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Diagnostic utility of perilesional muscle edema in myositis ossificans

Veronika Zubler, Malin Mühlemann, Reto Sutter, Tobias Götschi, Daniel A Müller, Tobias Dietrich & Christian W Pfirrmann

abstract

OBJECTIVES
To investigate the value of extensive perilesional muscle edema for the differentiation between myositis ossificans (MO) and malignant intramuscular soft tissue tumors on MRI.

MATERIALS AND METHODS
Two blinded readers analyzed MR examinations of 90 consecutive patients with intramuscular soft tissue masses (group 1: MO, n = 20; group 2: malignant tumors, n = 70). Extent of edema around lesions was graded (0, none; 1, minimal edema; 2, moderate edema; 3, extensive edema). Edema-lesion ratio (ELR = ratio of the maximal diameter of the edema and the maximal diameter of the central lesion) was calculated. ROC analysis, Mann-Whitney U test, and Kappa test were used.

RESULTS
A total of 70% and 60% of patients with MO had edema grade 3 (reader 1/reader 2), 30%/40% edema grade 2. For the patients with malignant tumors, it was 2.9%/1.4% (edema grade 3) and 16%/23% (edema grade 2). Interrater reliability was substantial (kappa = 0.66). Extent of edema was significantly higher for patients of group 1 (p < 0.0001, both readers). Mean ELR was 3.60 (group 1) and 1.35 (group 2), with statistically significant differences (p < 0.0001). Grade 3 edema showed a sensitivity/specificity of 70%/97.1% (reader 1) and 60%/99% (reader 2) for diagnosing MO. For ELR > 2.0, sensitivity was 90% and specificity 91% for diagnosing MO.

CONCLUSIONS
Extensive perilesional muscle edema on MRI of more than double the size of the central lesion is highly specific, but not pathognomonic for myositis ossificans in the early/intermediate stage in the differentiation to malignant intramuscular soft tissue lesions.
   
citation Zubler V, Mühlemann M, Sutter R, Götschi T, Müller D A, Dietrich T, Pfirrmann C W. Diagnostic utility of perilesional muscle edema in myositis ossificans. Skeletal Radiol 2020; 49:929-936.
   
type journal paper/review (English)
date of publishing 07-01-2020
journal title Skeletal Radiol (49/6)
ISSN electronic 1432-2161
pages 929-936
PubMed 31907558
DOI 10.1007/s00256-019-03351-5