Background/Purpose: Calcinosis, reported in up to 47% of children with juvenile dermatomyositis (JDM), can cause significant morbidity, including ulceration, infection, and contractures. Given associations of diagnostic delay and duration of active disease with risk of developing calcinosis, early identification and treatment are critical. However, there is no standardized approach to assess or quantify calcinosis. Various imaging modalities, including conventional radiographs (X-rays), computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US), are used to assess calcinosis. However, they have not been directly compared, and they have limitations including 2-dimensional (2D) nature (X-rays), radiation (CT), cost and potential need for sedation (MRI), limited ability to detect deep lesions (US). The EOS® imaging system involves whole body evaluation via 2D X-rays in ~20 seconds with much lower doses of radiation than conventional X-rays. It is used for disorders of the spine, legs, and hips; however, its use in assessing calcinosis has not been assessed. Our objectives were to compare the ability of EOS® versus conventional X-rays in detecting calcinosis in children with JDM.

Methods: Children diagnosed with JDM before age 19 with calcinosis (confirmed with conventional X-rays and/or physical exam) at Hassenfeld Children’s Hospital at NYU Langone with at least one EOS® scan for calcinosis were included. Socio-demographics, clinical information (including detailed information on calcinosis), imaging modalities, and treatment were collected retrospectively via manual chart review. X-ray and EOS® images were independently assessed by two radiologists blinded to patient information; evaluation of calcinosis by each modality was recorded and compared. Descriptive statistics were used to summarize each variable. Bivariate analysis was performed using t-test or Chi-squared test, or their non-parametric equivalents (Mann Whitney or Fisher’s exact tests).

Results: Seven children with calcinosis and JDM had at least one EOS® scan for calcinosis; 57% of children had an EOS® within one year of JDM diagnosis. All patients were receiving systemic therapy. Three patients (43%) had clinically active skin and/or muscle disease at the time of EOS®. In most children, calcinosis was initially detected by physical exam; however, in 57%, additional calcinosis was detected by EOS® that was missed on physical exam. There were no significant differences in detection of any given calcinosis lesion by EOS® compared to X-rays; however, EOS® detected additional calcinosis lesions compared to X-rays.

Conclusion: This is the first study to explore the use of EOS® in detecting calcinosis in JDM and to compare EOS® to conventional X-rays. Our single-center retrospective study suggests that EOS® may be comparable to X-rays in detecting a given calcinosis lesion with the advantage of detecting additional lesions given whole-body imaging with much less radiation than conventional X-rays or ultra-low dose whole body CT. Future prospective multi-center studies with a larger sample size comparing other imaging modalities will be critical to further understand the role of EOS® in detecting and monitoring calcinosis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/eos-imaging-system-is-a-novel-rapid-safe-and-effective-technique-to-detect-and-assess-calcinosis-in-jdm/