Preoperative Diagnosis of Proliferative Myositis by Enhanced Computed Tomography and the Apparent Diffuse Coefficient Ma
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CASE REPORT
Preoperative Diagnosis of Proliferative Myositis by Enhanced Computed Tomography and the Apparent Diffuse Coefficient Map from Magnetic Resonance Imaging Toshitaka Ouchi 1 & Hisashi Hasegawa 1,2
&
Hiroumi Matsuzaki 1 & Takeshi Oshima 1
Received: 23 April 2020 / Accepted: 26 August 2020 # Association of Surgeons of India 2020
Abstract Proliferative myositis is a rare intramuscular inflammatory lesion that occurs in the head and neck and which could be resolved without treatment. Herein, we present the imaging characteristics for its preoperative diagnosis, potentially mitigating the need for surgery. We describe the enhanced computed tomography (CT) and magnetic resonance imaging (MRI) findings of two patients. We observed a checkerboard-like pattern in the sternocleidomastoid muscle on enhanced CT in one patient. We also identified the involvement of two heads of the sternocleidomastoid muscle. Coronal enhanced CT imaging was also useful in the preoperative diagnosis because it revealed a lattice structure, equivalent to muscle fibers. On MRI, diffusion-weighted sequences showed hyperintensity, and the apparent diffusion coefficient map showed hypointensity in proliferative myositis. Enhanced CT and MRI-based diffusion-weighted sequences and the apparent diffusion coefficient map are useful in the preoperative diagnosis of proliferative myositis and could be useful for avoiding the need for complete surgical excision. Keywords Proliferative myositis . Sternocleidomastoid muscle . Intramuscular lesion . Computed tomography . Apparent diffusion coefficient map of magnetic resonance imaging
Introduction Proliferative myositis (PM) is a rare, self-limiting, pseudosarcomatous intramuscular inflammatory lesion. It occurs in the head, neck, and, infrequently, in the sternocleidomastoid (SCM) muscle [1, 2]. The etiology of PM is unclear, although trauma is suspected to contribute to its development. It is often misdiagnosed as a malignant tumor, such as sarcoma or metastasis from head and neck cancer because of its rapid growth. Most cases are diagnosed by complete excision of the mass [3–6]. The ability to diagnose PM on imaging would avoid the need for unnecessary surgery.
Compared with magnetic resonance imaging (MRI), computed tomography (CT) has not been extensively used for the preoperative PM diagnosis because of the presence of nonspecific features [7]. However, it has been reported that enhanced CT in cases of PM can reveal a specific characteristic, referred to as the “checkerboard-like” pattern [4]. Here, we report the cases of two patients with PM and describe several new imaging findings. We found that enhanced CT, diffusionweighted (DW) sequences, and apparent diffusion coefficient (ADC) maps were potentially useful tools in the preoperative diagnosis of PM.
Case Reports * Hisashi Hasegawa [email protected] 1
Department of Otolaryngology-Head and Neck Surgery, Nihon University Hospital, 1-6 Kandasurugadai, Chiyoda-ku, Tokyo 101-8309, Japan
2
TMG Asaka Medical Center, 1340-1
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