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Various forms of (18)F-FDG PET and PET/CT findings in patients with polymyalgia rheumatica

Zdenek Rehak1,2, Jiri Vasina1,3, Petr Nemec4

  • 1Department of Nuclear Medicine and PET Center, Masaryk Memorial Cancer Institute and Faculty of Medicine, Masaryk University, Brno, Czech Republic.

Biomedical Papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia
|May 27, 2015
PubMed
Abstract

Insights

Positron emission tomography/computed tomography (PET/CT) effectively identifies polymyalgia rheumatica (PMR) involvement in joints, bursae, and arteries. This imaging technique aids in diagnosing PMR variants and assessing disease extent.

Area of Science:

  • Rheumatology
  • Nuclear Medicine
  • Radiology

Background:

  • Polymyalgia rheumatica (PMR) is characterized by pain and stiffness, primarily affecting shoulders, hips, and neck in individuals over 50.
  • Inflammatory markers can support PMR diagnosis, which may coexist with giant cell arteritis.

Purpose of the Study:

  • To evaluate the utility of Fluorine-18-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG PET/CT) in identifying different patterns of PMR involvement.
  • To assess the diagnostic performance of FDG PET/CT in patients meeting Healey's criteria for PMR.

Main Methods:

  • Retrospective analysis of 67 patients diagnosed with PMR between 2004 and 2013 with positive FDG PET/CT findings.
  • FDG uptake was assessed in large arteries, proximal joints (shoulders, hips, sternoclavicular joints), and extra-articular synovial structures (bursae).

Main Results:

  • Articular/periarticular involvement (A) was observed in 88.1% of patients, and extra-articular synovial involvement (E) in 76.1%.
  • Vascular involvement (V) was present in 40.3% of patients, always in combination with A and/or E.
  • Combinations included A+E (44.8%), A+V (11.9%), E+V (9%), and A+E+V (19.4%).

Conclusions:

  • PMR manifestations include articular/periarticular synovitis, extra-articular synovitis, and potential vascular involvement, often seen with giant cell arteritis.
  • FDG PET/CT reveals distinct findings for each type of involvement, detectable individually or in combination.
  • FDG PET/CT serves as a valuable one-step tool for diagnosing PMR variants, evaluating disease extent, and ruling out malignancy.
Keywords:
FDGPETPET/CTbursitisgiant cell arteritispolymyalgia rheumaticasynovitisvasculitis

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