Department of Neurology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam Neuroscience.
Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Amsterdam Movement Sciences, Amsterdam.
Rheumatology (Oxford). 2022 Dec 23;62(1):300-309. doi: 10.1093/rheumatology/keac263.
To prospectively compare ultrasound (US) and whole-body MRI for detection of muscle abnormalities compatible with idiopathic inflammatory myopathies (IIM).
Newly diagnosed IIM patients underwent US (14 muscles) and MRI (36 muscles) at diagnosis and after nine weeks monotherapy with intravenous immunoglobulin. Muscles were compatible with IIM when quantitative US echo-intensity (EI) z scores was ≥1.5, semi-quantitative US Heckmatt score was ≥2, qualitative US was abnormal, or when MRI showed oedema on T2-weighted images. At patient level, findings were classified as abnormal when quantitative US EI z scores was >1.5 (n = 3 muscles), >2.5 (n = 2 muscles) or >3.5 (n = 1 muscle), or if ≥3 muscles showed abnormalities as described above for the other diagnostic methods.
At diagnosis, in 18 patients US of 252 muscles revealed abnormalities in 36 muscles (14%) with quantitative, in 153 (61%) with semi-quantitative and in 168 (67%) with qualitative analysis. MRI showed oedema in 476 out of 623 muscles (76%). Five patients (28%) reached abnormal classification with quantitative US, 16 (89%) with semi-quantitative and qualitative US, and all patients (100%) with MRI. Nine-week follow-up of 12 patients showed no change over time with quantitative US or MRI, and a decrease in abnormalities with semi-quantitative US (P <0.01), and qualitative US (P <0.01).
At diagnosis, MRI was more sensitive than US to detect muscle abnormalities compatible with IIM. Semi-quantitative US and qualitative US detected abnormalities in the majority of the patients while evaluating fewer muscles than MRI and showed change over time after nine weeks of treatment.
前瞻性比较超声（US）和全身 MRI 检测与特发性炎症性肌病（IIM）相符的肌肉异常。
新诊断的 IIM 患者在诊断时以及静脉免疫球蛋白单药治疗 9 周后进行 US（14 块肌肉）和 MRI（36 块肌肉）检查。当定量 US 回声强度（EI）z 评分≥1.5、半定量 US Heckmatt 评分≥2、定性 US 异常或 MRI 显示 T2 加权图像上的水肿时，肌肉与 IIM 相符。在患者水平，当定量 US EI z 评分>1.5（n=3 块肌肉）、>2.5（n=2 块肌肉）或>3.5（n=1 块肌肉）时，或当上述其他诊断方法描述的≥3 块肌肉出现异常时，将发现归类为异常。
在诊断时，在 18 名患者的 252 块肌肉的 US 中，36 块肌肉（14%）出现异常，其中定量分析有 153 块（61%），半定量分析有 168 块（67%），定性分析有 168 块（67%）。MRI 在 623 块肌肉中的 476 块（76%）显示水肿。5 名患者（28%）达到定量 US 的异常分类，16 名患者（89%）达到半定量和定性 US 的异常分类，所有患者（100%）达到 MRI 的异常分类。12 名患者的 9 周随访显示，定量 US 或 MRI 无时间变化，半定量 US（P<0.01）和定性 US（P<0.01）的异常减少。
在诊断时，MRI 比 US 更敏感地检测与 IIM 相符的肌肉异常。半定量 US 和定性 US 在评估较少肌肉的情况下，检测到大多数患者的异常，并且在 9 周治疗后显示出时间变化。
