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Predictive value of brain 18F-FDG PET/CT in macrophagic myofasciitis?: A case report
Axel Van Der Gucht1, Mukedaisi Abulizi, Paul Blanc-Durand
1Department of Nuclear Medicine, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University INSERM U955-Team 10 Department of Neurology Department of Pathology, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University Reference Center for Neuromuscular Disorders, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil CHU Nancy, Nuclear Medecine and Nancyclotep Experimental Imaging Platform, Nancy INSERM U955-GRC Amyloid Research Institute, Créteil, France.
Rationale:
Although several functional studies have demonstrated that positron emission tomography/computed tomography with F-fluorodeoxyglucose (F-FDG PET/CT) appears to be efficient to identify a cerebral substrate in patients with known macrophagic myofasciitis (MMF), the predictive value of this imaging technique for MMF remains unclear.
Patient Concerns:
We presented data and images of a 46-year-old woman.
Diagnoses:
The patient was referred to our center for suspected MMF due to diffuse arthromyalgias and cognitive disorder (involving an impairment of visual selective attention and a weakness in executive functions revealed by neuropsychological assessment) which occurred few years after last vaccine injections.
Interventions:
After a first negative deltoid muscle biopsy, a brain F-FDG PET/CT was performed and revealed the known spatial pattern of a cerebral glucose hypometabolism involving occipital cortex, medial temporal areas, and cerebellum.
Outcomes:
Given the clinical suspicion of MMF and brain F-FDG PET/CT findings, a 2nd deltoid muscle biopsy was performed and confirmed the diagnosis of MMF with typical histopathological features.
Lessons:
This case highlights the predictive value of brain F-FDG PET/CT as a noninvasive imaging tool for MMF diagnosis, even when muscle biopsy result comes back negative.
Insights
Positron emission tomography/computed tomography with F-fluorodeoxyglucose (F-FDG PET/CT) can predict macrophagic myofasciitis (MMF) diagnosis. This imaging tool is valuable even with negative muscle biopsy results, aiding in early MMF detection.
Area of Science:
- Neurology
- Radiology
- Immunology
Background:
- Macrophagic myofasciitis (MMF) diagnosis can be challenging, with functional studies suggesting F-FDG PET/CT's utility in identifying cerebral involvement.
- The predictive value of F-FDG PET/CT for MMF diagnosis, especially in cases with inconclusive initial biopsies, remains to be fully elucidated.
Observation:
- A 46-year-old woman presented with arthralgias and cognitive deficits post-vaccination, suspected for MMF.
- Initial deltoid muscle biopsy was negative; however, a subsequent brain F-FDG PET/CT revealed characteristic cerebral glucose hypometabolism in the occipital cortex, medial temporal areas, and cerebellum.
Findings:
- The F-FDG PET/CT findings, coupled with clinical suspicion, led to a second muscle biopsy.
- The second biopsy confirmed MMF, demonstrating typical histopathological features.
Implications:
- This case underscores the predictive value of brain F-FDG PET/CT as a noninvasive diagnostic tool for MMF.
- F-FDG PET/CT can aid in MMF diagnosis when initial muscle biopsies are negative, improving diagnostic accuracy and potentially enabling earlier treatment.
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