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Muscle MRI in immune-mediated necrotizing myopathy (IMNM): implications for clinical management and treatment strategies
OBJECTIVES: Immune-mediated necrotizing myopathy (IMNM) is the most severe idiopathic inflammatory myopathy (IIM) and early aggressive poly-immunotherapy is often required to reduce long-term disability. The aim of this study is to investigate muscle MRI in IMNM as outcome measure for disease activi...
Autores principales: | , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9886642/ https://www.ncbi.nlm.nih.gov/pubmed/36329184 http://dx.doi.org/10.1007/s00415-022-11447-7 |
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author | Fionda, Laura Lauletta, Antonio Leonardi, Luca Perez, Jorge Alonso Morino, Stefania Merlonghi, Gioia Alfieri, Girolamo Costanzo, Rocco Tufano, Laura Vanoli, Fiammetta Rossini, Elena Vigo, Eduard Gallardo Tartaglione, Tommaso Salvetti, Marco Antonini, Giovanni Diaz-Manera, Jordi Garibaldi, Matteo |
author_facet | Fionda, Laura Lauletta, Antonio Leonardi, Luca Perez, Jorge Alonso Morino, Stefania Merlonghi, Gioia Alfieri, Girolamo Costanzo, Rocco Tufano, Laura Vanoli, Fiammetta Rossini, Elena Vigo, Eduard Gallardo Tartaglione, Tommaso Salvetti, Marco Antonini, Giovanni Diaz-Manera, Jordi Garibaldi, Matteo |
author_sort | Fionda, Laura |
collection | PubMed |
description | OBJECTIVES: Immune-mediated necrotizing myopathy (IMNM) is the most severe idiopathic inflammatory myopathy (IIM) and early aggressive poly-immunotherapy is often required to reduce long-term disability. The aim of this study is to investigate muscle MRI in IMNM as outcome measure for disease activity, severity, progression, response to treatment, and to better characterize the pattern of muscle involvement. METHODS: This is a retrospective, observational, cross-sectional, and longitudinal study including 22 IMNM patients, divided into three groups based on timing of first MRI and if performed before or under treatment. T1 score and percentage of STIR positive muscles (STIR%) were considered and analyzed also in relation to demographic, clinical and laboratory characteristics. RESULTS: STIR% was higher in untreated patients and in those who performed MRI earlier (p = 0.001). Pelvic girdle and thighs were in general more affected than legs. T1 score was higher in patients with MRI performed later in disease course (p = 0.004) with a prevalent involvement of the lumbar paraspinal muscles, gluteus medius and minimus, adductor magnus and hamstrings. 22% of STIR positive muscles showed fat replacement progression at second MRI. Higher STIR% at baseline correlated with higher risk of fat replacement at follow-up (p = 0.003); higher T1 score correlated with clinical disability at follow-up, with late treatment start and delayed treatment with IVIG (p = 0.03). INTERPRETATION: Muscle MRI is a sensitive biomarker for monitoring disease activity and therapy response, especially when performed early in disease course and before treatment start, and could represent a supportive outcome measure and early prognostic index in IMNM. |
format | Online Article Text |
id | pubmed-9886642 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-98866422023-02-01 Muscle MRI in immune-mediated necrotizing myopathy (IMNM): implications for clinical management and treatment strategies Fionda, Laura Lauletta, Antonio Leonardi, Luca Perez, Jorge Alonso Morino, Stefania Merlonghi, Gioia Alfieri, Girolamo Costanzo, Rocco Tufano, Laura Vanoli, Fiammetta Rossini, Elena Vigo, Eduard Gallardo Tartaglione, Tommaso Salvetti, Marco Antonini, Giovanni Diaz-Manera, Jordi Garibaldi, Matteo J Neurol Original Communication OBJECTIVES: Immune-mediated necrotizing myopathy (IMNM) is the most severe idiopathic inflammatory myopathy (IIM) and early aggressive poly-immunotherapy is often required to reduce long-term disability. The aim of this study is to investigate muscle MRI in IMNM as outcome measure for disease activity, severity, progression, response to treatment, and to better characterize the pattern of muscle involvement. METHODS: This is a retrospective, observational, cross-sectional, and longitudinal study including 22 IMNM patients, divided into three groups based on timing of first MRI and if performed before or under treatment. T1 score and percentage of STIR positive muscles (STIR%) were considered and analyzed also in relation to demographic, clinical and laboratory characteristics. RESULTS: STIR% was higher in untreated patients and in those who performed MRI earlier (p = 0.001). Pelvic girdle and thighs were in general more affected than legs. T1 score was higher in patients with MRI performed later in disease course (p = 0.004) with a prevalent involvement of the lumbar paraspinal muscles, gluteus medius and minimus, adductor magnus and hamstrings. 22% of STIR positive muscles showed fat replacement progression at second MRI. Higher STIR% at baseline correlated with higher risk of fat replacement at follow-up (p = 0.003); higher T1 score correlated with clinical disability at follow-up, with late treatment start and delayed treatment with IVIG (p = 0.03). INTERPRETATION: Muscle MRI is a sensitive biomarker for monitoring disease activity and therapy response, especially when performed early in disease course and before treatment start, and could represent a supportive outcome measure and early prognostic index in IMNM. Springer Berlin Heidelberg 2022-11-03 2023 /pmc/articles/PMC9886642/ /pubmed/36329184 http://dx.doi.org/10.1007/s00415-022-11447-7 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Communication Fionda, Laura Lauletta, Antonio Leonardi, Luca Perez, Jorge Alonso Morino, Stefania Merlonghi, Gioia Alfieri, Girolamo Costanzo, Rocco Tufano, Laura Vanoli, Fiammetta Rossini, Elena Vigo, Eduard Gallardo Tartaglione, Tommaso Salvetti, Marco Antonini, Giovanni Diaz-Manera, Jordi Garibaldi, Matteo Muscle MRI in immune-mediated necrotizing myopathy (IMNM): implications for clinical management and treatment strategies |
title | Muscle MRI in immune-mediated necrotizing myopathy (IMNM): implications for clinical management and treatment strategies |
title_full | Muscle MRI in immune-mediated necrotizing myopathy (IMNM): implications for clinical management and treatment strategies |
title_fullStr | Muscle MRI in immune-mediated necrotizing myopathy (IMNM): implications for clinical management and treatment strategies |
title_full_unstemmed | Muscle MRI in immune-mediated necrotizing myopathy (IMNM): implications for clinical management and treatment strategies |
title_short | Muscle MRI in immune-mediated necrotizing myopathy (IMNM): implications for clinical management and treatment strategies |
title_sort | muscle mri in immune-mediated necrotizing myopathy (imnm): implications for clinical management and treatment strategies |
topic | Original Communication |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9886642/ https://www.ncbi.nlm.nih.gov/pubmed/36329184 http://dx.doi.org/10.1007/s00415-022-11447-7 |
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