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Whole-Body MR Imaging in the Diagnosis of Polymyositis

Martin J. O'Connell1, Tom Powell1, Darren Brennan2, Timothy Lynch3, Conor J. McCarthy4 and Stephen J. Eustace1,2

1 Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland.
2 Department of Radiology, Mater Misericordiae Hospital, Eccles St., Dublin 7, Ireland.
3 Department of Neurology, Mater Misericordiae Hospital, Dublin 7, Ireland.
4 Department of Rheumatology, Mater Misericordiae Hospital, Dublin 7, Ireland.



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  		Fig. 1. —Schematic drawing shows distribution of muscle involvement in patient cohort. Note both muscle group involved and number of times muscle appears to be affected.

 


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  		Fig. 2A. —46-year-old woman with suspected polymyositis. Whole-body turbo short tau inversion recovery (STIR) MR image (TR/TE, 4000/30; inversion time, 160 msec) shows gross symmetric inflammation or muscle edema in proximal upper (curved arrows) and lower limb girdle muscles. Note florid inflammation or muscle edema (straight arrow) in psoas muscles bilaterally. Edema is worse on right.

 


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  		Fig. 2B. —46-year-old woman with suspected polymyositis. Whole-body turbo STIR MR image in plane anterior to that seen in A shows inflammation in neck flexor muscles (thin arrow) in addition to gross involvement of glutei that is worse on left (thick arrow).

 


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  		Fig. 3. —46-year-old man with suspected polymyositis and systemic lupus erythematosus. Whole-body turbo short tau inversion recovery MR image (TR/TE, 4000/30; inversion time, 160 msec) shows focal symmetric edema or inflammation (arrows) in myofascial distribution in gluteus medius muscle group bilaterally. Muscle biopsy helped confirm myofascial inflammation.

 


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  		Fig. 4A. —56-year-old man with suspected polymyositis. Whole-body turbo short tau inversion recovery MR image (TR/TE, 4000/30; inversion time, 160 msec) of posterior aspect of upper torso shows extensive inflammation in deltoid, trapezius, triceps, and latissimus dorsi muscles bilaterally (straight arrows) and further muscle edema and inflammation in vastus medialis and lateralis muscles of left thigh (curved arrow). Note susceptibility artifact at site of right hip prosthesis, limiting assessment of muscles adjacent to this site.

 


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  		Fig. 4B. —56-year-old man with suspected polymyositis. Individual image from coronal slab of thorax allows detailed assessment of shoulder girdle muscle involvement (arrows).

 


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  		Fig. 4C. —56-year-old man with suspected polymyositis. Individual image from coronal slab of thighs facilitates detailed evaluation of muscle and subcutaneous connective tissue inflammation in left thigh (curved arrows) and of prosthesis-induced artifact on right (straight arrow).

 


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  		Fig. 5. —32-year-old woman with creatine kinase level of 1020 U/L and suspected polymyositis. Whole-body turbo short tau inversion recovery MR image (TR/TE, 4000/30; inversion time, 160 msec) shows moderate myositis of vastus lateralis and to lesser extent of vastus medialis muscles bilaterally. Myositis is worse on right, at site of recent electromyographic study (arrow). Other muscle groups are free of disease.

 

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