von Kempis J, Kalden P, Gutfleisch J, Grimbacher B, Krause T, Uhl M, Ketelsen U P, Volk B, Röther E, Vaith P, Peter H H
University Hospital, Department of Medicine, Freiburg, Germany.
Rheumatol Int. 1998;17(5):207-13. doi: 10.1007/s002960050036.
Our objective was to study the value of 99mtechnetium-pyrophosphate (99mTc-PYP) muscle scintigraphy and magnetic resonance imaging (MRI) in detecting areas of likely muscle inflammation and in increasing the rate of positive muscle biopsies in patients with suspected myositis. The results showed that in 13 out of 13 patients with clinical and/or signs of inflammatory muscle disease, increased 99mTc-PYP uptake was demonstrated at different muscle sites 3 h after isotope injection. Subsequent MRI of symmetric muscle areas with enhanced 99mTc-PYP uptake revealed signal patterns suggesting inflammation in all cases. Biopsy of these targeted muscles demonstrated characteristic histopathologic signs of muscle inflammation in 9 out of 13 patients. Four of these 9 patients had clinically atypical disease or did not show elevated creatine phosphokinase levels. Seven of these 9 patients had not been pretreated with corticosteroids. In 4 patients only muscle fiber atrophy and/or necrosis without cellular infiltrations was seen. These 4 patients had received either high doses of corticosteroids or low doses over longer periods of time before muscle biopsy. In conclusion, the combination of 99mTc-PYP muscle scintigraphy and MRI demonstrated muscle areas with maximum inflammatory signal patterns. Targeting of muscles by MRI only will probably yield reliable results of muscle biopsy in cases of clinically and serologically characteristic myositis. 99mTc-PYP muscle scintigraphy may provide useful initial information about localization of inflamed muscle tissue, especially in atypical disease. Treatment with corticosteroids prior to histologic diagnosis may abolish inflammatory infiltrations in affected muscle tissue.
我们的目的是研究锝-99m焦磷酸盐（99mTc-PYP）肌肉闪烁扫描术和磁共振成像（MRI）在检测疑似肌炎患者可能存在的肌肉炎症区域以及提高肌肉活检阳性率方面的价值。结果显示，在13例有临床和/或炎症性肌肉疾病体征的患者中，同位素注射后3小时，不同肌肉部位均显示99mTc-PYP摄取增加。随后对99mTc-PYP摄取增强的对称肌肉区域进行MRI检查，所有病例均显示提示炎症的信号模式。对这些靶向肌肉进行活检，13例患者中有9例显示出肌肉炎症的特征性组织病理学体征。这9例患者中有4例临床症状不典型或肌酸磷酸激酶水平未升高。这9例患者中有7例未接受过皮质类固醇预处理。4例患者仅见肌纤维萎缩和/或坏死，无细胞浸润。这4例患者在肌肉活检前接受过高剂量皮质类固醇治疗或长期低剂量治疗。总之，99mTc-PYP肌肉闪烁扫描术和MRI相结合显示出具有最大炎症信号模式的肌肉区域。在临床和血清学特征性肌炎病例中，仅通过MRI靶向肌肉可能会获得可靠的肌肉活检结果。99mTc-PYP肌肉闪烁扫描术可能会提供有关炎症肌肉组织定位的有用初始信息，尤其是在非典型疾病中。在组织学诊断之前使用皮质类固醇治疗可能会消除受影响肌肉组织中的炎症浸润。
