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[Polymyalgia rheumatica in 18-fluorodeoxyglucose-positron-emission-tomography/computed tomography : Improvement in
F Witte1, H-J Lakomek2, J Holzinger3
1Johannes Wesling Klinikum Minden, Universitätsklinikum der Ruhr-Universität Bochum, Minden, Deutschland. felix.witte@ukmuenster.de.
Background:
The diagnosis of patients with polymyalgia rheumatica (PMR) has relied upon the clinical examination of symptoms and laboratory parameters of inflammation until now. Currently, the use of different imaging modalities is being explored, including ultrasound, MRI and PET.
Objectives:
The aim was to evaluate the diagnostic value of 18-fluorodeoxyglucose-positron-emission-tomography/computed tomography (18F-FDG-PET/CT) for PMR, in order to improve the sensitivity and specificity of diagnosing PMR and to improve the differential diagnosis of rheumatoid arthritis (RA).
Materials And Methods:
Examinations using 18F-FDG-PET/CT of 284 rheumatological patients, including 97 patients with PMR, were retrospectively evaluated over a 44-month period. Furthermore, 13 regions changed by inflammation were analysed via a three-dimensional region of interest (ROI) measurement with determination of maximum standardized uptake values (SUVmax), followed by statistical analyses.
Results And Discussion:
Patients with PMR presented significantly elevated uptake in all regions examined (p < 0.001), compared with a control group treated for rheumatological diseases. The method with the highest diagnostic relevance was represented by the combination of four SUVmax values of both anterolateral hip capsules and both ischial tuberosities, reaching a sensitivity of 91.3% and a specificity of 97.6% with a cut-off of 11.0 SUV at the initial diagnosis of PMR patients who had not yet received any immunosuppressive therapy. Patients with RA could be significantly distinguished from those with PMR at initial diagnosis in the same anatomical regions (p < 0.001).
Insights
18-fluorodeoxyglucose-positron-emission-tomography/computed tomography (18F-FDG-PET/CT) significantly improves the diagnosis of polymyalgia rheumatica (PMR). This imaging technique offers high sensitivity and specificity, aiding in distinguishing PMR from rheumatoid arthritis (RA).
Area of Science:
- Rheumatology
- Nuclear Medicine
- Diagnostic Imaging
Context:
- Polymyalgia rheumatica (PMR) diagnosis traditionally relies on clinical symptoms and inflammatory markers.
- Advanced imaging modalities like ultrasound, MRI, and PET are being explored to enhance diagnostic accuracy.
- Distinguishing PMR from rheumatoid arthritis (RA) can be challenging, necessitating improved diagnostic tools.
Purpose:
- To evaluate the diagnostic value of 18-fluorodeoxyglucose-positron-emission-tomography/computed tomography (18F-FDG-PET/CT) for PMR.
- To improve the sensitivity and specificity of PMR diagnosis using 18F-FDG-PET/CT.
- To enhance the differential diagnosis between PMR and RA with 18F-FDG-PET/CT.
Summary:
- Retrospective analysis of 284 rheumatological patients, including 97 with PMR, using 18F-FDG-PET/CT over 44 months.
- Analysis of 13 inflamed regions using 3D ROI measurements and SUVmax determination.
- Patients with PMR showed significantly elevated uptake in all examined regions compared to controls.
Impact:
- A combination of four SUVmax values (hip capsules and ischial tuberosities) achieved 91.3% sensitivity and 97.6% specificity for PMR diagnosis.
- A cut-off SUV of 11.0 demonstrated high diagnostic relevance in untreated PMR patients.
- 18F-FDG-PET/CT effectively distinguished PMR from RA at initial diagnosis based on uptake patterns in specific anatomical regions.
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