RESUMO
Inherited myopathies are a group of disease, which, although distinct from a genetic and prognostic point of view, can lead to non-specific clinical pictures due to phenotypic overlap. Acquired immuno-mediated myopathies may also pose the problem of clinically accurate etiological orientation. The assessment of fatty infiltration and pathological increase in water volume of the muscle contingent on whole-body muscle MRI is becoming increasingly important in aiding the initial diagnosis of inherited and acquired myopathies. MRI helps orientating the clinical diagnostic hypotheses thanks to the patterns of muscle involved (more or less specific according to the entities), which led to the development of decision-making algorithms proposed in the literature. The aim of this article is to specify the proper MRI protocol for the evaluation of myopathies and the basis of the interpretation and to provide a summary of the most frequently inherited and acquired myopathies described in the literature.
Assuntos
Doenças Musculares , Humanos , Doenças Musculares/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Diagnóstico DiferencialRESUMO
BACKGROUND AND OBJECTIVES: Spinal muscular atrophy (SMA) is a progressive neurodegenerative disease due to homozygous loss-of-function of the survival motor neuron gene SMN1 with absence of the functional SMN protein. Nusinersen, a costly intrathecally administered drug approved in 2017 in Europe, induces alternative splicing of the SMN2 gene, which then produces functional SMN protein, whose amount generally increases with the number of SMN2 gene copies. METHODS: We retrospectively collected data from consecutive wheelchair-bound adults with SMA managed at a single center in 2018-2020. The following were collected at each injection, on days 1, 14, 28, 63, 183, and 303: 32-item Motor Function Measurement (MFM) total score and D2 and D3 subscores; the Canadian Occupational Performance Measure (COPM) performance and satisfaction scores; and lung function tests. The patients were divided into two groups based on whether their MFM total score wasAssuntos
Atrofia Muscular Espinal
, Doenças Neurodegenerativas
, Atrofias Musculares Espinais da Infância
, Adulto
, Canadá
, Humanos
, Atrofia Muscular Espinal/tratamento farmacológico
, Oligonucleotídeos
, Estudos Retrospectivos
, Atrofias Musculares Espinais da Infância/tratamento farmacológico
RESUMO
Deficiency neuropathies and rhabdomyolysis have previously been reported after bariatric surgery (BS) but never myopathies. We report cases of five patients with morbid obesity who developed within 2 to 4 months of a BS, proximal myopathy following significant and rapid weight loss worsened by postoperative gastrointestinal complications. Muscle weakness concerned lower limbs in particular in quadriceps and less frequently in upper limbs and diaphragm, sometimes mimicked a Guillain-Barré syndrome. Muscle biopsy performed in 1 patient, revealed selective atrophy of type 2 fibers. Weakness slowly decreased with refeeding with vitamins supplementation. We enlarge here the clinical pattern of post-BS complications.
Assuntos
Cirurgia Bariátrica , Síndrome de Guillain-Barré , Obesidade Mórbida , Cirurgia Bariátrica/efeitos adversos , Feminino , Humanos , Debilidade Muscular/etiologia , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologiaRESUMO
OBJECTIVE: Mutations in one of the 3 genes encoding collagen VI (COLVI) are responsible for a group of heterogeneous phenotypes of which Bethlem myopathy (BM) represents the milder end of the spectrum. Genotype-phenotype correlations and long-term follow-up description in BM remain scarce. METHODS: We retrospectively evaluated the long-term clinical evolution, and genotype-phenotype correlations in 35 genetically identified BM patients (23 index cases). RESULTS: Nineteen patients showed a typical clinical picture with contractures, proximal weakness and slow disease progression while 11 presented a more severe evolution. Five patients showed an atypical presentation, namely a limb girdle muscle weakness in 2 and a congenital myopathy pattern with either no contractures, or only limited to ankles, in 3 of them. Pathogenic COL6A1-3 mutations were mostly missense or in frame exon-skipping resulting in substitutions or deletions. Twenty one different mutations were identified including 12 novel ones. The mode of inheritance was, autosomal dominant in 83% of the index patients (including 17% (N=4) with a de novo mutation), recessive in 13%, and undetermined in one patient. Skipping of exon 14 of COL6A1 was found in 35% of index cases and was mostly associated with a severe clinical evolution. Missense mutations were detected in 39% of index cases and associated with milder forms of the disease. CONCLUSIONS: Long-term follow-up identified important phenotypic variability in this cohort of 35 BM patients. However, worsening of the functional disability appeared typically after the age of 40 in 47% of our patients, and was frequently associated with COL6A1 exon 14 skipping.
Assuntos
Colágeno Tipo VI/genética , Contratura/genética , Distrofias Musculares/congênito , Adolescente , Adulto , Idade de Início , Envelhecimento , Biópsia , Criança , Pré-Escolar , Estudos de Coortes , Contratura/patologia , Progressão da Doença , Éxons/genética , Feminino , Seguimentos , Genótipo , Humanos , Imageamento por Ressonância Magnética , Masculino , Debilidade Muscular/etiologia , Distrofias Musculares/genética , Distrofias Musculares/patologia , Mutação , Mutação de Sentido Incorreto/genética , Exame Neurológico , Fenótipo , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
Myofibrillar myopathies (MFM) have been described in the mid-1990s as a group of diseases sharing common histological features, including an abnormal accumulation of intrasarcoplasmic proteins, the presence of vacuoles and a disorganization of the intermyofibrillar network beginning at the Z-disk. The boundaries of this concept are still uncertain, and whereas six genes (DES, CRYAB, LDB3/ZASP, MYOT, FLNC and BAG3) are now classically considered as responsible for MFM, other entities such as FHL1 myopathy or Hereditary Myopathy with Early Respiratory Failure linked to mutations of titin can now as well be included in this group. The diagnosis of MFM is not always easy; as histological lesions can be focal, and muscle biopsy may be disappointing; this has led to a growing importance of muscle imaging, and the selectivity of muscle involvement has now been described in several disorders. Due to the rarity of these myopathies, if some clinical patterns (such as distal myopathy associated with cardiomyopathy due to desmin mutations) are now well known, surprises remain possible and should lead to systematic testing of the known genes in case of a typical histological presentation. In this paper, we aim at reviewing the data acquired on the six main genes listed above as well as presenting the experience from two French reference centres, Paris and Marseilles.
Assuntos
Miofibrilas/patologia , Miopatias Congênitas Estruturais/patologia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas Musculares/genética , Músculo Esquelético/patologia , Miofibrilas/genética , Miopatias Congênitas Estruturais/genética , Miopatias Congênitas Estruturais/terapia , Adulto JovemRESUMO
BACKGROUND: Paraosteoarthropathy (POA) is a frequent disabling orthopedic complication after severe central neurological impairment. The hip is the most frequently affected joint (32.1%) followed by the elbow and the shoulder (25%). PURPOSE: To evaluate coraco- and costoclavicular paraosteoarthropathy in patients with severe central neurological disorders. MATERIAL AND METHODS: We report a series of five consecutive patients with severe central neurological disorders who developed a POA of the clavicular region (coracoclavicular or costoclavicular POA). Every patient underwent a clinical, radiological, and computed tomographic (CT) examination of the shoulder region. RESULTS: Four patients had a history of traumatic brain injury (TBI), and one an acute disseminated encephalomyelitis (ADEM). They developed POA of the clavicular region, although not around the glenohumeral joint. The patients complained of shoulder pain and of moderate limitation of movements. Radiological and CT examinations showed the presence of a bony formation in the coracoclavicular space in four cases and extending from the clavicle to the first rib around the costoclavicular joint in one case. CONCLUSION: In patients with severe brain lesions suffering from shoulder pain and moderate limitation of joint movements, POAs of the clavicular region are rare but should be considered.
Assuntos
Doenças do Sistema Nervoso Central/complicações , Clavícula/diagnóstico por imagem , Osteoartrite/diagnóstico , Osteoartrite/etiologia , Articulação do Ombro/diagnóstico por imagem , Adulto , Lesões Encefálicas/complicações , Meios de Contraste/administração & dosagem , Diagnóstico Diferencial , Encefalomielite Aguda Disseminada/complicações , Feminino , Humanos , Iotalamato de Meglumina , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/diagnóstico , Ossificação Heterotópica/etiologia , Intensificação de Imagem Radiográfica/métodos , Amplitude de Movimento Articular , Índice de Gravidade de Doença , Dor de Ombro/etiologia , Tomografia Computadorizada Espiral/métodos , Tomografia Computadorizada por Raios X/métodosRESUMO
PURPOSE: To characterize intra-abdominal adipose tissue changes in HIV patients with clinical lipodystrophy using a reproducible imaging technique. Materials and methods. 89 HIV patients with clinical lipodystrophy were included. A single axial T1W image was acquired at the mid L4 vertebral level. Two radiologists measured subcutaneous (SAT) and visceral (VAT) adipose tissues using a semi-automated method. Measurements were compared to a matched population (race, sex, age and BMI). RESULTS: Measurements of abdominal adipose tissue on MRI are reproducible. Three clinical types of lipodystrophy are described in males with increased visceral (VAT) and reduced subcutaneous (SAT) adipose tissues compared to control subjects. Two clinical types of lipodystrophy are described in females with increased visceral (VAT) and unchanged subcutaneous (SAT) adipose tissues. CONCLUSION: MRI with comparison between HIV patients and normal control subjects is a reproducible method to characterize adipose tissue changes of lipodystrophy and evaluate its severity. Evaluation of a adipose tissue distribution in a large control population would be helpful to the study of metabolic disorders.
Assuntos
Gordura Abdominal/patologia , Síndrome de Lipodistrofia Associada ao HIV/diagnóstico , Imageamento por Ressonância Magnética , Adulto , Estatura , Índice de Massa Corporal , Peso Corporal , Estudos de Casos e Controles , Feminino , Humanos , Gordura Intra-Abdominal/patologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores Sexuais , Gordura Subcutânea Abdominal/patologiaRESUMO
BACKGROUND AND PURPOSE: Dolichoectasia of the basilar artery is a characteristic finding of Fabry disease. However, its prevalence, severity, and course have been poorly studied. This study quantitatively evaluated, by MRA, a panel of basilar artery parameters in a large cohort of patients with Fabry disease. MATERIALS AND METHODS: Basilar artery mean diameter, curved length, "origin-to-end" linear distance (linear length), and tortuosity index ([curved length ÷ linear length] - 1) were retrospectively measured on 1.5T MRA studies of 110 patients with Fabry disease (mean age, 39.4 ± 18.6 years; 40 males) and 108 control patients (mean age, 42.0 ± 18.2 years; 40 males). RESULTS: Patients with Fabry disease had increased basilar artery mean diameter (P < .001) and basilar artery linear length (P = .02) compared with control patients. Basilar artery curved length and tortuosity index correlated with age in both groups (P < .001), whereas basilar artery linear length correlated with age only in patients with Fabry disease (P = .002). Patients with Fabry disease showed a basilar artery curved length mean increase of 4.2% (9.7% in male patients with Fabry disease versus male control patients), whereas the basilar artery mean diameter had a mean increase of 12.4% (14.3% in male patients with Fabry disease versus male control patients). Male patients with Fabry disease had increased basilar artery mean diameter, curved length, and tortuosity index compared with female patients with Fabry disease (P = .04, P = .02, and P < .001, respectively) and male control patients (P < .001, P = .01, and P = .006, respectively). Female patients with Fabry disease demonstrated an age-dependent increase of basilar artery mean diameter that became significant (P < .001) compared with female control patients above the age of 45 years. CONCLUSIONS: The basilar artery of patients with FD is subjected to major remodeling that differs according to age and sex, thus providing interesting clues about the pathophysiology of cerebral vessels in Fabry disease.
Assuntos
Artéria Basilar/patologia , Encéfalo/patologia , Doença de Fabry/patologia , Adulto , Idoso , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
Neurogenic myositis ossificans is a disabling condition affecting the large joints of patients with severe post-traumatic impairment of the central nervous system. It can result in ankylosis of the joint and vascular or neural compression. Surgery may be hazardous with potential haemorrhage, neurovascular injury, iatrogenic fracture and osteochondral injury. We undertook pre-operative volumetric CT assessment of 45 ankylosed hips with neurogenic myositis ossificans which required surgery. Helical CT with intravenous contrast, combined with two- and three-dimensional surface reconstructions, was the only pre-operative imaging procedure. This gave good differentiation of the heterotopic bone from the adjacent vessels. We established that early surgery, within 24 months of injury, was neither complicated by peri-operative fracture nor by the early recurrence of neurogenic myositis ossificans. Surgical delay was associated with a loss of joint space and a greater degree of bone demineralisation. Enhanced volumetric CT is an excellent method for the pre-operative assessment of neurogenic myositis ossificans and correlates well with the operative findings.
Assuntos
Anquilose/diagnóstico por imagem , Miosite Ossificante/diagnóstico por imagem , Tomografia Computadorizada Espiral/métodos , Adulto , Idoso , Anquilose/cirurgia , Lesões Encefálicas/complicações , Feminino , Articulação do Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Miosite Ossificante/cirurgia , Estudos ProspectivosRESUMO
STUDY DESIGN: A case report of cervical osteomyelitis possibly associated with a Zenker's diverticulum perforation. OBJECTIVES: To present clinical, radiologic, and surgical findings of a cervical osteomyelitis due to a Zenker's diverticulum perforation. SUMMARY OF BACKGROUND DATA: A 56-year-old patient was in an intensive care unit for a severe head injury. He was fed via a nasogastric tube. Four months later he developed a pyogenic cervical vertebral infection. METHODS: Plain films and magnetic resonance imaging showed a diffuse cervical osteomyelitis. Investigation of his dysphagia revealed a Zenker's diverticulum. RESULTS: After administration of antibiotics and surgical treatment of the diverticulum, the cervical infection resolved. Plain films and magnetic resonance imaging showed healing with vertebral fusion. CONCLUSIONS: Cervical osteomyelitis is uncommon. Only one case of direct contamination leading to cervical vertebral osteomyelitis after esophageal perforation has been previously described. Direct contamination of the prevertebral soft tissues by bacteria traveling through the fistula may have occurred. The development of vertebral osteomyelitis in this case is consistent with the hypothesis of direct contamination. Management relies on appropriate antimicrobial therapy and surgical management of the diverticulum. The association of Zenker's diverticulum with vertebral osteomyelitis and discitis is a unique, previously undescribed situation.
Assuntos
Vértebras Cervicais , Osteomielite/etiologia , Doenças da Coluna Vertebral/etiologia , Divertículo de Zenker/complicações , Anti-Infecciosos , Antibióticos Antituberculose/uso terapêutico , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/patologia , Fístula/complicações , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ofloxacino/uso terapêutico , Osteomielite/diagnóstico , Osteomielite/tratamento farmacológico , Rifampina/uso terapêutico , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/tratamento farmacológico , Supuração , Tomografia Computadorizada por Raios X , Divertículo de Zenker/cirurgiaRESUMO
Paraganglioma of the filum terminale is a rare tumor but well described in the neurosurgery and pathology literature. Few MRI reports are mentioned. Paraganglioma, often misdiagnosed with ependymoma or schwannoma on MRI images, must be kept in mind, when a highly vascular lesion with serpentine vessels is observed.
Assuntos
Cauda Equina , Imageamento por Ressonância Magnética , Paraganglioma/diagnóstico , Neoplasias do Sistema Nervoso Periférico/diagnóstico , Adulto , Cauda Equina/patologia , Meios de Contraste , Diagnóstico Diferencial , Ependimoma/diagnóstico , Gadolínio , Humanos , Vértebras Lombares/patologia , Masculino , Neurilemoma/diagnóstico , Paraganglioma/irrigação sanguínea , Paraganglioma/patologia , Neoplasias do Sistema Nervoso Periférico/irrigação sanguínea , Neoplasias do Sistema Nervoso Periférico/patologiaRESUMO
Lumbar subdural abscesses have rarely been reported in the literature, and the complications of epidural infiltrations predominantly include arachnoiditis, meningitis and epidural abscesses. We report a case of lumbar subdural abscess confirmed by surgery, which appeared following epidural infiltration for lumbar sciatica and was examined with computed tomography and MRI. Only the latter technique alone showed the abscess, after gadolinium injection, and established its intradural site.
Assuntos
Corticosteroides/efeitos adversos , Empiema Subdural/etiologia , Injeções Epidurais/efeitos adversos , Adulto , Empiema Subdural/diagnóstico , Feminino , Humanos , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios XRESUMO
Peripheral nervous system (PNS) imaging is usually carried out by ultrasound and MRI. Thanks to its wide availability and excellent spatial resolution, ultrasound is a mature investigation with clearly established indications, particularly in entrapment syndromes and tumors. MRI is generally a second-line examination, which provides decisive additional information thanks to its excellent contrast resolution and its multiplanar abilities. This review describes the current methods for imaging the PNS, concentrating on acquisition techniques, normal results and basic pathological semiology. Ongoing and future developments are described in order to underline the forthcoming changes in this very dynamic field of musculoskeletal radiology.
Assuntos
Aumento da Imagem , Imageamento Tridimensional , Imageamento por Ressonância Magnética , Traumatismos dos Nervos Periféricos/diagnóstico , Nervos Periféricos/patologia , Doenças do Sistema Nervoso Periférico/diagnóstico , Tomografia Computadorizada por Raios X , Ultrassonografia , Animais , Meios de Contraste , Imagem de Tensor de Difusão , Modelos Animais de Doenças , Humanos , Espectroscopia de Ressonância Magnética , Denervação Muscular , Músculo Esquelético/inervação , Sensibilidade e Especificidade , Degeneração Walleriana/patologiaRESUMO
Collagen VI-related myopathies are hereditary disorders causing progressive restrictive respiratory insufficiency. Specific diaphragm involvement has been suggested by a drop in supine volumes. This pilot study aimed at characterizing the respiratory muscle phenotype in patients with COL6A1-3 genes mutations. Lung function, blood gases, muscle strength and respiratory mechanics were measured in 7 patients between 2002 and 2012. Patients were classified as Early-Severe (n = 3), Moderate-Progressive (n = 2) and Mild (n = 2) according to clinical disease presentation. Seven patients (aged 6-28) were evaluated. Forced vital capacity distinguished the Mild group (>60% predicted) from the two other groups (<50% predicted). This distinction was also possible using the motor function measure scale. Diaphragmatic dysfunction at rest was observed in all the Early-Severe and Moderate-Progressive patients. During a voluntary sniff maneuver diaphragmatic dysfunction was observed in all patients, as assessed by a negative gastric pressure. All patients had diaphragmatic fatigue assessed by a tension-time index over the threshold of 0.15. Diaphragmatic dysfunction during a maximal voluntary maneuver and diaphragmatic fatigue are constant features in Collagen VI myopathies. These observations can assist the diagnosis and should be taken in account for the clinical management, with the early detection of sleep-disordered breathing.
Assuntos
Diafragma/fisiopatologia , Doenças Musculares/fisiopatologia , Adolescente , Adulto , Criança , Colágeno Tipo VI/genética , Colágeno Tipo VI/metabolismo , Diagnóstico Diferencial , Feminino , Técnicas de Genotipagem , Humanos , Imuno-Histoquímica , Masculino , Atividade Motora/fisiologia , Força Muscular/genética , Força Muscular/fisiologia , Doenças Musculares/diagnóstico , Doenças Musculares/genética , Fenótipo , Descanso/fisiologia , Índice de Gravidade de Doença , Capacidade Vital , Adulto JovemAssuntos
Conservadores da Densidade Óssea/uso terapêutico , Neoplasias Ósseas/diagnóstico por imagem , Denosumab/uso terapêutico , Tumores de Células Gigantes/diagnóstico por imagem , Ísquio , Neoplasias Ósseas/tratamento farmacológico , Quimioterapia Adjuvante , Tumores de Células Gigantes/tratamento farmacológico , Humanos , Imageamento por Ressonância Magnética , Masculino , Terapia Neoadjuvante , Adulto JovemRESUMO
Upright standing radiographs of the entire spine, at times completed by supine radiographs, allow diagnosis and follow-up of scolioses to detect progression over time and enable timely intervention to avoid painful, esthetic, respiratory and cutaneous complications. Motor difficulties that may accompany severe scolioses may confine affected individuals to bed. Cross-sectional imaging with tridimensional reconstructions combined with myelographic MR imaging sequences allow complete evaluation of the disease and have alleviated the need for conventional myelography. Evaluation of the imaging data allows comprehensive patient management that may include therapy, image-guided spinal injections or surgery with the help of new titanium hardware enabling follow-up MRI.
Assuntos
Escoliose , Pessoas com Deficiência , Humanos , Imageamento por Ressonância Magnética , Escoliose/complicações , Escoliose/diagnósticoRESUMO
Neuromuscular diseases have different characteristics. Respiratory and cardiovascular manifestations are frequent and severe. Respiratory difficulties secondary to muscle involvement and bronchial secretions worsen complications related to a frequent scoliosis. CT is a useful complement to standard radiographs in the setting of acute symptomatic deterioration and for presurgical evaluation of a scoliosis. Echocardiography is performed to determine the presence of cardiomyopathy. Gastrointestinal motility disorders are assessed with standard barium studies or CT in the acute setting. Urinary tract involvement also is possible in these patients given the increased survival and follow-up imaging may be helpful for palliative management. The imaging features of frequent manifestations will be discussed along with the imaging appearance of a few specific entities.
Assuntos
Doenças do Sistema Digestório/etiologia , Doenças Neuromusculares/complicações , Transtornos Respiratórios/etiologia , Doenças Urológicas/etiologia , Adulto , Doenças do Sistema Digestório/diagnóstico por imagem , Feminino , Humanos , Transtornos Respiratórios/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Doenças Urológicas/diagnóstico por imagemRESUMO
Spasticity, a component of the pyramidal syndrome, characterized by increased tonic stretch reflexes and hyperactive deep tendon reflexes, occurs in patients with central nervous system lesions (stroke, brain or cord injury, multiple sclerosis, cerebral motor impairment). The implementation of standard procedures (patient positioning, increased examination time, turning off certain devices before MR imaging) allows the acquisition of high quality examinations in spastic patients. Worsening spasticity in a handicaped patients is due to an irritative process (deep seated infection, fracture, syrinx...) usually detectable with imaging. Ultrasound or CT guided injections of botulinum agents provides radiologists with the opportunity to further participate in the management of spastic patients.