Shereen Paramalingam1,2, Merrilee Needham3,4,5,6, Warren Raymond7, Frank Mastaglia6, Daniel Lightowler7, Narelle Morin8, Peter Counsel9, Helen Isobel Keen10,7. 1. University of Notre Dame Australia, Fremantle, Western Australia, Australia. shereen.paramalingam@health.wa.gov.au. 2. Department of Rheumatology, Fiona Stanley Hospital, 11 Robin Warren Dr, Western Australia, 6150, Murdoch, Australia. shereen.paramalingam@health.wa.gov.au. 3. University of Notre Dame Australia, Fremantle, Western Australia, Australia. 4. Institute of Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia. 5. Department of Neurology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia. 6. Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia. 7. University of Western Australia, Crawley, Western Australia, Australia. 8. Sonowest Healthcare, Siemens Healthineers, Bayswater, Australia. 9. Department of Radiology, Perth Children's Hospital, Nedlands, Western Australia, Australia. 10. Department of Rheumatology, Fiona Stanley Hospital, 11 Robin Warren Dr, Western Australia, 6150, Murdoch, Australia.
Abstract
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.
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.
Authors: Shereen Paramalingam; Kelly Morgan; Fabio Becce; Louise P Diederichsen; Kei Ikeda; Peter Mandl; Sarah Ohrndorf; Andrea Delle Sedie; Veronika Sharp; Ai Lyn Tan; Lene Terslev; Richard J Wakefield; George A W Bruyn; Maria-Antonietta D'Agostino; Helen I Keen Journal: Semin Arthritis Rheum Date: 2020-11-21 Impact factor: 5.532
Authors: Abdulrahman M Alfuraih; Ai Lyn Tan; Philip O'Connor; Paul Emery; Richard J Wakefield Journal: Aging Clin Exp Res Date: 2019-02-14 Impact factor: 3.636
Authors: Jonathan Nicholls; Abdulrahman M Alfuraih; Elizabeth M A Hensor; Philip Robinson Journal: Skeletal Radiol Date: 2019-12-12 Impact factor: 2.199