| Objective To evaluate the value of whole body magnetic resonance imaging(WB-MRI)in the diagnosis and treatment of patients with polymyositis(PM)and dermatomyositis(DM).Methods For patients with PM/DM who met Bohan and Peter’s diagnostic criteria,the Siemens MRI verio 3.0T MRI machine was used for T1WI and T2-STIR sequences for whole body coronal and thigh axial MRI scans to observe systemic muscle manifestations and other systemic lesions(ILD).,neoplastic lesions)and osteonecrosis after hormone therapy.Muscle biopsy,electromyography(EMG)examination and serum creatine kinase test were performed on the patient.A retrospective analysis of all observations and data.Patients who were negative for the first muscle biopsy and electromyography(EMG)examination were repositioned under the guidance of WB-MRI for examination.The positive rates of WB-MRI and first muscle biopsy,electromyography(EMG),and serum creatine kinase assays were compared.Compare the positive rate of the first muscle biopsy and electromyography(EMG)and the examination under the guidance of WB-MRI.Compare WB-MRI results in DM and PM patients.Observe the degree of systemic edema and complications in patients with PM/DM.The WB-MRI examination sequences were observed to show the sensitivity of the lesion.Compare the results of WB-MRI with chest CT for detecting interstitial lung disease(ILD).Observe the effect of disease duration on muscle fat infiltration.The two observers were compared for the assessment of muscle and extramuscular changes in WB-MRI.Statistical analysis was performed usingχ2 test,Kappa test,t test,and McNemar test.Results The study included 43 patients(10 PM patients and 33 DM patients).Among them,81.40%(35/43)of WB-MRI showed obvious inflammatory muscular edema;30.23%(13/43)had different degrees of fatty infiltration(3 cases had obvious muscular atrophy).The positive rates of WB-MRI and first muscle biopsy,electromyography(EMG)and serum creatine kinase test were 86.05%(37/43),83.72%(36/43),81.48%(22/27)and 77.50%(31/40).There was no significant difference in the positive rate between WB-MRI and muscle biopsy(χ~2=0.091,p=0.763).The positive rate of WB-MRI was higher than the serum creatine kinase test(χ~2=1.022,p=0.312)and electromyography(EMG)(χ~2=0.261,p=0.609).The positive rates of muscle biopsy and electromyography(EMG)under the guidance of WB-MRI were 100%(7/7)and 100%(5/5),respectively.The positive rate of muscle biopsy under WB-MRI guidance was higher than that under non-WB-MRI guidance(χ~2=1.325,p=0.250).The positive rate of electromyography(EMG)under WB-MRI guidance was higher than that under non-WB-MRI guidance(χ~2=1.097,p=0.295).In addition to changes of muscle,WB-MRI also detected interstitial lung disease(ILD)in 13 patients(30.23%),osteonecrosis in 5 patients(11.63%),and neoplastic lesions(5 cases of malignant;3 cases of benign)in 8 patients(18.60%).Of the 20 patients who underwent conventional chest CT,WB-MRI and chest CT showed 10 cases and 12 cases of interstitial lung disease(ILD),respectively.There was no significant difference in sensitivity between WB-MRI and CT(k=0.600,p=0.06).Conclusion WB-MRI is a sensitive,non-invasive and effective imaging method.It comprehensively shows the degree of muscular involvement in patients with PM/DM.Targeted clinical puncture biopsy under the WB-MRI positioning can greatly reduce the false negative rate,thereby improving the early diagnosis rate of the disease.And it has high application value for the determination of disease activity and evaluation of curative effect during treatment.WB-MRI can also diagnose the other diseases besides muscular,such as interstitial lung disease(ILD)and systemic neoplastic lesions.It can also help screen for steroid-induced osteonecrosis. |
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