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Updated: Mar 19, 2026
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Published on: April 25, 2025
Circulating microparticles bearing Fibrin associated with whole-body 18FDG-PET: diagnostic tools to detect
Diane Mege1,2, Serge Cammilleri3, Olivier Mundler3
1INSERM UMR-S1076, VRCM, Aix Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France.
Abstract:
Polymyalgia rheumatica (PMR), a chronic inflammatory rheumatism, can be the expression of a paraneoplastic syndrome. The same clinical symptoms are frequently observed at the early stage of the benign and malignant forms. Here, our aim was to develop diagnostic tools to differentiate paraneoplastic PMR from essential PMR. We combined an 18FDG-PET and detection of circulating procoagulant microparticles (MPs), such as fibrin positive (FibMPs), by flow cytometry. Two patients with PMR and a similar profile were selected. In the two patients, the 18FDG-PET revealed a hypermetabolic focus. However, the concentrations of fibrin+/annexin+ microparticles detected were (10 times higher in one of the two patients, who was later found to have breast cancer. The association of 18FDG-PET and the detection of microparticle fibrin positives by flow cytometry allows separating essential PMR (hypermetabolism by 18FDG-PET, low FibMPs) from paraneoplastic PMR.
Insights
Polymyalgia rheumatica can be a paraneoplastic syndrome. Combining 18FDG-PET scans with microparticle detection helps distinguish paraneoplastic PMR from essential PMR.
Area of Science:
- Rheumatology
- Oncology
- Diagnostic Imaging
Background:
- Polymyalgia rheumatica (PMR) is a chronic inflammatory condition that can mimic paraneoplastic syndromes.
- Distinguishing paraneoplastic PMR from essential PMR is clinically significant for appropriate patient management.
Observation:
- Two PMR patients with similar clinical presentations were evaluated.
- Both patients showed hypermetabolism on 18FDG-PET scans.
- One patient, later diagnosed with breast cancer, had significantly higher levels of fibrin-positive microparticles.
Findings:
- The combination of 18FDG-PET and flow cytometry detection of fibrin-positive microparticles (FibMPs) can differentiate paraneoplastic PMR.
- Essential PMR is characterized by 18FDG-PET hypermetabolism and low FibMPs.
- Paraneoplastic PMR exhibits 18FDG-PET hypermetabolism and elevated FibMPs.
Implications:
- This diagnostic approach offers a novel method for identifying PMR cases associated with malignancy.
- Early differentiation can lead to timely cancer diagnosis and treatment.
- Further research is warranted to validate these findings in larger patient cohorts.
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