Non-invasive assessment of peripheral skeletal muscle weakness in idiopathic pulmonary fibrosis: a pilot study with multiparametric MRI of the rectus femoris muscle

Wagner Diniz de Paula; Marcelo Palmeira Rodrigues; Nathali Mireise Costa Ferreira; Viviane Vieira Passini; César Augusto Melo-Silva

doi:10.4081/mrm.2020.707

Non-invasive assessment of peripheral skeletal muscle weakness in idiopathic pulmonary fibrosis: a pilot study with multiparametric MRI of the rectus femoris muscle

Authors

Wagner Diniz de Paula Department of Radiology, Brasilia University Hospital, University of Brasilia https://orcid.org/0000-0002-4572-2205
Marcelo Palmeira Rodrigues Department of Pulmonology, Brasilia University Hospital, University of Brasilia https://orcid.org/0000-0002-9895-646X
Nathali Mireise Costa Ferreira Department of Pulmonology, Brasilia University Hospital, University of Brasilia https://orcid.org/0000-0002-9239-7273
Viviane Vieira Passini Department of Pulmonology, Brasilia University Hospital, University of Brasilia https://orcid.org/0000-0003-0899-1112
César Augusto Melo-Silva Department of Pulmonology, Brasilia University Hospital, University of Brasilia https://orcid.org/0000-0002-3544-6999

DOI: https://doi.org/10.4081/mrm.2020.707

Keywords:

Interstitial lung disease, idiopathic pulmonary fibrosis, skeletal muscle, magnetic resonance imaging

Abstract

Background: To investigate differences in magnetic resonance imaging (MRI) features of rectus femoris muscle between idiopathic pulmonary fibrosis (IPF) patients and healthy volunteers.
Methods: Thirteen IPF patients with GAP Index stage II disease were subjected to pulmonary function tests, 6-minute walk test (6MWT), quadriceps femoris muscle strength measurement and MRI of the thigh at rest. At MRI, muscle cross-sectional areas, T2 and T2* relaxometry, and 3-point Dixon fat fraction were measured. The results were compared to those of eight healthy sedentary volunteers.
Results: IPF patients had significantly lower %predicted FVC, FEV1 and D_LCO (p<0.001 for the three variables) and walked significantly less in the 6MWT (p=0.008). Mean quadriceps femoris muscle strength also was significantly lower in IPF patients (p=0.041). Rectus femoris muscle T2* measurements were significantly shorter in IPF patients (p=0.027). No significant intergroup difference was found regarding average muscle cross-sectional areas (p=0.790 for quadriceps and p=0.816 for rectus femoris) or rectus femoris fat fraction (p=0.901). Rectus femoris T2 values showed a non-significant trend to be shorter in IPF patients (p=0.055).
Conclusions: Our preliminary findings suggest that, besides disuse atrophy, other factors such as hypoxia (but not inflammation) may play a role in the peripheral skeletal muscle dysfunction observed in IPF patients. This might impact the rehabilitation strategies for IPF patients and warrants further investigation.

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