Use of 18F FDG PET-CT to discriminate polymyalgia rheumatica and atypical spondylarthritis in clinical practice

Introduction: 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) plays a key role in oncology, and it is now being used increasingly to diagnose, characterize, and monitor disease activity in inflammatory disorders, including vasculitis. Unfortunately, its role in the management of vasculitis is still not well-defined, and clinicians are often unsure how this metabolic imaging technique should be used in these diseases, although its usefulness in diagnosing large-vessel vasculitis has been clearly demonstrated. Materials and methods: We reviewed the literature about the use of PET/CT in the management of vasculitis in an attempt to identify the applications and the limitations of this technique in clinical practice. Results and discussion: Our literature review revealed that 18F-FDG PET/CT is a useful tool for diagnosing vasculitis (especially when the symptoms of the disease are non-specific); guiding biopsy procedures (areas with high glucose consumption); evaluating disease extension; and monitoring treatment responses. The main limitations of this method are the relatively low spatial resolution of the tomograph, which can lead to false-negative results in the presence of small-vessel vasculitis, and risk of false positive results, especially those related to the presence of atherosclerosis and to post-treatment vascular remodeling.

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Diagnostic value of [18F]FDG-PET/CT in polymyalgia rheumatica: a systematic review and meta-analysis

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-020-05162-6 ◽

2020 ◽

Author(s):

K. S. M. van der Geest ◽

G. Treglia ◽

A. W. J. M. Glaudemans ◽

E. Brouwer ◽

F. Jamar ◽

...

Keyword(s):

Systematic Review ◽

Polymyalgia Rheumatica ◽

Fdg Pet ◽

Meta Analysis ◽

Diagnostic Value ◽

Current Evidence ◽

Interpretation Criteria ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

Abstract Purpose Polymyalgia rheumatica (PMR) can be difficult to diagnose. Whole-body [18F]FDG-PET/CT allows for a comprehensive evaluation of all relevant articular and extra-articular structures affected by PMR. We aimed to summarize current evidence on the diagnostic value of [18F]FDG-PET/CT for a diagnosis of PMR. Methods PubMed/MEDLINE and the Cochrane Library database were searched from inception through May 31, 2020. Studies containing patients with PMR who underwent [18F]FDG-PET/CT were included. Screening and full-text review were performed by 3 investigators and data extraction by 2 investigators. Risk of bias was examined with the QUADAS-2 tool. Diagnostic test meta-analysis was performed with a bivariate model. Results Twenty studies were included in the systematic review, of which 9 studies (n = 636 patients) were eligible for meta-analysis. [18F]FDG positivity at the following sites was associated with a diagnosis of PMR: interspinous bursae (positive likelihood ratio (LR+) 4.00; 95% CI 1.84–8.71), hips (LR+ 2.91; 95% CI 2.09–4.05), ischial tuberosities (LR+ 2.86; 95% CI 1.91–4.28), shoulders (LR+ 2.57; 95% CI 1.24–5.32) and sternoclavicular joints (LR+ 2.31; 95% CI 1.33–4.02). Negative likelihood ratios (LR−) for these sites, as well as the greater trochanters, were all less than 0.50. Composite [18F]FDG-PET/CT scores, as reported in 3 studies, provided a pooled LR+ of 3.91 (95% CI 2.42–6.32) and LR− of 0.19 (95% CI 0.10–0.36). Moderate to high heterogeneity was observed across the studies, mainly due to differences in patient selection, scanning procedures and/or interpretation criteria. Conclusion Significant [18F]FDG uptake at a combination of anatomic sites is informative for a diagnosis of PMR. [18F]FDG-PET/CT might be an important diagnostic tool in patients with suspected PMR. This study also highlights the need for adherence to published procedural recommendations and standardized interpretation criteria for the use of [18F]FDG-PET/CT in PMR.

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Diagnostischer Mehrwert der 18F-FDG PET/CT bei Abklärung einer steroid-refraktären Großgefäßvaskulitis und Polymyalgia rheumatica

10.1055/s-0041-1726728 ◽

2021 ◽

Author(s):

R Sherzay ◽

RA Werner ◽

J Sommerlath Sohns ◽

M Hoepfner ◽

T Witte ◽

...

Keyword(s):

Polymyalgia Rheumatica ◽

Fdg Pet ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Predictors of positive 18F-FDG PET/CT-scan for large vessel vasculitis in patients with persistent polymyalgia rheumatica

Seminars in Arthritis and Rheumatism ◽

10.1016/j.semarthrit.2018.05.007 ◽

2019 ◽

Vol 48 (4) ◽

pp. 720-727 ◽

Cited By ~ 16

Author(s):

Diana Prieto-Peña ◽

Isabel Martínez-Rodríguez ◽

Javier Loricera ◽

Ignacio Banzo ◽

Mónica Calderón-Goercke ◽

...

Keyword(s):

Ct Scan ◽

Polymyalgia Rheumatica ◽

Fdg Pet ◽

Large Vessel Vasculitis ◽

Large Vessel ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Pet Ct Scan

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18F-FDG PET/CT in polymyalgia rheumatica—a pictorial review

British Journal of Radiology ◽

10.1259/bjr.20170198 ◽

2017 ◽

Vol 90 (1076) ◽

pp. 20170198 ◽

Cited By ~ 11

Author(s):

Zdenek Rehak ◽

Andrea Sprlakova-Pukova ◽

Tomas Kazda ◽

Zdenek Fojtik ◽

Lenka Vargova ◽

...

Keyword(s):

Polymyalgia Rheumatica ◽

Fdg Pet ◽

Pictorial Review ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Usefulness of 18F-FDG PET/CT for the Diagnosis of Polymyalgia Rheumatica

Polymyalgia Rheumatica and Giant Cell Arteritis ◽

10.1007/978-3-319-52222-7_10 ◽

2017 ◽

pp. 95-98

Author(s):

Lenka Franeková

Keyword(s):

Polymyalgia Rheumatica ◽

Fdg Pet ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Muscle involvement on 18F-FDG PET-CT in polymyalgia rheumatica. A controlled retrospective study of 101 patients

Joint Bone Spine ◽

10.1016/j.jbspin.2020.01.006 ◽

2020 ◽

Vol 87 (3) ◽

pp. 225-228 ◽

Cited By ~ 2

Author(s):

Daniel Wendling ◽

Maxime Sondag ◽

Nicolas Giraud ◽

Mickael Chouk ◽

Hatem Boulahdour ◽

...

Keyword(s):

Retrospective Study ◽

Polymyalgia Rheumatica ◽

Fdg Pet ◽

Muscle Involvement ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Prognostic impacts of glucocorticoid treatment in patients with polymyalgia rheumatica and giant cell arteritis

Scientific Reports ◽

10.1038/s41598-021-85857-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Amir Emamifar ◽

Torkell Ellingsen ◽

Anne Pernille Hermann ◽

Søren Hess ◽

Oke Gerke ◽

...

Keyword(s):

Blood Pressure ◽

Body Composition ◽

Arterial Stiffness ◽

Giant Cell Arteritis ◽

Polymyalgia Rheumatica ◽

Fdg Pet ◽

Glucocorticoid Treatment ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

AbstractIdentifying comorbidities in polymyalgia rheumatica/giant cell arteritis (PMR/GCA) is crucial for patients’ outcomes. The present study aimed to evaluate the impact of the inflammatory process and glucocorticoid treatment on aortic arterial stiffness and body composition in PMR/GCA. 77 patients with newly diagnosed PMR/GCA were treated with oral glucocorticoids and followed for 40 weeks. Aortic pulse wave velocity (PWV) was measured at baseline and during the follow-up period and compared to the results of temporal artery biopsy (TAB) and 18F-FDG PET/CT. Body composition was assessed by total body DXA at baseline and the end of the study. Of 77 patients (49 (63.6%) female, mean of age: (71.8 ± 8.0)), 64 (83.1%) had pure PMR, 10 (13.0%) concomitant PMR and GCA, and 3 (3.9%) pure GCA. Compared to baseline values, aortic PWV was initially decreased at week 16 (p = 0.010) and remained lower than baseline at week 28 (p = 0.002) and week 40 (p < 0.001), with no association with results of TAB and 18F-FDG PET/CT. Aortic PWV was significantly associated with age, male gender, left systolic and diastolic blood pressure, right diastolic blood pressure, and CRP. Total bone mineral content (BMC) was decreased in both genders (p < 0.001), while fat mass (FM) was significantly increased (p < 0.001). However, lean body mass did not significantly change during the study. Changes in FM were correlated with cumulative prednisolone dose (rho: 0.26, p = 0.031). Glucocorticoid treatment of patients with PMR/GCA had several prognostic impacts. Arterial stiffness was decreased due either to the treatment or a reduction in the inflammatory load. Additionally, treatment led to changes in body composition, including a decrease in BMC and FM excess.

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Polymyalgia rheumatica in der 18-Fluordesoxyglukose-Positronenemissionstomographie/Computertomographie

Zeitschrift für Rheumatologie ◽

10.1007/s00393-021-01133-w ◽

2021 ◽

Author(s):

F. Witte ◽

H.-J. Lakomek ◽

J. Holzinger ◽

W.-D. Reinbold

Keyword(s):

Rheumatoide Arthritis ◽

Polymyalgia Rheumatica ◽

Fdg Pet ◽

Standardized Uptake Value ◽

Region Of Interest ◽

Sensitivität Und Spezifität ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Positronenemissionstomographie Computertomographie

Zusammenfassung Hintergrund Die Diagnose von Patienten mit Polymyalgia rheumatica (PMR) beruht bislang auf der klinischen Symptomatik und laborchemischen Entzündungsparametern. Aktuell wird der Nutzen verschiedener bildgebender Verfahren evaluiert, hierunter die Sonographie, MRT und PET. Ziel der Arbeit/Fragestellung Ziel war die Evaluation der diagnostischen Wertigkeit der 18-Fluordesoxyglukose-Positronenemissionstomographie/Computertomographie (18F-FDG-PET/CT) bei PMR, um die Sensitivität und Spezifität in der diagnostischen Aufarbeitung zu verbessern, sowie die rheumatoide Arthritis (RA) differentialdiagnostisch verbessert abzugrenzen. Material und Methoden Es wurden 18F-FDG-PET/CT-Untersuchungen von 284 rheumatologischen Patienten – hierunter 97 Patienten mit PMR – aus einem 44-monatigen Zeitraum retrospektiv evaluiert. Weiter wurden 13 entzündlich veränderte Regionen via dreidimensionaler Region-of-interest(ROI)-Messung mit Bestimmung des maximalen Standardized-Uptake-Value (SUVmax) analysiert, gefolgt von statistischen Analysen. Ergebnisse und Diskussion Patienten mit PMR zeigten im Vergleich mit einer rheumatologisch behandelten Kontrollgruppe signifikant erhöhte Anreicherungen in allen gemessenen Regionen (p < 0,001). Die Methode mit der stärksten diagnostischen Aussagekraft stellte die Kombination aus vier SUVmax-Messwerten – beider anterolateraler Hüftkapseln und beider Tubera ischiadica – dar, mit einer Sensitivität von 91,3 % und einer Spezifität von 97,6 % bei einem Cut-off von 11,0 SUV für die Erstdiagnose von PMR-Patienten, die noch keine immunsuppressive Therapie erhalten hatten. Patienten mit RA konnten bei Erstdiagnose an ebenjenen anatomischen Regionen signifikant von Patienten mit PMR unterschieden werden (p < 0,001).

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