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A Single-Blind Study of the Diagnostic Value of Magnetic Resonance Imaging and Ultrasound

Marcus R. Stonecipher, MD; Joseph L. Jorizzo, MD; Johnny Monu, MD; Francis Walker, MD; Paul G. Sutej, MD

Arch Dermatol. 1994;130(10):1294-1299.

Abstract
Background and Methods
It is well documented that the cutaneous lesions of dermatomyositis may precede clinical myositis or may occur in the absence of any muscle disease detectable by current diagnostic criteria. In this single-blind study, we used magnetic resonance imaging (MRI) and ultrasound to evaluate five patients who presented with classical clinicopathologic dermatomyositis, but with normal levels of serum muscle enzymes. This patient group has not been previously studied with these techniques. Patients who served as positive and negative control subjects were also examined.

Results
Ultrasonography revealed hyperechogenicity, and MRI revealed high signals on T₂-weighted images in several muscle groups of the patient with active myositis (positive control). Increased echogenicity was also noted in the deltoid region of one patient who had previously had a normal muscle biopsy finding. In the same patient, MRI revealed inflammatory changes in the lumbar paraspinal muscles. Another patient, with all previous study results being normal, had MRI evidence of T₂ high signals in the gluteus minimus.

Conclusions
Noninvasive examinations such as MRI and ultrasound are beneficial as adjunctive means of examination in the evaluation of patients with dermatomyositis sine myositis or dermatomyositis. Future studies may suggest additional uses for these tests, including serial evaluation of patients, noninvasive confirmation of diagnosis in pediatric patients, or in directing muscle biopsy, thus increasing sensitivity. Ultrasound appears to be the more cost-effective and simple test; but MRI, although more expensive, may be more sensitive and specific.

(Arch Dermatol. 1994;130:1294-1299)

Author Affiliations
From the Departments of Dermatology (Drs Stonecipher and Jorizzo), Radiology (Dr Monu), Neurology (Dr Walker), and Internal Medicine, Section of Rheumatology (Dr Sutej), Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC.

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