Localized scleroderma: multiparametric MRI with diffusion-weighted imaging and gadolinium-based perfusion imaging for assessing disease activity.

OBJECTIVE

Conventional MRI has been used to evaluate morphea, but its role in assessing disease activity remains limited. This study explores the utility of multiparametric MRI (MPMRI) in assessing disease activity in morphea.

MATERIALS AND METHODS

This retrospective study included 35 patients with morphea who underwent MRI with diffusion-weighted imaging (DWI) and perfusion techniques, including delayed post-contrast sequences. Most patients were female (n = 23, 65.7%) with a mean age of 39.1 years (± 15.7). Morphea subtypes included linear (n = 16), generalized (n = 10), En-Coup-de Sabre (n = 4), Parry Romberg (n = 2), and eosinophilic fasciitis (n = 3). Three musculoskeletal radiologists independently assessed lesion extent and activity, with findings correlated to the Physician Global Assessment (PGA) of clinical activity. Inter-reader agreement was assessed using weighted Conger's Kappa and Intraclass Correlation Coefficient (ICC).

RESULTS

Clinically active disease was present in 21 patients (60%), while 14 (40%) had inactive disease. Increased perfusion and delayed enhancement were noted in 15/21 (71%) active cases and absent in 10/14 (71%) inactive cases (P = 0.0181). Radiologist-classified active lesions had significantly higher PGA scores than inactive lesions (P = 0.016). Mean apparent diffusion coefficient (ADC) values were higher in active lesions (1.21 ± 0.72 × 10 mm/s) versus inactive lesions (0.82 ± 0.58 × 10 mm/s) (P = 0.11), though inter-reader reliability for ADC was poor (ICC = 0.29). Inter-reader agreement for perfusion and disease activity was excellent (Kappa = 0.87).

CONCLUSION

MPMRI shows promise for assessing disease extent and activity in morphea, correlating with dermatologic assessment. Perfusion and delayed enhancement were associated with active disease, while DWI showed a nonsignificant trend and variability, limiting its current utility.