Article Text

PDF
SAT0302 Does MRI Have an Added Value over CK in Assessing Disease Activity in the Idiopathic Inflammatory Myopathies?
  1. A. Notarnicola1,
  2. F. Iannone1,
  3. M. Giannini1,
  4. S. Paolotti2,
  5. A. Scardapane2,
  6. C. Salvarani3,
  7. N. Pipitone4
  1. 1Rheumatology Clinic, University of Bari
  2. 2Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Bari
  3. 3Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Rheumatology Unit
  4. 4Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Rheumatology Unit, Reggio Emilia, Italy

Abstract

Background MRI is the most widely used imaging procedure to assess disease activity of the idiopathic inflammatory Myopathies (IIM). Thigh muscle oedema, detected by T2-weighted and fat-suppressed (short tau inversion recovery, STIR) sequences, reflects active inflammation in 89-98% of IIM patients1–2.Despite its high sensitivity in visualizing biopsy-proven inflammatory muscle lesions, the real usefulness of MRI in evaluating myositis disease activity is still controversial3–4

Objectives To assess the concordance between creatine-phosphokinase (CK) levels and MRI oedema of thigh muscles in a cohort of patients with IIM.

Methods We enrolled in 2 Italian Rheumatology centers 44 IIM patients, 19 with Polymyositis (PM) and 25 with Dermatomyositis (DM) according to Bohan and Peter criteria. In all patients, CK levels (n.v. 60-190 U/L) were measured and STIR MRI sequences were acquired at the same time. MRI oedema (1= present, 0= absent) was assessed bilaterally by STIR in 17 thigh and pelvic floor muscles. A MR global oedema score (0-17) was calculated by adding the separate scores bilaterally and dividing them by two.

Results At baseline, 18 patients (41%) showed positive MRI and positive CK, 5 (11%) negative MRI and negative CK, 14 (32%) positive MRI and negative CK, and 7 (16%) negative MRI and positive CK. CK levels were in the normal range in 5 out of 19 PM patients (26%) and in 14 out of 25 DM patients (56%). The presence of oedema was detected in 11 out of 19 PM patients (56%) and in 21 out of 25 DM patients (84%). Considering the two subsets separately, the combination of negative CK and positive MRI was observed in 2 PM (11%) and in 12 DM (48%) patients. The CK-MRI concordance/discordance rate was 1.7 for PM and 0.78 for DM patients.

Conclusions At the first evaluation 32% of IIM patients (5% PM and 27% DM) had active inflammation (MRI oedema) despite normal CK levels. MRI muscle oedema was observed more frequently in DM (84%) than PM (56%) patients. Therefore, our preliminary data suggest that MRI may be considered a useful tool for disease activity assessment of IIM, especially in DM. Further studies of larger cohort of IIM patients are needed to confirm our results and evaluate the role of MRI in monitoring the disease course.

References

  1. Reimers CD, Schedel H, Fleckenstein JL, Nägele M, Witt TN, Pongratz DE, Vogl TJ. Magnetic resonance imaging of skeletal muscles in idiopathic inflammatory myopathies of adults. J Neurol 1994; 241:306-14.

  2. Fraser DD, Frank JA, Dalakas M, Miller FW, Hicks JE, Plotz P: Magnetic resonance imaging in the idiopathic inflammatory myopathies. J Rheumatol 1991; 18(11):1693-700.

  3. Tomasová Studynková J, Charvát F, Jarosová K, Vencovsky J. The role of MRI in the assessment of polymyositis and dermatomyositis. Rheumatology 2007; 46:11.

  4. A. Notarnicola, A. Scardapane, N. Pipitone, G. Zuccoli, G. Levrini, C. Salvarani, A. Marbini, A. Amati, M. Ficco, G. Angelelli, F. Iannone, G. Lapadula. The role of magneting resonance imaging (MRI) in the aassessment of idiophatic inflammatory myopathies (IIM). Ann Rheum Dis 2011;70(Suppl3):474.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.5064

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.