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Diagnostic value of [18F]FDG-PET/CT in polymyalgia rheumatica: a systematic review and meta-analysis
K S M van der Geest1, G Treglia2,3,4,5, A W J M Glaudemans6
1Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB, Groningen, the Netherlands. k.s.m.van.der.geest@umcg.nl.
Purpose:
Polymyalgia rheumatica (PMR) can be difficult to diagnose. Whole-body [18F]FDG-PET/CT allows for a comprehensive evaluation of all relevant articular and extra-articular structures affected by PMR. We aimed to summarize current evidence on the diagnostic value of [18F]FDG-PET/CT for a diagnosis of PMR.
Methods:
PubMed/MEDLINE and the Cochrane Library database were searched from inception through May 31, 2020. Studies containing patients with PMR who underwent [18F]FDG-PET/CT were included. Screening and full-text review were performed by 3 investigators and data extraction by 2 investigators. Risk of bias was examined with the QUADAS-2 tool. Diagnostic test meta-analysis was performed with a bivariate model.
Results:
Twenty studies were included in the systematic review, of which 9 studies (n = 636 patients) were eligible for meta-analysis. [18F]FDG positivity at the following sites was associated with a diagnosis of PMR: interspinous bursae (positive likelihood ratio (LR+) 4.00; 95% CI 1.84-8.71), hips (LR+ 2.91; 95% CI 2.09-4.05), ischial tuberosities (LR+ 2.86; 95% CI 1.91-4.28), shoulders (LR+ 2.57; 95% CI 1.24-5.32) and sternoclavicular joints (LR+ 2.31; 95% CI 1.33-4.02). Negative likelihood ratios (LR-) for these sites, as well as the greater trochanters, were all less than 0.50. Composite [18F]FDG-PET/CT scores, as reported in 3 studies, provided a pooled LR+ of 3.91 (95% CI 2.42-6.32) and LR- of 0.19 (95% CI 0.10-0.36). Moderate to high heterogeneity was observed across the studies, mainly due to differences in patient selection, scanning procedures and/or interpretation criteria.
Conclusion:
Significant [18F]FDG uptake at a combination of anatomic sites is informative for a diagnosis of PMR. [18F]FDG-PET/CT might be an important diagnostic tool in patients with suspected PMR. This study also highlights the need for adherence to published procedural recommendations and standardized interpretation criteria for the use of [18F]FDG-PET/CT in PMR.
Insights
Whole-body [18F]FDG-PET/CT imaging can aid in diagnosing polymyalgia rheumatica (PMR). Specific sites of [18F]FDG uptake, like bursae and joints, are particularly informative for PMR diagnosis.
Area of Science:
- Nuclear medicine
- Radiology
- Rheumatology
Background:
- Polymyalgia rheumatica (PMR) presents diagnostic challenges.
- [18F]FDG-PET/CT offers comprehensive imaging of articular and extra-articular structures.
- Evidence on the diagnostic utility of [18F]FDG-PET/CT for PMR requires synthesis.
Purpose of the Study:
- To systematically review and meta-analyze the diagnostic value of whole-body [18F]FDG-PET/CT for polymyalgia rheumatica (PMR).
Main Methods:
- A systematic search of PubMed/MEDLINE and Cochrane Library databases was conducted.
- Included studies involved patients with PMR who underwent [18F]FDG-PET/CT.
- Diagnostic test meta-analysis using a bivariate model was performed on data from 9 studies (636 patients).
Main Results:
- [18F]FDG positivity in interspinous bursae, hips, ischial tuberosities, shoulders, and sternoclavicular joints was associated with PMR diagnosis (LR+ ranging from 2.31 to 4.00).
- Negative likelihood ratios (LR-) for these sites and greater trochanters were below 0.50.
- Composite [18F]FDG-PET/CT scores showed a pooled LR+ of 3.91 and LR- of 0.19.
Conclusions:
- Significant [18F]FDG uptake in combined anatomic sites is valuable for diagnosing PMR.
- [18F]FDG-PET/CT shows promise as a diagnostic tool for suspected PMR cases.
- Standardized procedural recommendations and interpretation criteria are crucial for consistent [18F]FDG-PET/CT use in PMR.
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