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Mervi Löfberg, MD; Kristian Liewendahl, MD, PhD; Antti Lamminen, MD, PhD; Ossi Korhola, MD, PhD; Hannu Somer, MD, PhD

Arch Neurol. 1998;55:987-993.

Objective  To compare indium In 111 altumomab pentetate–labeled antimyosin scintigraphy with magnetic resonance imaging (MRI) in the diagnosis and follow-up of patients with myositis.

Design and Methods  Sixteen patients with polymyositis and 1 patient with dermatomyositis, all verified with biopsy samples, were examined during diagnostic evaluation with antimyosin antibody scintigraphy and low-field MRI of the thighs and calves using T₁- and T₂-weighted sequences. Both examinations were repeated 6 to 22 months after therapeutic intervention with anti-inflammatory drugs. The performance of the 2 methods for the assessment of the severity of muscle inflammation was evaluated using comparison with clinical examination and the serum creatine kinase level.

Results  At diagnosis all patients had increased uptake of antimyosin antibody in the thighs and/or calves. In T₂-weighted MRI images, increased signal intensity changes reflecting intramuscular edema and inflammation were seen in all patients in at least 1 muscle group in the thighs or calves. After anti-inflammatory drug therapy, the mean uptake of antibody and the mean signal intensity changes in T₂-weighted MRI had decreased. However, in T₁-weighted MRI the signal intensity changes reflecting intramuscular fatty degeneration were more pronounced in the follow-up study. The level of serum creatine kinase had decreased markedly by the second examination except in 1 patient who also had more accumulation of antibody in the calves after than before treatment. The clinical condition improved in 8 patients and remained unchanged in 9 patients.

Conclusions  Antimyosin scintigraphy and T₂-weighted MRI are feasible tools for the detection and follow-up of lesions in patients with myositis. Scintigraphy findings correlate with serum creatine kinase activity and seem to reflect disease activity better than T₂-weighted MRI changes, whereas secondary degenerative intramuscular lesions are only detectable using T₁-weighted MRI.

From the Department of Neurology, Institute of Neurosciences (Drs Löfberg and Somer), the Laboratory Department, Division of Nuclear Medicine (Dr Liewendahl), and the Department of Radiology (Drs Lamminen and Korhola), Helsinki University Central Hospital, Helsinki, Finland.

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