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. 2017 May;90(1073):20160780.
doi: 10.1259/bjr.20160780. Epub 2017 Mar 29.

Value of whole-body magnetic resonance imaging for screening multifocal osteonecrosis in patients with polymyositis/dermatomyositis

Huang Zhen-Guo  1 , Yang Min-Xing  1 , Chen Xiao-Liang  1 , Yan Ran  1 , Chen He  1 , Gao Bao-Xiang  1 , Yin Li-Guo  2 , Shi Kai-Ning  3 , Queenie Chan  4 , Wang Guo-Chun  2
Affiliations

Value of whole-body magnetic resonance imaging for screening multifocal osteonecrosis in patients with polymyositis/dermatomyositis

Huang Zhen-Guo et al. Br J Radiol. 2017 May.

Abstract

Objective: To assess the value of coronal short-tau inversion recovery whole-body MRI (STIR-WBMRI) for screening osteonecrosis in patients with polymyositis (PM)/dermatomyositis (DM).

Methods: The imaging and medical records of 129 patients with PM/DM who met the Bohan and Peter diagnostic criteria were retrospectively analyzed. STIR-WBMRI was performed in all patients. 18 patients had follow-up STIR-WBMRI. 12 patients underwent regional knee and/or hip MRI while 25 patients underwent radiography of the lower extremities.

Results: STIR-WBMRI detected osteonecrosis in 15 (11.6%) patients. 38 joints were affected (mean, 2.5 per patient; range, 1-5 joints). Of the 38 joints affected by osteonecrosis, 33 had no clinical symptoms. Among the 12 patients who underwent regional MRI, STIR-WBMRI detected all 10 osteonecrotic sites seen on the regional MRI. The location, shape and size of the osteonecrotic lesions revealed on regional MRI were in accordance with those displayed on STIR-WBMRI. Of the 15 patients with osteonecrosis, 6 performed routine radiography of the affected joints and revealed no osteonecrotic lesions. Follow-up WBMRI detected new osteonecrosis in two patients whose first WBMRI revealed that there was no osteonecrosis in any skeleton.

Conclusion: In addition to displaying muscle inflammation, STIR-WBMRI can efficiently detect early multifocal osteonecrosis in the whole bodies of patients with PM/DM. Advances in knowledge: In patients with PM/DM, WBMRI which takes 12-15 min can display muscular involvement and detect early multisite osteonecrosis in the whole body at the same time. Osteonecrotic lesions revealed by WBMRI are in accordance with those displayed on regional WBMRI.

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Figures

Figure 1.
Figure 1.
Osteonecrosis of the bilateral femoral heads in a 50-year-old female with dermatomyositis. (a–e) Short-tau inversion recovery whole-body MRI (STIR-WBMRI) (a), the hip area of coronal STIR-WBMRI (b), corresponding regional hip MR T2 weighted spectral pre-saturation inversion recovery (T2W SPIR) (c), T1 weighted (T1W) images (d) and anteroposterior radiograph (e). The necrotic region (white arrows) is surrounded by a distinct high-intensity rim on STIR-WBMRI, T2W SPIR and is surrounded by a low-signal band on T1W. A high degree of consistency was demonstrated between STIR-WBMRI and regional hip MR on necrotic lesion size, shape and position. Radiography did not detect the osteonecrosis shown on STIR-WBMRI.
Figure 2.
Figure 2.
Osteonecrosis of the bilateral femoral heads in a 43-year-old male with dermatomyositis. A distinct high-intensity rim (white arrows) in the normally low-intensity marrow surrounds the osteonecrotic lesions at the bilateral femoral heads.
Figure 3.
Figure 3.
Coronal short-tau inversion recovery whole-body MRI displaying osteonecrosis (white arrows) involving the bilateral distal femurs, proximal tibia and right distal tibia in a 40-year-old female with polymyositis.
Figure 4.
Figure 4.
Osteonecrosis of the bilateral knees and calcanei in a 55-year-old female with dermatomyositis. (a) The knee area of the coronal short-tau inversion recovery whole-body MRI (STIR-WBMRI) before treatment, (b–d) the knee area of the coronal STIR-WBMRI (b), anteroposterior radiograph of the bilateral knees (c) and the ankle area of the coronal STIR-WBMRI images (d) after 6 months of treatment with corticosteroids. The first STIR-WBMRI did not show osteonecrosis in bilateral knees before treatment (a). After 6 months of treatment with corticosteroids, STIR-WBMRI displayed osteonecrosis, but radiography did not show osteonecrosis. Meanwhile, osteonecrotic lesions in both calcanei were displayed on STIR-WBMRI.
Figure 5.
Figure 5.
A 24-year-old female patient with dermatomyositis, displaying inflammatory muscular oedema, and osteonecrosis in both knees. Coronal short-tau inversion recovery whole-body MRI (STIR-WBMRI) showed significantly increased muscle signal at both the shoulders, thighs and legs (black arrows), suggesting the presence of inflammatory oedema. Meanwhile, coronal STIR-WBMRI displayed osteonecrosis involving the bilateral distal femurs and proximal tibia (white arrows).
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