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Improved diagnostic accuracy for polymyalgia rheumatica using FDG-PET/CT with clinical diagnosis or 2012 ACR/EULAR
Andreas Wiggers Nielsen1,2,3, Kornelis S M van der Geest4, Ib Tønder Hansen1,2
1Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
Objective:
In routine care, clinicians may employ 2-[18F]fluoro-2-deoxy-D-glucose (FDG)-PET/CT to validate their initial clinical diagnosis of PMR. Nevertheless, the diagnostic utility of combining FDG-PET/CT findings with clinical presentation has not been explored. Therefore, this study aimed to investigate whether the diagnostic accuracy for PMR could be enhanced by combining FDG-PET/CT findings with the clinical baseline diagnosis or the 2012 ACR/EULAR clinical classification criteria for PMR.
Methods:
An investigation and a validation cohort were included from two countries, encompassing 66/27 and 36/21 PMR/non-PMR patients, respectively. The cohorts comprised treatment-naïve patients suspected of PMR, who initially received a clinical baseline diagnosis and underwent FDG-PET/CT scans. The FDG-PET/CT Leuven score was applied to classify patients as either PMR or non-PMR and combined with the clinical baseline diagnosis. Final diagnoses were established through clinical follow-up after 12 or six months in the investigation and validation cohorts, respectively.
Results:
In the investigation cohort, a clinical baseline diagnosis yielded a sensitivity/specificity of 94%/82%, compared with 78%/70% using the ACR/EULAR criteria. Combining the clinical baseline diagnosis with a positive Leuven score showed a sensitivity/specificity of 80%/93%, compared with 80%/82% for an ACR/EULAR-Leuven score. In the validation cohort, the baseline diagnosis revealed a sensitivity/specificity of 100%/91%, compared with 92%/76% using the ACR/EULAR criteria. Combining FDG-PET/CT with the baseline diagnosis demonstrated a sensitivity/specificity of 83%/95% compared with 89%/81% for the ACR/EULAR-Leuven score.
Conclusion:
Combining FDG-PET/CT findings with the clinical baseline diagnosis or ACR/EULAR clinical classification criteria can improve the diagnostic specificity for PMR.
Insights
Combining 2-[18F]fluoro-2-deoxy-D-glucose (FDG)-PET/CT scans with clinical assessments improves the diagnostic specificity for polymyalgia rheumatica (PMR). This approach enhances accuracy beyond traditional classification criteria for diagnosing PMR.
Area of Science:
- Nuclear medicine imaging
- Rheumatology
- Diagnostic accuracy
Background:
- Clinicians use 2-[18F]fluoro-2-deoxy-D-glucose (FDG)-PET/CT to aid in diagnosing polymyalgia rheumatica (PMR).
- The added diagnostic value of combining FDG-PET/CT with clinical presentation for PMR has not been fully explored.
- Existing diagnostic methods for PMR include clinical baseline diagnosis and the 2012 ACR/EULAR classification criteria.
Purpose of the Study:
- To determine if combining FDG-PET/CT findings with the clinical baseline diagnosis enhances PMR diagnostic accuracy.
- To investigate if combining FDG-PET/CT findings with the 2012 ACR/EULAR classification criteria improves PMR diagnostic accuracy.
- To evaluate the diagnostic utility of FDG-PET/CT in conjunction with clinical assessments for PMR.
Main Methods:
- Two cohorts (investigation and validation) comprising treatment-naïve patients suspected of PMR were analyzed.
- Patients underwent initial clinical baseline diagnosis and FDG-PET/CT scans.
- The FDG-PET/CT Leuven score was used, and final diagnoses were confirmed by clinical follow-up.
Main Results:
- In the investigation cohort, combining clinical baseline diagnosis with FDG-PET/CT yielded 80% sensitivity and 93% specificity.
- In the validation cohort, combining baseline diagnosis with FDG-PET/CT resulted in 83% sensitivity and 95% specificity.
- Both cohorts showed improved diagnostic specificity when FDG-PET/CT was combined with clinical assessments compared to ACR/EULAR criteria alone.
Conclusions:
- Combining FDG-PET/CT findings with the clinical baseline diagnosis improves PMR diagnostic specificity.
- Integrating FDG-PET/CT results with the ACR/EULAR classification criteria also enhances diagnostic specificity for PMR.
- FDG-PET/CT serves as a valuable tool to augment clinical judgment in diagnosing PMR.
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