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Contrast-enhanced Ultrasound in Dermatomyositis- and Polymyositis

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An Erratum to this article was published on 01 September 2007

Abstract

Objective

To evaluate prospectively contrast-enhanced ultrasound (CEUS) in patients suspected of having dermatomyositis or polymyositis.

Methods

In 35 patients (23 women, 12 men; mean age, 51 years ± 16 years) who were suspected of having dermatomyositis or polymyositis, perfusion in clinically affected skeletal muscles was quantified with contrast-enhanced intermittent power Doppler ultrasound. By applying a modified model that analyzed the replenishment kinetics of microbubbles, the perfusion-related parameters blood flow, local blood volume and blood flow velocity were measured. Findings were compared with muscle biopsy appearances and with the results of MRI that was performed with a 1.5-Tesla unit. Receiver operating characteristic analysis was performed and optimum thresholds for diagnosis of myositis were determined.

Results

Eleven patients had histologically confirmed dermatomyositis or polymyositis and showed significantly higher blood flow velocity (P = .01 for dermato- and P < .001 for polymyositis), blood flow (P < .001 for dermato- and polymyositis), and blood volume (P = .007 for dermato- and P < .001 for polymyositis) on contrast-enhanced ultrasound than those who did not have myositis. An increase in signal intensity on T2-weighted MR images was found in all patients with myositis. MRI had a sensitivity, specificity, positive (PPV), and negative predicting values (NPV) of 100%, 88%, 77%, and 100% for diagnosis of myositis, respectively. CEUS blood flow was the best ultrasound measure for diagnosis of dermato- or polymyositis with sensitivity, specificity, PPV, and NPV of 73%, 91%, 80%, and 88%, respectively.

Conclusions

Increased skeletal muscle perfusion measured by CEUS could serve as an additional measurer for the diagnosis of an inflammatory myopathy.

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Abbreviations

a.u.:

Arbitrary units

B :

CEUS-derived local blood volume [∼ml]

CEUS:

Contrast-enhanced ultrasound

CK:

Creatine kinase

CP:

Color pixels

CT:

Computed tomography

d :

Ultrasound beam width

DM:

Dermatomyositis

f :

CEUS-derived blood flow [∼ml/min/100 g tissue]

IBM:

Inclusion-body myositis

m:

Slope of the replenishment curve

max:

Plateau of the replenishment curve

MHC:

Major histocompatibility complex

MI:

Mechanical index

MRI:

Magnetic resonance imaging

PM:

Polymyositis

ROI:

Region of interest

SD:

Standard deviation

STIR:

Short tau inversion recovery

U:

Units

US:

Ultrasound

v :

CEUS-derived blood flow velocity [mm/s]

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Acknowledgements

The authors thank Saida Zoubaa, MD, Department of Pathology, University of Heidelberg, Heidelberg, Germany, for reviewing the muscle biopsy samples and reviewing this manuscript.

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Authors and Affiliations

  1. Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    Marc-André Weber, Uta Jappe, Marco Essig, Martin Krix, Carina Ittrich, B. Hagen Huttner, Uta Meyding-Lamadé, Marius Hartmann, Hans-Ulrich Kauczor & Stefan Delorme

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  1. Marc-André Weber
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  2. Uta Jappe
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  3. Marco Essig
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  4. Martin Krix
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  7. Uta Meyding-Lamadé
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Corresponding author

Correspondence to Marc-André Weber.

Additional information

Received in revised form: 6 June 2006

An erratum to this article is available at http://dx.doi.org/10.1007/s00415-007-0704-7.

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Weber, MA., Jappe, U., Essig, M. et al. Contrast-enhanced Ultrasound in Dermatomyositis- and Polymyositis. J Neurol 253, 1625–1632 (2006). https://doi.org/10.1007/s00415-006-0318-5

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