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Sarcopenia in juvenile localized scleroderma: new insights on deep involvement

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Juvenile localized scleroderma (JLS) is a rare chronic autoimmune disease which can also affect bones and muscles. Nevertheless, muscle loss was not previously investigated in patients with JLS. Thus, the aim of this study was to retrospectively evaluate deep involvement and assess and quantify sarcopenia in JLS patients using magnetic resonance imaging (MRI).

Methods

Fourteen children with JLS (nine females, mean age ± SD, 7.1 ± 3.6 years) referring to our tertiary center from January 2012 to January 2018 who underwent at least one MRI examination including axial T1-weighted and short tau inversion recovery images were included. Two readers assessed in consensus superficial and deep involvement. Muscle edema, muscle fatty infiltration, and sarcopenia were independently scored (absent, moderate, or severe) and the Cohen’s kappa coefficient computed. Skin perimeter, subcutaneous area, muscle area, and muscle volume were independently measured using the contralateral unaffected extremity as reference (paired Student’s t test, p < 0.05). The intraclass correlation coefficient (ICC) was used to investigate the reliability of the measurements.

Results

All patients showed superficial involvement with subcutaneous fat atrophy being the most common finding (13 patients). Bone marrow edema occurred in five patients. Muscle edema affected ten children (moderate in seven, severe in three; k = 0.89), muscle fatty replacement occurred in one case (severe; k = 1.00), and sarcopenia was detected in eight patients (severe in two; k = 0.78). All quantitative parameters were lower on the affected side than on the unaffected contralateral limb (p < 0.05, each) and all measurements showed a high reliability (ICC > 0.750, each).

Conclusion

Patients with JLS can be affected by sarcopenia and quantitative analyses allow a robust characterization of such finding.

Key Points

• Deep involvement in juvenile localized scleroderma is frequently characterized by sarcopenia.

• In juvenile localized scleroderma, muscle edema and sarcopenia are mostly moderate while fatty infiltration, even if rare, can be severe.

• Sarcopenia can be reliably quantified in children with juvenile localized scleroderma using MRI.

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Abbreviations

CI:

Confidence interval

ICC:

Intraclass correlation coefficient

JLS:

Juvenile localized scleroderma

k :

Cohen’s kappa

MA:

Muscle area

MRI:

Magnetic resonance imaging

MV:

Muscle volume

SA:

Subcutaneous area

SP:

Skin perimeter

STIR:

Short tau inversion recovery

TSE:

Turbo spin echo

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Medicine – DIMED, Radiology Institute, University of Padova, Via Giustiniani 2, 35100, Padua, Italy

    Silvia Karem Janet Flores Quispe, Annachiara Cavaliere, Roberto Stramare, Monica Zuliani, Emilio Quaia & Chiara Giraudo

  2. Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria

    Michael Weber

  3. Pediatric Rheumatology, University of Padova, Padua, Italy

    Francesco Zulian

Authors
  1. Silvia Karem Janet Flores Quispe
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  2. Annachiara Cavaliere
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  3. Michael Weber
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  4. Roberto Stramare
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  5. Monica Zuliani
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  6. Emilio Quaia
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  7. Francesco Zulian
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  8. Chiara Giraudo
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Corresponding author

Correspondence to Chiara Giraudo.

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Guarantor

The scientific guarantor of this publication is Dr. Chiara Giraudo, MD, PhD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Michael Weber kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was not required for this study because it is retrospective but the parents gave written informed consent to the MRI examination, as usually performed in clinical practice, since all patients were minor.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Cross sectional study

• Performed at one institution

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Flores Quispe, S.K.J., Cavaliere, A., Weber, M. et al. Sarcopenia in juvenile localized scleroderma: new insights on deep involvement. Eur Radiol 30, 4091–4097 (2020). https://doi.org/10.1007/s00330-020-06764-2

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  • DOI: https://doi.org/10.1007/s00330-020-06764-2

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