Harjacek Miroslav
Djecja bolnica Srebrnjak, Srebrnjak 100, 10000 Zagreb.
Reumatizam. 2012;59(2):39-43.
In patients with chronic inflammatory myositis noninvasive diagnostic modalities, such as magnetic resonance (MR) imaging, and ultrasonography (US), are able to demonstrate muscular edema, fluid collections, fatty infiltration, atrophy, fibrosis, and calcifications. Because MR imaging is sensitive to the presence of edema and offers better tissue differentiation, current MR imaging with fat suppressed T2-weighted techniques or STIR images appears to be more efficient than US in the diagnosis and management of inflammatory myopathies. MR imaging has also been proposed as a means to guide biopsy in an area of active disease, thereby reducing the problem of sampling error. These changes in signal intensity, however, are not specific for myositis. Although MR imaging is now the imaging modality of choice in this issue, reduced availability, patient discomfort, and exclusion of certain patients with indwelling metal objects, such as pacemakers, are disadvantages. The availability and ease of use of US makes it preferable to MR imaging. Real-time sonoelastography can be used for various musculoskeletal applications, but the clinical utility in diagnosis of myositis is yet to be established. On the other hand, the contrast-enhanced US is a feasible method for noninvasively demonstrating increased perfusion in the involved muscle groups, and most likely, will soon become preferable, noninvasive imaging method in patients with myositis.
在慢性炎症性肌炎患者中，磁共振成像（MR）和超声检查（US）等非侵入性诊断方法能够显示肌肉水肿、液体积聚、脂肪浸润、萎缩、纤维化和钙化。由于磁共振成像对水肿的存在敏感且能提供更好的组织分辨能力，目前采用脂肪抑制T2加权技术或短T1反转恢复（STIR）序列成像的磁共振成像在炎症性肌病的诊断和管理方面似乎比超声更有效。磁共振成像还被提议作为在疾病活动区域指导活检的一种手段，从而减少抽样误差问题。然而，这些信号强度的变化并非肌炎所特有。尽管磁共振成像目前是这个问题上的首选成像方式，但可用性降低、患者不适以及排除某些体内有植入金属物体（如起搏器）的患者等都是其缺点。超声的可用性和易用性使其比磁共振成像更具优势。实时超声弹性成像可用于各种肌肉骨骼应用，但在肌炎诊断中的临床效用尚未确立。另一方面，超声造影是一种非侵入性显示受累肌肉群灌注增加的可行方法，很可能很快成为肌炎患者首选的非侵入性成像方法。
