Abstract
Objectives
To compare the performance of magnetic resonance (MR) relaxometry parameters to discriminate myocardial and skeletal muscle inflammation in idiopathic inflammatory myopathy (IIM) patients from healthy controls.
Materials and methods
For this retrospective case-control study, 20 consecutive IIM patients (54 ± 18 years, 11 females) with cardiac involvement (troponin level > 50 ng/l) and 20 healthy controls (47 ± 12 years, 9 females) were included. All patients without cardiac MR imaging < 2 weeks prior to the laboratory testings were excluded. T1/T2 relaxation times, as well as T1-derived extracellular volume (ECV), relative tissue T1 shortening ΔT1 = (native T1tissue-post contrast T1tissue)/native T1tissue), and enhancement fraction EHF = (native T1tissue-post contrast T1tissue)/(native T1blood-post contrast T1blood), were compared using Mann-Whitney U test and ROC analysis.
Results
All measured MR relaxometry parameters significantly discriminated IIM patients and healthy controls, except T2 in skeletal muscles and ECV in the myocardium. In skeletal muscles, post contrast T1 and T1-derived parameters showed the best performance to discriminate IIM patients from healthy controls (AUC = 0.98 for post contrast T1 and AUC 0.94–0.97 for T1-derived parameters). Inversely, in the myocardium, native T1 and T2 showed better diagnostic performance (AUC = 0.89) than post contrast T1 (AUC = 0.76), ECV (AUC = 0.58), ΔT1 (AUC = 0.80) and EHF (0.82).
Conclusions
MR relaxometry parameters applied to the myocardium and skeletal muscles might be useful to separate IIM patients from healthy controls. However, different tissue composition and vascularization should be taken into account for their interpretation. ΔT1 and EHF may be simple alternatives to ECV in highly vascularized tissues such as the myocardium.
Key Points
• MR relaxometry parameters applied to the myocardium and skeletal muscles are highly useful to separate IIM patients from healthy controls.
• Different tissue composition and vascularization should be taken into account for T1 and T2 mapping parameter interpretation.
• ΔT1 and EHF may be simple alternatives to ECV in highly vascularized tissues such as the myocardium.
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Abbreviations
- AVM:
-
Acute viral myocarditis
- ECS:
-
Extracellular space
- ECV:
-
Extracellular volume
- EF:
-
Ejection fraction
- EHF:
-
Enhancement fraction
- IIM:
-
Idiopathic inflammatory myopathy
- MOLLI:
-
Modified Look-Locker inversion recovery
- MR:
-
Magnetic resonance
- SAPPHIRE:
-
Saturation pulse prepared heart rate independent inversion recovery
- SASHA:
-
Saturation recovery single-shot acquisition
- TE:
-
Echo times
- TI:
-
Times of inversion
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Acknowledgements
AH received a research grant from the Helmut-Hartweg-Foundation of the Swiss Academy of Medical Sciences (SAMS). JL received a research grant from the Institute of Cardiometabolism and Nutrition (ICAN). The project was financially supported by the Institut Universitaire d’Ingénierie en Santé (IUIS).
We thank Dr. Alain Giron for his statistical advice for this manuscript.
Funding
This study has received funding by the Helmut-Hartweg-Foundation of the Swiss Academy of Medical Sciences (SAMS), the Institute of Cardiometabolism and Nutrition (ICAN), and by the Institut Universitaire d’Ingénierie en Santé (IUIS). Paris, France.
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The scientific guarantor of this publication is Dr. Nadjia Kachenoura.
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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
Dr. Alain Giron kindly provided statistical advice for this manuscript.
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Written informed consent was obtained from all subjects (patients) in this study.
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Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
The data presented in this paper are novel and have never been published before. Since idiopathic inflammatory myositis (IIM) with myocardial involvement is a very rare condition and a valuable model of myocardial and skeletal muscle alterations, we used the same IIM patients in the present manuscript than those previously used in the JCMR paper entitled “Non-invasive differentiation of idiopathic inflammatory myopathy with cardiac involvement from acute viral myocarditis using cardiovascular magnetic resonance imaging T1and T2 mapping”. 20.1 (2018): 11. However, while the JCMR paper focused on the usefulness of skeletal muscles conventional T1 and T2 mapping indices in differentiating acute viral myocarditis (AVM) from IIM, the present paper focusses on the comparison of several established and newly proposed myocardial and skeletal muscle mapping-derived biomarkers in terms of their ability to distinguish IIM patients from controls. There are no AVM patients in this paper, so we present a different patient population.
Methodology
• retrospective
• case-control study
• performed at one institution
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Huber, A.T., Lamy, J., Bravetti, M. et al. Comparison of MR T1 and T2 mapping parameters to characterize myocardial and skeletal muscle involvement in systemic idiopathic inflammatory myopathy (IIM). Eur Radiol 29, 5139–5147 (2019). https://doi.org/10.1007/s00330-019-06054-6
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DOI: https://doi.org/10.1007/s00330-019-06054-6