Impaired skeletal muscle microcirculation in systemic sclerosisReport as inadecuate

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Arthritis Research and Therapy

, 14:R209

First Online: 04 October 2012Received: 28 May 2012Revised: 11 August 2012Accepted: 27 September 2012


IntroductionMuscle symptoms in systemic sclerosis SSc may originate from altered skeletal muscle microcirculation, which can be investigated by means of blood oxygenation level dependent BOLD magnetic resonance imaging MRI.

MethodsAfter ethics committee approval and written consent, 11 consecutive SSc patients 5 men, mean age 52.6 years, mean SSc disease duration 5.4 years and 12 healthy volunteers 4 men, mean age 45.1 years were included. Subjects with peripheral arterial occlusive disease were excluded. BOLD MRI was performed on calf muscles during cuff-induced ischemia and reactive hyperemia, using a 3-T whole-body scanner Verio, Siemens, Erlangen, Germany and fat-suppressed single-short multi-echo echo planar imaging EPI with four different effective echo times. Muscle BOLD signal time courses were obtained for gastrocnemius and soleus muscles: minimal hemoglobin oxygen saturation T2*min and maximal T2* values T2*max, time to T2* peak TTP, and slopes of oxygen normalization after T2* peaking.

ResultsThe vast majority of SSc patients lacked skeletal muscle atrophy, weakness or serum creatine kinase elevation. Nevertheless, more intense oxygen desaturation during ischemia was observed in calf muscles of SSc patients mean T2*min -15.0%, compared with controls -9.1%, P = 0.02. SSc patients also had impaired oxygenation during hyperemia median T2*max 9.2% vs. 20.1%, respectively, P = 0.007. The slope of muscle oxygen normalization was significantly less steep and prolonged TTP in SSc patients P<0.001 for both. Similar differences were found at a separate analysis of gastrocnemius and soleus muscles, with most pronounced impairment in the gastrocnemius.

ConclusionsBOLD MRI demonstrates a significant impairment of skeletal muscle microcirculation in SSc.

KeywordsSystemic sclerosis skeletal muscle vasculopathy magnetic resonance imaging AbbreviationsACRAmerican College of Rheumatology

BMIbody mass index

BOLDblood oxygenation level-dependent

CKcreatinine kinase

DSdeclining slope

DUdigital ulcer

EPIecho planar imaging

EVend value

GEgradient echo

IQRinterquartile range

MRImagnetic resonance imaging

PAODperipheral artery occlusive disease

ROIregion of interest

mRSSmodified Rodnan skin score

SScsystemic sclerosis

T2*T2 star an MRI signal

T2*minminimal hemoglobin oxygen saturation

T2*maxmaximal hemoglobin oxygen saturation

TTPtime to T2* peak.

Electronic supplementary materialThe online version of this article doi:10.1186-ar4047 contains supplementary material, which is available to authorized users.

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Author: Sasan Partovi - Anja-Carina Schulte - Markus Aschwanden - Daniel Staub - Daniela Benz - Stephan Imfeld - Björn Jacobi - Pa


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