhatib M, Alneasan M, Aji W. Focal myositis in the foot: one unique case in the plantar aspect. J Surg Case Rep 2022; 2022:rjac594. [PMID: 36601091 PMCID: PMC9803970 DOI: 10.1093/jscr/rjac594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/02/2022] [Indexed: 01/01/2023] Open
Abstract
We present a case of an acquired deformity of the toes of a young patient with no previous pathologic or traumatic history. Later, it emerged that it was 'Focal Myositis' at the Flexor Digitorum Brevis muscle of the right foot. The clinical course of the case involved a hard painless mass at the muscle belly that increased in size very slowly over several years, causing flexion contracture of the third toe without an accompanying skin lesion.
Collapse
Affiliation(s)
- Mohammad Alkhatib
- Department of Orthopaedic Surgery, Damascus Hospital, Damascus, Syria
| | - Moaaz Alneasan
- Correspondence address. Residential Building For Residents Of Tishreen University Hospital, Halap Street, GRG3+M3G Latakia, Syria. Tel: +963937497810; E-mail:
| | - Widad Aji
- Department of Rhumatology, Damascus Hospital, Damascus, Syria
| |
Collapse
|
2
|
Simonsen JA, Thøgersen KF, Hvidsten S, Gerke O, Høilund-Carlsen PF, Diederichsen LP. Treatment-naïve idiopathic inflammatory myopathy: disease evaluation by fluorodeoxyglucose versus pyrophosphate. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00822-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Imaging of idiopathic inflammatory myopathies (IIMs) is challenging, and no pathognomonic signs exist. Different tracers have been tested for this purpose, mainly inflammation markers including technetium-99m-pyrophosphate (PYP). We aimed to examine the utility of fluorine-18-fluorodeoxyglucose (FDG) relative to PYP in idiopathic inflammatory myopathy (IIM).
Methods
Using visual grading and CT-guided muscular segmentation and standardized uptake values (SUVs), we assessed muscular tracer uptake qualitatively and quantitatively, comparing FDG uptake in eight patients with recent-onset IIM and 24 healthy control persons and FDG and PYP uptake in seven patients.
Results
Muscular FDG and PYP uptake was increased in all patients. However, uptake distribution and signal intensity differed considerably. FDG scans revealed clear involvement of certain muscle groups including core and swallowing muscles and, in addition, abnormality in diseased extra-muscular organs. PYP was mainly visible in bones, whereas muscular PYP uptake was generally discrete and primarily located in the extremities. Quantitatively, FDG uptake was significantly higher in patients than in controls; the volume-weighted SUVmean for all right-side muscles was 0.84 versus 0.60 g/ml (95% confidence interval (CI) for mean difference 0.14–0.34, p = 0.0001). FDG SUVmean values were up to four times higher than PYP mean values in upper limb muscles (95% CI for the mean ratio 2.37–3.77, p = 0.0004) and two–three times higher in lower limb muscles (95% CI for the mean ratio 2.28–2.71, p < 0.0001).
Conclusions
Muscular FDG uptake was higher in treatment-naïve IIM patients than in healthy controls and more distinct than PYP uptake in patients with a potential to reveal extra-muscular IIM involvement and malignancy. Thus, FDG appears to be superior to PYP in the diagnostic evaluation of IIM.
Collapse
|
3
|
Thøgersen KF, Simonsen JA, Hvidsten S, Gerke O, Jacobsen S, Høilund-Carlsen PF, Buch-Olsen KM, Diederichsen LP. Quantitative 3D scintigraphy shows increased muscular uptake of pyrophosphate in idiopathic inflammatory myopathy. EJNMMI Res 2017; 7:97. [PMID: 29222707 PMCID: PMC5722781 DOI: 10.1186/s13550-017-0348-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/28/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Nuclear imaging is increasingly being used in the diagnostic work-up of idiopathic inflammatory myopathy (IIM). Increased muscular uptake of technetium-99m-pyrophosphate (99mTc-PYP) has hitherto been assessed qualitatively by planar scintigraphy. We set out to perform quantitative tomographic scintigraphy in IIM. RESULTS Ninety IIM patients and 48 control subjects underwent 99mTc-PYP single-photon emission computed tomography (SPECT)/CT of the upper and lower body. Scans were evaluated visually by an intensity score (1-4) and quantitatively by the mean standardized uptake value (SUVmean) in thigh muscles after semi-automated segmentation of these. Furthermore, a SUVmean gradient down along the thighs was determined by linear regression of the slice-by-slice activity. Interobserver analyses were performed on qualitative evaluations. Compared to controls, patients more often had a high intensity score (p < 0.0001), but interobserver analyses revealed only moderate agreement. The thigh muscular 99mTc-PYP activity (SUVmean) was 60% higher in patients than in controls, p < 0.0001, albeit with a wide range. There was an activity gradient down the thigh muscle, the proximal tracer uptake being highest, and this gradient was steeper in patients than in controls; the activity decreased by 0.00024 and 0.00010 SUVmean mm-1, respectively, along the thighs. CONCLUSIONS The muscular uptake of 99mTc-PYP was significantly higher in patients than in healthy controls by qualitative and quantitative assessment. The tracer uptake was higher in the proximal than in the distal part of the thigh muscle, and SUVmean gradients differed between groups. Hence, tomographic nuclear imaging allowing for quantification of the 99mTc-PYP uptake might contribute to the diagnosis of IIM, and SPECT/CT of the lower body might suffice.
Collapse
Affiliation(s)
- Karin Folmer Thøgersen
- Department of Nuclear Medicine, Odense University Hospital, Kløvervænget 47, 5000, Odense, Denmark.,Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Jane Angel Simonsen
- Department of Nuclear Medicine, Odense University Hospital, Kløvervænget 47, 5000, Odense, Denmark.
| | - Svend Hvidsten
- Department of Nuclear Medicine, Odense University Hospital, Kløvervænget 47, 5000, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Kløvervænget 47, 5000, Odense, Denmark.,Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Kløvervænget 47, 5000, Odense, Denmark.,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | | | - Louise Pyndt Diederichsen
- Department of Rheumatology, Odense University Hospital, Odense, Denmark.,Clinical Institute, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
4
|
Diederichsen LP, Simonsen JA, Diederichsen AC, Hvidsten S, Hougaard M, Junker P, Søndergaard K, Lundberg IE, Tvede N, Sandgaard NCF, Christensen AF, Dreyer L, Kay S, Eskerud KS, Petersen H, Ejstrup L, Jacobsen S. Cardiac Abnormalities in Adult Patients With Polymyositis or Dermatomyositis as Assessed by Noninvasive Modalities. Arthritis Care Res (Hoboken) 2017; 68:1012-20. [PMID: 26502301 DOI: 10.1002/acr.22772] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/09/2015] [Accepted: 10/20/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Cardiac events are a major cause of death in patients with idiopathic inflammatory myopathies. The study objective was in a controlled setting to describe cardiac abnormalities by noninvasive methods in a cohort of patients with polymyositis (PM) or dermatomyositis (DM) and to identify predictors for cardiac dysfunction. METHODS In a cross-sectional study, 76 patients with PM/DM and 48 matched healthy controls (HCs) were assessed by serum levels of cardiac troponin I, electrocardiography, Holter monitoring, echocardiography with tissue Doppler imaging, and quantitative cardiac (99m) Tc-pyrophosphate ((99m) Tc-PYP) scintigraphy. RESULTS Compared to HCs, patients with PM/DM more frequently had left ventricular diastolic dysfunction (LVDD) (12% versus 0%; P = 0.02) and longer QRS and QT intervals (P = 0.007 and P < 0.0001, respectively). In multivariate analysis, factors associated with LVDD were age (P = 0.001), disease duration (P = 0.004), presence of myositis-specific or -associated autoantibodies (P = 0.05), and high cardiac (99m) Tc-PYP uptake (P = 0.006). In multivariate analysis of the pooled data for patients and HCs, a diagnosis of PM/DM (P < 0.0001) was associated with LVDD. CONCLUSION Patients with PM or DM had an increased prevalence of cardiac abnormalities compared to HCs. LVDD was a common occurrence in PM/DM patients and correlated to disease duration. In addition, the association of LVDD with myositis-specific or -associated autoantibodies and high cardiac (99m) Tc-PYP uptake supports the notion of underlying autoimmunity and myocardial inflammation in patients with PM/DM.
Collapse
Affiliation(s)
| | | | | | - S Hvidsten
- Odense University Hospital, Odense, Denmark
| | - M Hougaard
- Odense University Hospital, Odense, Denmark
| | - P Junker
- Odense University Hospital, Odense, Denmark
| | | | - I E Lundberg
- Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - N Tvede
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - L Dreyer
- Gentofte University Hospital, Hellerup, Denmark
| | - S Kay
- Odense University Hospital, Odense, Denmark
| | | | - H Petersen
- Odense University Hospital, Odense, Denmark
| | | | - S Jacobsen
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
5
|
Van De Vlekkert J, Maas M, Hoogendijk JE, De Visser M, Van Schaik IN. Combining MRI and muscle biopsy improves diagnostic accuracy in subacute-onset idiopathic inflammatory myopathy. Muscle Nerve 2015; 51:253-8. [DOI: 10.1002/mus.24307] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 05/09/2014] [Accepted: 05/29/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Janneke Van De Vlekkert
- Department of Neurology; Academic Medical Center; Meibergdreef 9, 1105 AZ Amsterdam The Netherlands
| | - Mario Maas
- Department of Radiology, Academic Medical Center; University of Amsterdam; The Netherlands
| | - Jessica E. Hoogendijk
- Rudolf Magnus Institute for Neuroscience, Department of Neurology; University Medical Center Utrecht; The Netherlands
| | - Marianne De Visser
- Department of Neurology; Academic Medical Center; Meibergdreef 9, 1105 AZ Amsterdam The Netherlands
| | - Ivo N. Van Schaik
- Department of Neurology; Academic Medical Center; Meibergdreef 9, 1105 AZ Amsterdam The Netherlands
| |
Collapse
|
6
|
Role of bone scan in the assessment of polymyositis/dermatomyositis. Clin Rheumatol 2014; 34:699-706. [PMID: 25501462 DOI: 10.1007/s10067-014-2837-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/28/2014] [Accepted: 11/30/2014] [Indexed: 12/20/2022]
Abstract
The aim of this study was to determine the significance of bone scan findings in Korean polymyositis/dermatomyositis (PM/DM) patients. The participants in this study were 26 PM/DM patients who fulfilled the proposed criteria for definite or probable PM/DM. All patients had been examined by bone scan. The results were analyzed visually and quantitatively using the uptake ratios. Correlations between the bone scan parameters of six proximal muscle groups (trapezius, deltoid, biceps, iliopsoas, quadriceps, and gluteus medius and maximus) and clinical parameters (laboratory values and manual muscle test) representing disease activities were assessed. Based on visual analyses of their bone scans, 10 of 14 (71.4 %) patients with active PM/DM had abnormal muscle uptake. Visual grading of the bone scans had a sensitivity and specificity of 74 and 90.9 %, respectively, for the assessment of muscle inflammation. Maximal proximal muscle uptake ratios, as determined on the bone scans, were significantly higher in patients with active PM/DM than in those with inactive disease (median 1.97 vs. 1.02, p = 0.046). Maximal proximal uptake ratios correlated significantly with creatine kinase (r = 0.394, p = 0.046), lactate dehydrogenase (LDH, r = 0.473, p = 0.015), aldolase (r = 0.428, p = 0.029), erythrocyte sedimentation rate (r = 0.412, p = 0.036), C-reactive protein (r = 0.454, p = 0.002), and manual muscle test results (r = -0.399, p = 0.044). Mean proximal muscle uptake ratios correlated significantly with LDH (r = 0.438, p = 0.025) and aldolase (r = 0.572, p = 0.002). Visually assessed proximal muscle uptake grades and maximal proximal muscle uptake ratios as determined by bone scan correlated significantly with the levels of known PM/DM disease activity markers. The findings of this study suggest that bone scan is a useful imaging technique for the evaluation of PM/DM patients.
Collapse
|
7
|
Abstract
A 37-year-old woman was admitted to our department with general fatigue, fever, and asymmetric pain in her lower legs, 2 weeks after a common cold. Dynamic skeletal scintigraphy with 780 MBq (20 mCi) Tc-99m HDP revealed increased perfusion and tracer uptake in the soft tissue of the lower legs, suggesting an inflammatory etiology. A muscle biopsy revealed a vasculitic necrotizing myopathy predominantly affecting the small vessels of the lower legs. We diagnosed it as a postinfectious immunologic reaction.
Collapse
|
8
|
Walker UA, Garve K, Brink I, Miehle N, Peter HH, Kelly T. 99mTechnetium pyrophosphate scintigraphy in the detection of skeletal muscle disease. Clin Rheumatol 2006; 26:1119-22. [PMID: 17119862 DOI: 10.1007/s10067-006-0463-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Revised: 10/03/2006] [Accepted: 10/04/2006] [Indexed: 11/24/2022]
Abstract
We aimed to assess the specificity and sensitivity of (99m)technetium pyrophosphate muscle scintigraphy in the diagnostic workup of patients with suspected myopathy. We reviewed the charts of 166 patients; 52% of the subjects had myalgias, 36% had muscle weakness, 45% had an elevated serum creatine kinase (CK), and 49% had an increased C reactive protein (CRP). Scintigraphy was positive in 34 patients (20%). The test was more sensitive in the presence of muscle weakness, elevated CK, or increased CRP. The presence of myalgias did not influence the odds. Sensitivity was 60% in patients with the final diagnosis of polymyositis, dermatomyositis, or inclusion body myositis, and 70% in noninflammatory myopathies. Eight percent had false positive scintigrams. In individuals with biopsy-proven myopathy (51 subjects), the diagnostic sensitivity was 43%, and its specificity was 60%. Low positive and high negative likelihood ratios (5.0 and 0.65, respectively) document an only limited diagnostic efficiency of (99m)Tc-PYP scintigraphy in the evaluation of inflammatory and noninflammatory myopathies and suggest that the test is not helpful in the routine diagnostic workup of muscle complaints, even after a priori selection of patients for CK plus CRP abnormalities.
Collapse
Affiliation(s)
- U A Walker
- Department of Rheumatology and Clinical Immunology, Albert-Ludwigs University Medical School, Hugstetterstr. 55, 79106 Freiburg, Germany.
| | | | | | | | | | | |
Collapse
|
9
|
Abstract
Through the recent efforts of multi-center collaborative study groups, a number of measures have been developed and partially validated to assess disease activity, disease damage, and health-related quality of life in adult and juvenile patients with IIM. Preliminary core set domains and core set measures of activity and damage have also been developed for adult and juvenile patients with myositis. Validated definitions of improvement and disability should be forthcoming in the next few years. These extraordinary developments will enable much-needed standardization in the assessment of the IIM, particularly in therapeutic and other clinical research studies. Despite this substantial progress, there is a need to develop more sensitive measures to assess IIM disease activity and damage, to further validate the existing tools, to define their performance characteristics in various IIM subgroups, to develop improved imaging techniques that are also quantitative, and to validate activation markers as surrogate measures. The ongoing cooperation of multiple specialists with expertise in these disorders, combined with emerging novel technologies, should continue to enhance the assessment of myositis. Improved clinical care and more rapid development of new therapies for patients with myositis will be the ultimate gains realized from these efforts.
Collapse
Affiliation(s)
- Lisa G Rider
- National Institute of Environmental Health Sciences, NIH 9 Memorial Drive, Room 1W107, MSC 0958 Bethesda, MD 20892, USA.
| |
Collapse
|
10
|
Ince A, Alam SM, Tariq SH, Moore TL, Sundaram M. Myositis of the quadriceps muscle group including vastus lateralis, vastus medialis, and rectus femoris. Orthopedics 2001; 24:22,77-8. [PMID: 11199343 DOI: 10.3928/0147-7447-20010101-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- A Ince
- Department of Radiology, St Louis University, MO 63110-0250, USA
| | | | | | | | | |
Collapse
|
11
|
Lundberg I, Chung Y. Treatment and investigation of idiopathic inflammatory myopathies. Rheumatology (Oxford) 2000; 39:7-17. [PMID: 10662868 DOI: 10.1093/rheumatology/39.1.7] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- I Lundberg
- Department of Rheumatology, Karolinska Hospital, S-171 76, Sweden
| | | |
Collapse
|