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MRI of shoulder girdle in polymyalgia rheumatica: inflammatory findings and their diagnostic value
Martin Fruth1,2, Lucie Künitz2, Philipp Martin-Seidel1
1Evidia Radiologie am Rheumazentrum Ruhrgebiet, Herne, Germany.
Background:
Non-synovial inflammation as detected by MRI is characteristic in polymyalgia rheumatica (PMR) with potentially high diagnostic value.
Objective:
The objective is to describe inflammatory MRI findings in the shoulder girdle of patients with PMR and discriminate from other causes of shoulder girdle pain.
Methods:
Retrospective study of 496 contrast-enhanced MRI scans of the shoulder girdle from 122 PMR patients and 374 non-PMR cases. Two radiologists blinded to clinical and demographic information evaluated inflammation at six non-synovial plus three synovial sites for the presence or absence of inflammation. The prevalence of synovial and non-synovial inflammation, both alone and together with clinical information, was tested for its ability to differentiate PMR from non-PMR.
Results:
A high prevalence of non-synovial inflammation was identified as striking imaging finding in PMR, in average 3.4±1.7, mean (M)±SD, out of the six predefined sites were inflamed compared with 1.1±1.4 (M±SD) in non-PMR group, p<0.001, with excellent discriminatory effect between PMR patients and non-PMR cases. The prevalence of synovitis also differed significantly between PMR patients and non-PMR cases, 2.5±0.8 (M±SD) vs 1.9±1.1 (M±SD) out of three predefined synovial sites, but with an inferior discriminatory effect. The detection of inflammation at three out of six predefined non-synovial sites differentiated PMR patients from controls with a sensitivity/specificity of 73.8%/85.8% and overall better performance than detection of synovitis alone (sensitivity/specificity of 86.1%/36.1%, respectively).
Conclusion:
Contrast-enhanced MRI of the shoulder girdle is a reliable imaging tool with significant diagnostic value in the assessment of patients suffering from PMR and differentiation to other conditions for shoulder girdle pain.
Insights
Non-synovial inflammation detected by MRI is a key indicator for polymyalgia rheumatica (PMR). This imaging technique effectively differentiates PMR from other causes of shoulder pain, aiding in accurate diagnosis.
Area of Science:
- Rheumatology
- Radiology
- Medical Imaging
Background:
- Non-synovial inflammation on MRI is a characteristic finding in polymyalgia rheumatica (PMR).
- This imaging feature holds significant diagnostic potential for PMR.
Purpose of the Study:
- To describe inflammatory MRI findings in the shoulder girdle of PMR patients.
- To differentiate PMR from other causes of shoulder girdle pain using MRI.
Main Methods:
- Retrospective analysis of 496 contrast-enhanced shoulder girdle MRI scans (122 PMR, 374 non-PMR).
- Two blinded radiologists assessed inflammation at six non-synovial and three synovial sites.
- Evaluated the discriminatory ability of synovial and non-synovial inflammation for PMR diagnosis.
Main Results:
- PMR patients exhibited significantly higher prevalence of non-synovial inflammation (3.4±1.7 sites) compared to non-PMR cases (1.1±1.4 sites).
- Non-synovial inflammation demonstrated excellent discriminatory effect between PMR and non-PMR groups.
- Detection of inflammation at three non-synovial sites yielded 73.8% sensitivity and 85.8% specificity for PMR.
Conclusions:
- Contrast-enhanced MRI of the shoulder girdle is a reliable tool for assessing PMR.
- MRI findings, particularly non-synovial inflammation, significantly aid in differentiating PMR from other shoulder pain conditions.
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