Gadolinium-enhanced magnetic resonance imaging in shoulders contributes accurate diagnosis and predicting recurrence to patients with polymyalgia rheumatica
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Published on: June 20, 2014
Hiroyuki Nakamura1, Kazuro Kamada1, Masato Tarumi1
1Department of Internal Medicine, Tomakomai City Hospital, Tomakomai, Japan.
Objectives:
We aimed to evaluate whether gadolinium-enhanced magnetic resonance imaging (MRI) in shoulders can contribute to more accurate diagnosis and prediction of recurrence in patients with polymyalgia rheumatica (PMR).
Methods:
Gadolinium-enhanced MRI and ultrasonography (US) in shoulders were performed in the patients who had bilateral shoulders pain and fulfilled the Bird's Classification Criteria between June 2012 and June 2018. PMR was clinically diagnosed by at least two rheumatologists. MRI and US findings assessed by independent radiologists were compared between the PMR or non-PMR patients. PMR patients were treated with 20 mg/day of prednisolone and were followed-up until June 2019 to determine any recurrences of the disease.
Results:
PMR was diagnosed in 58 of 137 patients received gadolinium-enhanced MRI and US examinations. Enhancement of joint capsule, enhancement of rotator cuff tendon and focal bone oedema in humerus heads were frequently found in the PMR patients. If the three findings were used in combination to diagnose PMR, MRI had 76% sensitivity and 85% specificity, higher compared to US findings, which had 50% sensitivity and 72% specificity. During follow-up, PMR recurred in 24 patients. Patients with recurrent PMR were younger in age, had less enhancement of rotator cuff tendon and more synovial hypertrophy findings on their MRI.
Conclusions:
Gadolinium-enhanced MRI could display capsulitis, rotator cuff tendonitis and focal bone oedema in humerus heads that was sensitive and specific to patients with PMR, improving diagnostic accuracy in PMR. Rotator cuff tendonitis and synovial hypertrophy on MRI could help predict recurrence in PMR.
Insights
Gadolinium-enhanced MRI improves polymyalgia rheumatica (PMR) diagnosis by detecting joint capsule enhancement and bone edema. MRI findings also help predict PMR recurrence, offering better accuracy than ultrasonography.
Area of Science:
- Rheumatology
- Radiology
- Medical Imaging
Background:
- Polymyalgia rheumatica (PMR) diagnosis can be challenging.
- Accurate diagnostic and prognostic tools for PMR are needed.
Purpose of the Study:
- To evaluate gadolinium-enhanced MRI for PMR diagnosis.
- To assess MRI's ability to predict PMR recurrence.
Main Methods:
- Gadolinium-enhanced MRI and ultrasonography of shoulders were performed.
- Radiologists assessed MRI and US findings.
- PMR patients were followed for recurrence.
Main Results:
- MRI showed higher sensitivity (76%) and specificity (85%) than US (50%, 72%) for PMR diagnosis.
- Joint capsule enhancement, rotator cuff tendonitis, and bone edema were common in PMR patients.
- Recurrent PMR was associated with younger age, less rotator cuff tendonitis, and more synovial hypertrophy on MRI.
Conclusions:
- Gadolinium-enhanced MRI accurately diagnoses PMR by identifying capsulitis, tendonitis, and bone edema.
- MRI findings of rotator cuff tendonitis and synovial hypertrophy may predict PMR recurrence.
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