![Quantification of Atherosclerotic Plaque Activity and Vascular Inflammation using [18-F] Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography FDG-PET/CT](/_next/image?url=https%3A%2F%2Fcloudfront.jove.com%2FCDNSource%2Fteasers%2F3777.jpg&w=3840&q=50)
Usefulness of 18F-Fluorodeoxyglucose Positron Emission Tomography in Diagnosing Polymyalgia Rheumatica and
Anne Desvages1, Florent Hives2, Xavier Deprez3
1Department of Rheumatology, Lille University Hospital, University of Lille, CHU Lille, 59000 Lille, France.
Introduction:
We aimed to evaluate the utility of FDG-PET/CT in diagnosing polymyalgia rheumatica (PMR) and associated large-vessel vasculitis (LVV).
Methods:
We analyzed FDG-PET/CT completed between 2015 and 2019 on patients diagnosed with PMR. For comparisons, patients with PMR were matched 1:1 to controls based on age and gender. FDG-PET/CT had been completed on the controls over the same period. The FDG uptake was scored visually for 17 articular or periarticular sites and 13 vascular sites using a semi-quantitative scoring system (score of 0-3).
Results:
Eighty-one patients with PMR and eighty-one controls were included (mean age 70.7 (9.8) years; 44.4% women). Significant differences between the PMR and control groups were found at all articular and periarticular sites for the following: (i) the FDG uptake score (p < 0.001 for all locations); (ii) the number of patients per site with significant FDG uptake (score ≥ 2); (iii) the global FDG articular uptake scores (31 [IQR, 21 to 37] versus 6 [IQR, 3 to 10], p < 0.001); and (iv) the number of sites with significant FDG uptake (score ≥ 2) (scores of 0-17) (11 [IQR, 7 to 13] versus 1 [IQR, 0 to 2], p < 0.001). No significant differences in the global FDG vascular uptake scores were found between the patients who were considered isolated PMR and the control groups.
Conclusions:
The FDG uptake score and the number of sites with significant FDG uptake could be pertinent criteria for the diagnosis of PMR. Unlike others, we did not confirm the presence of vascular involvement in patients with isolated PMR.
Insights
FDG-PET/CT scans show increased uptake in polymyalgia rheumatica (PMR) patients at articular sites, aiding diagnosis. However, no significant vascular uptake was found in isolated PMR cases, suggesting distinct pathophysiology.
Area of Science:
- Nuclear Medicine
- Rheumatology
- Radiology
Background:
- Polymyalgia rheumatica (PMR) diagnosis can be challenging.
- Large-vessel vasculitis (LVV) is a potential comorbidity.
- Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT) is a valuable imaging modality.
Purpose of the Study:
- To assess the diagnostic utility of FDG-PET/CT in PMR.
- To investigate associated large-vessel vasculitis (LVV) in PMR patients.
Main Methods:
- Analysis of FDG-PET/CT scans from 81 PMR patients and 81 matched controls (2015-2019).
- Semi-quantitative scoring (0-3) of FDG uptake in 17 articular/periarticular and 13 vascular sites.
- Comparison of FDG uptake patterns between PMR patients and controls.
Main Results:
- PMR patients exhibited significantly higher FDG uptake scores at all articular and periarticular sites compared to controls (p < 0.001).
- Global articular FDG uptake scores and the number of affected sites were significantly higher in PMR patients.
- No significant differences in global FDG vascular uptake were observed between isolated PMR patients and controls.
Conclusions:
- FDG uptake scores and the number of involved sites are potential diagnostic criteria for PMR.
- Vascular involvement was not confirmed in patients with isolated PMR in this study.
- FDG-PET/CT demonstrates utility in diagnosing PMR by highlighting articular inflammation.
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