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Comparison and validation of FDG-PET/CT scores for polymyalgia rheumatica
Kornelis S M van der Geest1, Yannick van Sleen1, Pieter Nienhuis2
1Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Objectives:
To compare and validate the diagnostic accuracy of fluorodeoxyglucose (FDG)-PET/CT scores for PMR; and to explore their association with clinical factors.
Methods:
This retrospective study included 39 consecutive patients diagnosed with PMR and 19 PMR comparators. The final clinical diagnosis was established after 6 months follow-up. Patients underwent FDG-PET/CT prior to glucocorticoid treatment. Visual grading of FDG uptake was performed at 30 anatomic sites. Three FDG-PET/CT scores (the Leuven Score, two Besançon Scores) and two algorithms (the Saint-Etienne and Heidelberg Algorithms) were investigated. Receiver operating characteristic (ROC) analysis with area under the curve (AUC) was performed. Diagnostic accuracy was assessed at predefined cut-off points.
Results:
All three FDG-PET/CT scores showed high diagnostic accuracy for a clinical diagnosis of PMR in the ROC analysis (AUC 0.889-0.914). The Leuven Score provided a sensitivity of 89.7% and specificity of 84.2% at its predefined cut-off point. A simplified Leuven Score showed similar diagnostic accuracy to that of the original score. The Besançon Scores showed limited specificity at their predefined cut-off points (i.e. 47.4% and 63.2%), while ROC analysis suggested that substantially higher cut-off points are needed for these scores. The Heidelberg and Saint-Etienne Algorithms demonstrated high sensitivity, but lower specificity (i.e. 78.9% and 42.1%, respectively) for PMR. Female sex and presence of large-vessel vasculitis were associated with lower FDG-PET/CT scores in patients with PMR.
Conclusion:
The Leuven Score showed the highest diagnostic utility for PMR. A modified, concise version of the Leuven Score provided similar diagnostic accuracy to that of the original score.
Insights
The Leuven Score demonstrates high diagnostic accuracy for polymyalgia rheumatica (PMR) using FDG-PET/CT imaging. A simplified Leuven Score offers comparable diagnostic utility for PMR detection.
Area of Science:
- Nuclear medicine
- Radiology
- Rheumatology
Background:
- Polymyalgia rheumatica (PMR) diagnosis can be challenging.
- Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) shows promise in PMR diagnosis.
Purpose of the Study:
- To compare and validate FDG-PET/CT scores for PMR diagnosis.
- To explore associations between FDG-PET/CT scores and clinical factors in PMR.
Main Methods:
- Retrospective analysis of 39 PMR patients and 19 comparators.
- FDG-PET/CT imaging performed before glucocorticoid treatment.
- Evaluation of three FDG-PET/CT scores (Leuven, two Besançon) and two algorithms (Saint-Etienne, Heidelberg) using ROC analysis.
Main Results:
- All three scores showed high diagnostic accuracy (AUC 0.889-0.914).
- The Leuven Score achieved 89.7% sensitivity and 84.2% specificity.
- Simplified Leuven Score had similar accuracy; Besançon Scores and algorithms showed variable specificity.
Conclusions:
- The Leuven Score exhibits the highest diagnostic utility for PMR.
- A modified, concise Leuven Score maintains comparable diagnostic accuracy.
