Whole-body MRI in the assessment of disease activity in juvenile dermatomyositis

To compare whole-body MRI (WB-MRI) with clinical examination in the assessment of disease activity in juvenile dermatomyositis (JDM). WB-MR images were obtained from 41 JDM patients and 41 controls using a 1.5 T MRI scanner and short τ inversion recovery sequences. 18 patients had follow-up WB-MRI....

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Bibliographic Details
Published in:	Annals of the rheumatic diseases Vol. 73; no. 6; p. 1083
Main Authors:	Malattia, Clara, Damasio, Maria Beatrice, Madeo, Annalisa, Pistorio, Angela, Providenti, Anna, Pederzoli, Silvia, Viola, Stefania, Buoncompagni, Antonella, Mattiuz, Chiara, Beltramo, Agnese, Consolaro, Alessandro, Ravelli, Angelo, Ruperto, Nicolino, Picco, Paolo, Magnano, Gian Michele, Martini, Alberto
Format:	Journal Article
Language:	English
Published:	England 01-06-2014
Subjects:	Adolescent Case-Control Studies Child Cohort Studies Dermatomyositis - diagnosis Dermatomyositis - pathology Fascia - pathology Feasibility Studies Female Humans Inflammation - pathology Magnetic Resonance Imaging - methods Male Muscle, Skeletal - pathology Physical Examination Reproducibility of Results Severity of Illness Index Subcutaneous Tissue - pathology Whole Body Imaging Magnetic Resonance Imaging Disease Activity Dermatomyositis
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Summary:	To compare whole-body MRI (WB-MRI) with clinical examination in the assessment of disease activity in juvenile dermatomyositis (JDM). WB-MR images were obtained from 41 JDM patients and 41 controls using a 1.5 T MRI scanner and short τ inversion recovery sequences. 18 patients had follow-up WB-MRI. Muscle, subcutaneous tissue and myofascial signal abnormalities were scored in 36 muscular groups and on proximal and distal extremities. WB-MRI and clinical assessments were performed concurrently and results compared. Validation procedures included analysis of feasibility, reliability, construct validity, discriminative ability and responsiveness. WB-MRI revealed distal legs (26/41 patients) and forearm (19/41 patients) muscle inflammation undetected during clinical examination and allowed an accurate assessment of subcutaneous (23/41 patients) and myofascial involvement (13/41 patients). 27 patients showed a patchy distribution of muscle inflammation while in seven the abnormal hyperintense areas tended to be homogeneously distributed. The inter-reader agreement for muscular, subcutaneous and myofascial WB-MRI scores was excellent. Correlations between WB-MRI muscle score and disease activity measures were excellent (Manual Muscle Test: rs=-0.84, Childhood Myositis Assessment Scale: rs=-0.81). WB-MRI score was higher in JDM active patients when compared with the control group (pB<0.0001) and the inactive patients (pB=0.004), and showed an excellent responsiveness (standardised response mean=1.65). Follow-up WB-MRI showed resolution of inflammation in nine patients whereas clinical criteria for remission were satisfied in five. WB-MRI provides additional information to clinical evaluation and represents a promising tool to estimate total inflammatory burden, tailor treatment and monitor its efficacy.
ISSN:	1468-2060
DOI:	10.1136/annrheumdis-2012-202915