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Quantification of muscular inflammation by 18F-FDG PET/CT for initial evaluation and treatment response on inflammatory myopathy: A case report
A propósito de un caso de miopatía inflamatoria. Cuantificación de la inflamación muscular mediante PET/TC con 18F-FDG en la evaluación inicial y la respuesta terapéutica
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Cuantificación de la inflamación muscular mediante PET/TC con <span class="elsevierStyleSup">18</span>F-FDG en la evaluación inicial y la respuesta terapéutica" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "199" "paginaFinal" => "200" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Quantification of muscular inflammation by <span class="elsevierStyleSup">18</span>F-FDG PET/CT for initial evaluation and treatment response on inflammatory myopathy: A case report" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1096 "Ancho" => 805 "Tamanyo" => 90412 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Se ha practicado un estudio PET/TC, de cuerpo completo, una hora tras la administración de 124 MBq de <span class="elsevierStyleSup">18</span>F-FDG, habiendo colocado previamente una manta eléctrica al paciente, para evitar la captación de grasa parda y contractura muscular. El estudio PET/TC identifica actividad muscular proximal en brazos y piernas, más evidente en trapecios, deltoides, bíceps y cuádriceps, con media del SUV de 2,73, calculado según el método descrito por Rider et al. Además, se ha descartado su origen tumoral. B) Imágenes coronales STIR y supresión grasa T2 obtenidas en una RM de 1,5 teslas, sin contraste. Se identifica edema en brazos y piernas, que se correlacionan con los hallazgos de la PET/TC.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.R. García, A. Jaramillo, E. Iglesias, E. Inarejos, C. Jou, E. Riera" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J.R." "apellidos" => "García" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Jaramillo" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Iglesias" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Inarejos" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Jou" ] 5 => array:2 [ "nombre" => "E." 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Normal residual adrenal gland is visible between the capsule and the tumor (H/E stain, 20×). (B) Photomicrograph showing dense eosinophilic oncocytes, occasionally multinucleated. (H/E stain, 20×). (C) Immunohistochemistry showing positive cytoplasmic staining for synaptophysin (10×). (D) Ki-67 nuclear expression (10×).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Gilardi, M. Vadrucci, S. Pirola, C.M. Grana" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Gilardi" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Vadrucci" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Pirola" ] 3 => array:2 [ "nombre" => "C.M." 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"apellidos" => "García" "email" => array:1 [ 0 => "jrgarcia@cetir.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Jaramillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Iglesias" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "E." "apellidos" => "Inarejos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "C." "apellidos" => "Jou" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "E." "apellidos" => "Riera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Unidad PET/TC, CETIR-ERESA, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Sant Joan de Déu, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Radiología, Hospital Sant Joan de Déu, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Sant Joan de Déu, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "A propósito de un caso de miopatía inflamatoria. Cuantificación de la inflamación muscular mediante PET/TC con <span class="elsevierStyleSup">18</span>F-FDG en la evaluación inicial y la respuesta terapéutica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1067 "Ancho" => 775 "Tamanyo" => 85100 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) PET/CT study one year after therapy, reflects the reduction of the muscular activity, persisting activity in the right quadriceps and the left deltoid, with an average SUV of 1.12 (−58%). (B) MRI one year after therapy shows no significant changes, except for the improvement in the gluteal muscles.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 12-year-old male patient was hospitalised for asthenia, abdominal pain and skin lesions. The presence of hypercalcemia required symptomatic treatment (hyperhydration, diuretics and bisphosphonates).</p><p id="par0010" class="elsevierStylePara elsevierViewall">A PET/CT study using <span class="elsevierStyleSup">18</span>F-FDG was performed to rule out associated malignancy and to assess the presence of muscular inflammation. This study has been evaluated according to the method for quantification of muscle activity described by Rider et al. <a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a>: Calculation of the average of the SUV from eight bilateral proximal muscles (trapezius, deltoid, biceps, psoas, gluteus medius, gluteus maximus, quadriceps and flexors of the knee) obtaining a total of 16 SUV values.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The PET/CT study identified muscle activity in the arms and legs, with an average SUV of 2.73. In addition, it allowed to rule out a tumoral origin (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). MRI identified edema in the arms and legs, concordant with the PET/CT findings (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Inflammatory myopathies include a heterogeneous group of entities characterized by symmetrical muscular weakness, myalgia and elevation of skeletal muscle enzymes. The Polymyositis/Dermatomyositis is a well-known etiology, but there are other entities such as Granulomatous Myositis, that can explain this clinical presentation. The histological findings of granulomatous myositis are non-specific epithelial granulomas that may be in relation to sarcoidosis or other less frequent causes.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">MRI has a recognized role in the evaluation of inflammatory myopathies, but the sensitivity is not 100%. A PET/CT with <span class="elsevierStyleSup">18</span>F-FDG provides metabolic information about the striated muscles and it could have better sensitivity than MRI. However, the muscle biopsy continues to be the gold standard in its diagnosis, although it cannot determine the extension of the inflammation.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">PET/CT and MRI findings were used for target muscle biopsy, that confirmed the presence of non-necrotizing epithelial granulomas, composed of Epithelioid histiocytes, giant cells and mature lymphocytes with a final diagnosis of extrapulmonary sarcoidosis. An immunosuppressive treatment was established (corticosteroids, methotrexate and hydroxychloroquine).</p><p id="par0035" class="elsevierStylePara elsevierViewall">One year after treatment, PET/CT reflected the reduction of the muscular activity, with an average of the SUV of 1.12 (−58%) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). MRI showed no significant changes, with the exception of improvement of the gluteal muscles (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">In our case, the <span class="elsevierStyleSup">18</span>F-FDG PET/CT study has provided information about the extent and severity of muscle inflammation. The quantification method proposed has shown its utility in the evaluation of therapeutic response, complementary to the MRI and concordant with the histology. In addition, it has allowed to rule out a tumoral origin.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García JR, Jaramillo A, Iglesias E, Inarejos E, Jou C, Riera E. A propósito de un caso de miopatía inflamatoria. Cuantificación de la inflamación muscular mediante PET/TC con <span class="elsevierStyleSup">18</span>F-FDG en la evaluación inicial y la respuesta terapéutica. Rev Esp Med Nucl Imagen Mol. 2017;36:199–200.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1096 "Ancho" => 805 "Tamanyo" => 90412 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) A whole body PET/CT scanning was performed 1 h after the administration of 124 MBq of <span class="elsevierStyleSup">18</span>F-FDG, having previously placed an electric blanket on the patient, to avoid the uptake in brown fat and muscular contracture. The PET/CT study identified proximal muscle activity in the arms and legs, it was more evident in trapezius, deltoids, biceps and quadriceps, with an average SUV of 2.73, calculated according to the method described by Rider et al. In addition, unknown occult primary tumor was ruled out. (B) Coronal images, STIR and fat-suppressed T2-weighted, obtained in an MRI of 1.5 Tesla, without contrast, identified edema in arms and legs that correspond to the findings of the PET/CT.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1067 "Ancho" => 775 "Tamanyo" => 85100 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) PET/CT study one year after therapy, reflects the reduction of the muscular activity, persisting activity in the right quadriceps and the left deltoid, with an average SUV of 1.12 (−58%). (B) MRI one year after therapy shows no significant changes, except for the improvement in the gluteal muscles.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Validation of manual muscle testing and a subset of eight muscles for adult and juvenile idiopathic inflammatory myopathies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.G. Rider" 1 => "D. Koziol" 2 => "E.H. Giannini" 3 => "M.S. Jain" 4 => "M.R. Smith" 5 => "K. 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Horger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00296-009-0890-y" "Revista" => array:6 [ "tituloSerie" => "Rheumatol Int" "fecha" => "2009" "volumen" => "29" "paginaInicial" => "1511" "paginaFinal" => "1514" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19301008" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymyositis and dermatomyositis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.C. Dalakas" 1 => "R. Hohlfeld" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(03)14368-1" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2003" "volumen" => "362" "paginaInicial" => "971" "paginaFinal" => "982" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14511932" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000003600000003/v1_201704211006/S2253808917300101/v1_201704211006/en/main.assets" "Apartado" => array:4 [ "identificador" => "7927" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Interesting images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000003600000003/v1_201704211006/S2253808917300101/v1_201704211006/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808917300101?idApp=UINPBA00004N" ]
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