[Non-invasive imaging of chronic inflammatory myopathies]
| Autor: | Miroslav Harjaček |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
kronične upalne miopatije
dermatomiozitis polimiozitis magnetska rezonancija ultrazvuk elastografija PET scan chronic inflammatory myopathies dermatomyositis polymiositis magnetic resonance ultrasound elastography Myositis Positron-Emission Tomography Elasticity Imaging Techniques Humans Magnetic Resonance Imaging |
| Zdroj: | Reumatizam Volume 59 Issue 2 |
| ISSN: | 0374-1338 2459-6159 |
| Popis: | Cilj svakog uspješnog dijagnostičkog postupka je postići što pouzdaniji rezultat u što kraćem vremenu, koristeći se pritom što manje invazivnom dijagnostikom. Neinvazivnim slikovnim pretragama možemo u mišiću utvrditi edem, kolekcije tekućina, infiltracije masnog tkiva, atrofiju, fibrozu i kalcifikate. Najosjetljivija neinvazivna slikovna dijagnostička metoda u današnjoj suvremenoj dijagnostici upalnih bolesti mišića je MR u T2 slikovnim prikazima sa supresijom masnog tkiva i/ili STIR prikazu. MR je vrlo korisna metoda i pri određivanju preciznog mjesta biopsije mišića. Nespecifičnost nalaza promjena na mišiću, dostupnost, cijena, kao i kontraindikacije za primjenu kod bolesnika s metalnim protezama ili pacemakerima, kao i način izvođenja pretrage predstavljaju ozbiljna ograničenja te metode. Glavna prednost ultrazvuka mišića, u usporedbi s ostalim slikovnim metodama, je dostupnost i cijena pretrage. Pojačana vaskularnost mišića utvrđena pomoću PD-a korelira s dužinom trajanja miozitisa, a PD može biti i koristan za utvrđivanje pojačanog signala prokrvljenosti te isključivanje rupture mišića, bolesti poput cisticerkoze kao i apscesa mišića. Čini se da bi zbog dostupnosti i visoke osjetljivosti kvantitativni ultrazvuk s kontrastom (CEUS), metoda koja omogućuje procjenu pojačane vaskularnosti mišića u realnom vremenu, uz dodatak elastografije, uskoro mogao zauzeti važniju ulogu u potvrdi kliničke sumnje kronične upalne bolesti mišića. In patients with chronic inflammatory myositis noninvasive diagnostic modalities, such as magnetic resonance (MR) imaging, and ultrasonography (US), are able to demonstrate muscular edema, fluid collections, fatty infiltration, atrophy, fibrosis, and calcifications. Because MR imaging is sensitive to the presence of edema and offers better tissue differentiation, current MR imaging with fat suppressed T2-weighted techniques or STIR images appears to be more efficient than US in the diagnosis and management of inflammatory myopathies. MR imaging has also been proposed as a means to guide biopsy in an area of active disease, thereby reducing the problem of sampling error. These changes in signal intensity, however, are not specific for myositis. Although MR imaging is now the imaging modality of choice in this issue, reduced availability, patient discomfort, and exclusion of certain patients with indwelling metal objects, such as pacemakers, are disadvantages. The availability and ease of use of US makes it preferable to MR imaging. Real-time sonoelastography can be used for various musculoskeletal applications, but the clinical utility in diagnosis of myositis is yet to be established. On the other hand, the contrast-enhanced US is a feasible method for noninvasively demonstrating increased perfusion in the involved muscle groups, and most likely, will soon become preferable, noninvasive imaging method in patients with myositis. |
| Databáze: | OpenAIRE |
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