The diagnostic value of T2 map,diffusion tensor imaging,and diffusion kurtosis imaging in differentiating dermatomyositis from muscular dystrophy

Abstract

Background

Dermatomyositis (DM) and muscular dystrophy are clinically difficult to differentiate.

Purpose

To confirm the feasibility and assess the accuracy of conventional magnetic resonance imaging (MRI), T2 map, diffusion tensor imaging (DTI), and diffusion kurtosis imaging (DKI) in the differentiation of DM from muscular dystrophy.

Material and Methods

Forty-two patients with DM proven by diagnostic criteria were enrolled in the study along with 23 patients with muscular dystrophy. Conventional MR, T2 map, DTI, and DKI images were obtained in the thigh musculature for all patients. Intramuscular T2 value, apparent diffusion coefficient (ADC), fractional anisotropy (FA), mean diffusivity (MD), and mean kurtosis (MK) values were compared between the patients with DM and muscular dystrophy. Student’s t-tests and receiver operating characteristic (ROC) curve analyses were performed for all parameters. P values < 0.05 were considered statistically significant.

Results

The intramuscular T2, ADC, FA, MD, and MK values within muscles were statistically significantly different between the DM and muscular dystrophy groups (P<0.01). The MK value was statistically significantly different between the groups in comparison with T2 and FA value. As a supplement to conventional MRI, the parameters of MD and MK differentiated DM and muscular dystrophy may be valuable. The optimal cut-off value of ADC and MD values (with respective AUC, sensitivity, and specificity) between DM and muscular dystrophy were 1.698 ×10⁻³mm²/s (0.723, 54.1%, and 78.1%) and 1.80 ×10⁻³mm²/s (61.9% and 70.2%), respectively.

Conclusion

Thigh muscle ADC and MD parameters may be useful in differentiating patients with DM from those with muscular dystrophy.

Keywords

Magnetic resonance imaging T2 map diffusion tensor imaging dermatomyositis muscular dystrophy diffusion kurtosis imaging

Get full access to this article

View all access options for this article.

References

Findlay

Goyal

Mozaffar

An overview of polymyositis and dermatomyositis. Muscle Nerve 2015; 51:638–656.

Iaccarino

Ghirardello

Bettio

, et al. The clinical features, diagnosis and classification of dermatomyositis. J Autoimmun 2014; 49:122–127.

Troyanov

Targoff

Payette

, et al. Redefining dermatomyositis: a description of new diagnostic criteria that differentiate pure dermatomyositis from overlap myositis with dermatomyositis features. Medicine (Baltimore) 2014; 24:318–332.

Wokke

Van Den Bergen

Hooijmans

, et al. T2 relaxation times are increased in Skeletal muscle of DMD but not BMD patients. Muscle Nerve 2016; 53:38–43.

Helderman-van den Enden

van den Bergen

Breuning

, et al. Duchenne/Becker muscular dystrophy in the family: have potential carriers been tested at a molecular level? Clin Genet 2011; 3:236–242.

Iaccarino

Pegoraro

Bello

, et al. Assessment of patients with idiopathic inflammatory myopathies and isolated creatin-kinase elevation. Auto Immun Highlights 2014; 5:87–94.

Van De Vlekkert

Maas

Hoogendijk

, et al. Combining MRI and muscle biopsy improves diagnostic accuracy in subacute-onset idiopathic inflammatory myopathy. Muscle Nerve 2015; 2:253–258.

Keller

Wang

Golsari

, et al. Feasibility of peripheral nerve MR neurography using diffusion tensor imaging adapted to skeletal muscle disease. Acta Radiol 2018; 59:560–568.

Huang

Chen

Zhang

, et al. MRI quantification of non-Gaussian water diffusion in normal human kidney: a diffusional kurtosis imaging study. NMR Biomed 2015; 28:154–161.

10.

Marschar

Kuder

Stieltjes

, et al. In vivo imaging of the time-dependent apparent diffusional kurtosis in the human calf muscle. J Magn Reson Imaging 2015; 41:1581–1590.

11.

Gao

, et al. Diffusion tensor imaging in evaluation of thigh muscles in patients with polymyositis and dermatomyositis. Br J Radiol 2014; 87:20140261.

12.

Linklater

Pipitone

Rose

, et al. Classifying idiopathic inflammatory myopathies: comparing the performance of six existing criteria. Clin Exp Rheumatol 2013; 5:767–769.

13.

Kumar

Wadhwa

Phillips

, et al. MR imaging of skeletal muscle signal alterations: systematic approach to evaluation. Eur J Radiol 2016; 85:922–935.

14.

Maurer

Walker

U A.

Role of MRI in Diagnosis and Management of Idiopathic Inflammatory Myopathies. Curr Rheumatol Rep 2015; 17:67.

15.

Robba

Chianca

Albano

, et al. Diffusion-weighted imaging for the cellularity assessment and matrix characterization of soft tissue tumour. Radiol Med 2017; 11:871–879.

16.

Lilleker

Murphy

Cooper

Selected aspects of the current management of myositis. Ther Adv Musculoskelet Dis 2016; 4:136–144.

17.

Mammen

AL.

Autoimmune myopathies: autoantibodies, phenotypes and pathogenesis. Nat Rev Neurol 2011; 7:343–354.

18.

Gaeta

Messina

Mileto

, et al. Muscle fat-fraction and mapping in Duchenne muscular dystrophy: evaluation of disease distribution and correlation with clinical assessments. Skeletal Radiol 2012; 41:955–961.

19.

Kim

Laor

Horn

, et al. T2 Mapping in Duchenne Muscular Dystrophy: Distribution of Disease Activity and Correlation with Clinical Assessments. Radiology 2010; 3:899–908.

20.

Heemskerk

Drost

van Bochove

, et al. DTI-based assessment of ischemia-reperfusion in mouse skeletal muscle. Magn Reson Med 2006; 2:272–281.

21.

Froeling

Oudeman

Strijkers

, et al. Muscle changes detected with diffusion-tensor imaging after long-distance running. Radiology 2015; 2:548–562.

22.

Wang

Sun

, et al. Simultaneous Multislice Accelerated Diffusion-Tensor Imaging of Thigh Muscles in Myositis. AJR Am J Roentgenol 2018; 211:861–866.

23.

Rosenkrantz

Padhani

Chenevert

, et al. Body diffusion kurtosis imaging: Basic principles, applications, and considerations for clinical practice. J Magn Reson Imaging 2015; 5:1190–1202.

24.

Filli

Kenkel

Wurnig

, et al. Wurnig, et al. Diffusional kurtosis MRI of the lower leg: changes caused by passive muscle elongation and shortening. NMR Biomed 2016; 6:767–775.