Diagnostic Value of Muscle Ultrasound for Myopathies and Myositis
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IMAGING (J SAMUELS, SECTION EDITOR)
Diagnostic Value of Muscle Ultrasound for Myopathies and Myositis Jemima Albayda 1
&
Nens van Alfen 2
# The Author(s) 2020
Abstract Purpose of Review The purpose of this review is to critically discuss the use of ultrasound in the evaluation of muscle disorders with a particular focus on the emerging use in inflammatory myopathies. Recent Findings In myopathies, pathologic muscle shows an increase in echogenicity. Muscle echogenicity can be assessed visually, semi-quantitatively, or quantitatively using grayscale analysis. The involvement of specific muscle groups and the pattern of increase in echogenicity can further point to specific diseases. In pediatric neuromuscular disorders, the value of muscle ultrasound for screening and diagnosis is well-established. It has also been found to be a responsive measure of disease change in muscular dystrophies. In chronic forms of myositis like inclusion body myositis, ultrasound is very suitable for detecting markedly increased echogenicity and atrophy in affected muscles. Acute cases of muscle edema show only a mild increase in echogenicity, which can also reverse with successful treatment. Summary Muscle ultrasound is an important imaging modality that is highly adaptable to study various muscle conditions. Although its diagnostic value for neuromuscular disorders is high, the evidence in myositis has only begun to accrue in earnest. Further systematic studies are needed, especially in its role for detecting muscle edema. Keywords Muscle ultrasound . Myopathies . Myositis . Diagnostic test . Muscle echogenicity
Introduction The evaluation of muscle disorders and myopathies is greatly enhanced by the addition of imaging to identify structural abnormalities and provide an assessment of muscle quality. Ultrasound (US) of muscle was first described in 1968 [1], making it one of the first imaging modalities applied to muscle. The advent of improved technology has led to higher resolution sonography for soft tissue evaluation that is very suitable for muscles. Additionally, the patient-friendly nature, the lack of contraindications, and the ability to assess muscles dynamically in real time and at the bedside are important advantages of this tool. In this review, we will discuss the This article is part of the Topical Collection on Imaging * Jemima Albayda [email protected] 1
School of Medicine, Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA
2
Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
applications of muscle US for the diagnosis and evaluation of myopathies with a special focus on myositis.
Muscle Sonoanatomy Normal Muscle On cross-section, normal muscle appears as a relatively anechoic structure with hyperechoic speckles within the tissue representing perimysial septa, giving it the “starry night appearance” (Fig. 1A, C). The boundaries of each muscle are delineated by the presence
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