Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA.
National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA.
Rheumatology (Oxford). 2024 Jan 4;63(1):58-63. doi: 10.1093/rheumatology/kead256.
To utilize whole-body CT imaging and calcium scoring techniques as tools for calcinosis assessment in a prospective cohort of patients with adult and juvenile dermatomyositis (DM and JDM, respectively).
Thirty-one patients (14 DM and 17 JDM) who fulfilled Bohan and Peter Classification criteria as probable or definite DM, the EULAR-ACR criteria for definite DM, and with calcinosis identified by physical examination or prior imaging studies were included. Non-contrast whole-body CT scans were obtained using low-dose radiation procedures. Scans were read qualitatively and quantitated. We calculated the sensitivity and specificity of calcinosis detection of physician physical exam against CT. We quantified calcinosis burden using the Agatston scoring technique.
We identified five distinct calcinosis patterns: Clustered, Disjoint, Interfascial, Confluent and Fluid-filled. Novel locations of calcinosis were observed, including the cardiac tissue, pelvic and shoulder bursa, and the spermatic cord. Quantitative measures using Agatston scoring for calcinosis were used in regional distributions across the body. Physician physical exams had a sensitivity of 59% and a specificity of 90% compared with CT detection. A higher calcium score correlated with higher Physician Global Damage, Calcinosis Severity scores, and disease duration.
Whole-body CT scans and the Agatston scoring metric define distinct calcinosis patterns and provide novel insights relating to calcinosis in DM and JDM patients. Physicians' physical examinations underrepresented the presence of calcium. Calcium scoring of CT scans correlated with clinical measures, which suggests that this method may be used to assess calcinosis and follow its progression.
利用全身 CT 成像和钙评分技术作为评估成人和青少年皮肌炎（DM 和 JDM）患者钙沉积的工具。
纳入了 31 名患者（14 名 DM 和 17 名 JDM），这些患者均符合 Bohan 和 Peter 分类标准中的可能或明确 DM、EULAR-ACR 标准中的明确 DM，并通过体格检查或先前的影像学研究发现钙沉积。使用低剂量辐射程序获得非对比全身 CT 扫描。扫描进行定性和定量阅读。我们计算了体格检查对 CT 检测钙沉积的敏感性和特异性。我们使用 Agatston 评分技术量化钙沉积负担。
我们发现了五种不同的钙沉积模式：簇状、离散、筋膜间、融合和充满液体。还观察到钙沉积的新部位，包括心脏组织、骨盆和肩部滑囊以及精索。使用 Agatston 评分对钙沉积进行的定量测量用于身体的区域分布。与 CT 检测相比，体格检查的敏感性为 59%，特异性为 90%。较高的钙评分与较高的医师整体损伤、钙沉积严重程度评分和疾病持续时间相关。
全身 CT 扫描和 Agatston 评分指标定义了不同的钙沉积模式，并提供了有关 DM 和 JDM 患者钙沉积的新见解。医生的体格检查未能充分反映钙的存在。CT 扫描的钙评分与临床指标相关，这表明该方法可用于评估钙沉积并监测其进展。
