Conventional ultrasound and elastography as imaging outcome tools in autoimmune myositis: A systematic review by the OMERACT ultrasound group

Paramalingam, Shereen; Morgan, Kelly; Becce, Fabio; Diederichsen, Louise Pyndt; Ikeda, Kei; Mandl, Péter; Ohrndorf, Sarah; Sedie, Andrea Delle; Sharp, Veronika; Tan, Ai Lyn; Terslev, Lene; Wakefield, Richard J.; Bruyn, George A W; D'Agostino, Maria Antonietta; Keen, Helen

doi:10.1016/j.semarthrit.2020.11.001

Cited by 20 publications

(14 citation statements)

References 64 publications

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“…Other changes in the muscle properties in the IIM group included increased echogenicity, which was present in almost all muscle groups examined compared to healthy controls ≥ 50 years. In the acute setting, increased echogenicity may be the result of inflammation or fatty replacement (myosteatosis) [ 11 , 40 ]. However, the people with IIM in this study were all prevalent cases, without clinical evidence of inflammation, and therefore the increased echogenicity in these chronically affected muscles is likely to be a result of myosteatosis in which there is progressive loss of muscle fibres, as is known to occur in IBM [ 11 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the acute setting, increased echogenicity may be the result of inflammation or fatty replacement (myosteatosis) [ 11 , 40 ]. However, the people with IIM in this study were all prevalent cases, without clinical evidence of inflammation, and therefore the increased echogenicity in these chronically affected muscles is likely to be a result of myosteatosis in which there is progressive loss of muscle fibres, as is known to occur in IBM [ 11 , 41 ]. It is thought that fatty replacement increases echogenicity as opposed to intramuscular fibrosis [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…Point-of-care imaging tools such as shear wave elastography (SWE) and ultrasound (B mode and power Doppler) are being studied to assess their utility in the timelier diagnosis and monitoring of patients with IIM [ 7 – 11 ]. Although these modalities have been evaluated in neuromuscular disease and muscle injury [ 12 ], their use in IIM remains understudied, particularly in inclusion body myositis (IBM) and necrotising autoimmune myopathy (NAM) that pose diagnostic and management difficulties for clinicians [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…The capability of US to measure tissue perfusion and echogenicity makes it a promising tool to study muscle inflammation [ 20 ]. In addition, other US domains findings such as increased fascial thickness and reduced muscle bulk have been described in IIM but are still contentious and have not been validated, largely due to lack of normal values in healthy controls [ 11 ] Similarly, published evidence based on the use of SWE suggests that muscle stiffness is reduced with increasing age and in active IIMs, but this needs replication to ensure validity [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Muscle shear wave elastography, conventional B mode and power doppler ultrasonography in healthy adults and patients with autoimmune inflammatory myopathies: a pilot cross-sectional study

Paramalingam

Needham

Raymond

et al. 2021

BMC Musculoskelet Disord

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Background Before the role of shear wave elastography (SWE) and B mode ultrasound (US) in the diagnosis of different forms of idiopathic inflammatory myopathies (IIM) can be investigated, normative data is required. This study aimed to describe and then compare normative SWE and B mode ultrasound metrics of muscles in healthy controls and patients with IIM. Methods Twenty nine healthy adult controls and 10 IIM patients (5 with inclusion body myositis and 5 with necrotising autoimmune myopathy) underwent a full clinical examination, laboratory investigations, SWE and US measurements of selected proximal and distal limb muscles. Shear wave speed (SWS) and multiple US domains [echogenicity, fascial thickness, muscle bulk and power Doppler (PD)] were measured in both groups. Results In healthy controls (n = 29; mean age 46.60 ± 16.10; 44.8 % female), age was inversely correlated with SWS at the deltoid (stretch) (Rs. -0.40, p = 0.030) and PD score at the deltoid (rest) (Rs. -0.40, P = 0.032). Those ≥ 50 years old had a lower SWS at the deltoid (stretch) compared to the < 50 year group (2.92 m/s vs. 2.40 m/s, P = 0.032). Age correlated with increased echogenicity in the flexor digitorum profundus (Rs. 0.38, P = 0.045). Females had a smaller muscle bulk in the deltoid (P = 0.022). Body mass index (BMI) was inversely associated with SWS in the deltoid (stretch) (Rs – 0.45, P = 0.026), and positively correlated with echogenicity in the deltoid (Rs. 0.69, P = 0.026). In patients ≥50 years of age, patients with IIM (mean age 61.00 ± 8.18; females 20.0 %) had a higher proportion of abnormal echogenicity scores at the flexor digitorum profundus (FDP) (40.00 % vs. 14.30 %, P = 0.022) and tibialis anterior (TA) (80.00 % vs. 28.60 %, P = 0.004). Fascial thickness was lower in the FDP (0.63mm vs. 0.50mm, p = 0.012) and TA (0.58mm vs. 0.45mm, P = 0.001). Conclusions Our findings suggest there is scope for US techniques to be useful for diagnostic screening of affected muscles in patients with IIM, especially in those with suspected inclusion body myositis or necrotising autoimmune myopathy. We provide normative data for future studies into SWE and US techniques in skeletal muscle. The differences between IIM patients and controls warrant further study in a broader IIM patient cohort.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Muscle shear wave elastography, conventional B mode and power doppler ultrasonography in healthy adults and patients with autoimmune inflammatory myopathies: a pilot cross-sectional study

Paramalingam

Needham

Raymond

et al. 2021

BMC Musculoskelet Disord

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“…US can detect typical myositis features such as edema, calcifications, atrophy, fascial thickening, and degenerative processes (i.e., fibrosis, fatty infiltration) (127)(128)(129). Inflammatory muscle fascicles appear as hyperechoic surrounded by fibroadipose septa filled by inflammatory exudates with hypoechoic appearance (130).…”

Section: Conventional B-mode Usmentioning

confidence: 99%

MRI and muscle imaging for idiopathic inflammatory myopathies

et al. 2021

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Although idiopathic inflammatory myopathies (IIM) are a heterogeneous group of diseases nearly all patients display muscle inflammation. Originally, muscle biopsy was considered as the gold standard for IIM diagnosis. The development of muscle imaging led to revisiting not only the IIM diagnosis strategy but also the patients’ follow‐up. Different techniques have been tested or are in development for IIM including positron emission tomography, ultrasound imaging, ultrasound shear wave elastography, though magnetic resonance imaging (MRI) remains the most widely used technique in routine. Whereas guidelines on muscle imaging in myositis are lacking here we reviewed the relevance of muscle imaging for both diagnosis and myositis patients’ follow‐up. We propose recommendations about when and how to perform MRI on myositis patients, and we describe new techniques that are under development.

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Can we differentiate patients with dysferlinopathies and inflammatory myopathies by ultrasound? A discriminant analysis study

Solorzano-Flores,

Soto-Fajardo,

Ángeles-Acuña

et al. 2024

Rheumatol Int

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Conventional ultrasound and elastography as imaging outcome tools in autoimmune myositis: A systematic review by the OMERACT ultrasound group

Cited by 20 publications

References 64 publications

Muscle shear wave elastography, conventional B mode and power doppler ultrasonography in healthy adults and patients with autoimmune inflammatory myopathies: a pilot cross-sectional study

Muscle shear wave elastography, conventional B mode and power doppler ultrasonography in healthy adults and patients with autoimmune inflammatory myopathies: a pilot cross-sectional study

MRI and muscle imaging for idiopathic inflammatory myopathies

Can we differentiate patients with dysferlinopathies and inflammatory myopathies by ultrasound? A discriminant analysis study

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