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Fatty infiltration in the posterior muscles of the lower extremities as an MRI feature in antimitochondrial antibody–associated myopathy

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Abstract

Objective

Idiopathic inflammatory myopathy (IIM) with antimitochondrial M2 antibody (AMA-M2) has been associated with distinct clinical characteristics. In this study, we explore the magnetic resonance imaging (MRI) findings of the muscles of the lower extremities in AMA-M2-positive IIM to gain more insight.

Methods

MRI of 22 lower extremity muscles was retrospectively evaluated in 14 patients with AMA-M2-positive IIM and 37 age- and sex-matched patients with AMA-M2-negative IIM. Muscles with inflammatory edema and fatty infiltration were assessed according to the Stramare and Mercuri criteria.

Results

Patients with AMA-M2-positive IIM had significantly higher incidence of MRI involvement with fatty infiltration in five lower extremity muscles, namely the adductor magnus (AM) (13/14 VS 14/37, p < 0.001), semimembranosus (SM) (13/14 VS 17/37, p = 0.002), biceps femoris (BF) (12/14 VS 15/37, p = 0.004), soleus (13/14 VS 23/37, p = 0.041), and the medial head of the gastrocnemius (Gastroc M) (13/14 VS 17/37, p = 0.002) than patients with AMA-M2-negative IIM. Furthermore, the severity scores of fatty infiltrations of the above five muscles in AMA-M2-positive IIM were significantly higher than those in patients with AMA-M2-negative IIM (p < 0.001).

Conclusions

Severe fatty infiltrations of the AM, SM, BF, soleus, and Gastroc M in the posterior muscles of the lower extremities are dominant MRI features in our patients with AMA-M2-positive IIM. This unique muscle MRI character may be a helpful indicator in clinical practice for patients with AMA-M2-positive IIM.

Key Points

• Striking involvement and prominent fatty infiltrations of five lower extremity muscles (adductor magnus, semimembranosus, biceps femoris, soleus, and the medial head of the gastrocnemius) are interesting MRI performances.

• Severe fatty infiltrations in the posterior muscles of the lower extremities are dominant MRI features in AMA-M2-positive IIM.

• This unique muscle MRI character may be very helpful for the diagnosis of the AMA-M2-positive IIM.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.

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Acknowledgements

We would like to thank Editage (www.editage.cn) for English language editing.

Funding

This work was supported by National Natural Science Foundation of China (81601425).

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Authors and Affiliations

  1. Department of Radiology, China-Japan Friendship Hospital, Beijing, 100029, China

    Yuli Wang, Zhenguo Huang & Sheng Xie

  2. Department of Clinical Research and Data Management, China-Japan Friendship Hospital, Beijing, 100029, China

    Jieping Lei

  3. Department of Rheumatology, China-Japan Friendship Hospital, 2 Yinghua Road, Chaoyang District, Beijing, 100029, China

    Xin Lu, Sizhao Li, Guochun Wang & Lu Zhang

Authors
  1. Yuli Wang
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  2. Zhenguo Huang
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  3. Jieping Lei
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  4. Xin Lu
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  6. Guochun Wang
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  7. Sheng Xie
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  8. Lu Zhang
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Contributions

YLW and LZ contributed to the study conception, study design, data acquisition, data analysis, data interpretation, and drafting and revising the manuscript. YLW and ZGH assessed the MR images. SZL and XS collected data and participated in statistical work. XL and GCW assisted in data interpretation and revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Lu Zhang.

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Wang, Y., Huang, Z., Lei, J. et al. Fatty infiltration in the posterior muscles of the lower extremities as an MRI feature in antimitochondrial antibody–associated myopathy. Clin Rheumatol 43, 1127–1133 (2024). https://doi.org/10.1007/s10067-024-06877-9

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  • DOI: https://doi.org/10.1007/s10067-024-06877-9

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