Diagnosing polymyalgia rheumatica on 18F-FDG PET/CT: typical uptake patterns.

Abstract

OBJECTIVE:

The diagnosis of polymyalgia rheumatica (PMR) is often challenging, since similar clinical features and laboratory findings can be observed in several inflammatory conditions. PMR involves affected sites in a specific manner, and 18F-FDG PET/CT has the advantage for assessing the disease activity of each site. The purpose of this study was to identify the patterns of 18F-FDG uptake that suggest the diagnosis of PMR.

METHODS:

We studied 60 patients who had undergone 18F-FDG PET/CT scans for workup of suspected PMR, arthritis, enthesitis, or myopathy. Final diagnoses were made by board-certified rheumatologists. The incidence of significant 18F-FDG uptake, higher than mediastinal blood pool, of the following sites were compared among PMR patients and patients with other diseases: wrists, elbows, shoulders, sternoclavicular joints, acromioclavicular joints, spinous processes, ischial tuberosities, and greater trochanters. For the spinous processes, the incidence of "Y"-shaped uptake along the interspinous bursae was also evaluated.

RESULTS:

A definitive diagnosis of PMR was given to 16 of 60 patients. The incidence of significant 18F-FDG uptake in the definitive PMR group was 6% for wrists and for elbows, 88% for glenohumeral and sternoclavicular joints, 25% for acromioclavicular joints, 81% for spinous processes, 69% for ischial tuberosities, and 81% for greater trochanters. Patients with PMR showed a significantly higher incidence of "Y"-shaped uptake along the interspinous bursae than the other patients (38 vs. 9%) (P = 0.016).

CONCLUSION:

18F-FDG uptake distribution patterns and morphology can contribute to the diagnosis of PMR. Significant 18F-FDG uptake in the sternoclavicular joints is one of the characteristic findings in patients with PMR as well as the uptake in the shoulders, ischial tuberosities, and greater trochanters. "Y"-shaped spinous process uptake may be one of the specific findings for PMR.

• Authors: Shunsuke Yuge, Koya Nakatani, Kumiko Yoshino, Takashi Koyama
• Journal: Annals of nuclear medicine (Ann Nucl Med) Vol. 32 Issue 8 Pg. 573-577 (Oct 2018) ISSN: 1864-6433 [Electronic] Japan
• PMID: 29948622 (Publication Type: Journal Article)

Chemical References

• Fluorodeoxyglucose F18

Topics

• Aged
• Biological Transport
• Female
• Fluorodeoxyglucose F18 (metabolism)
• Humans
• Male
• Polymyalgia Rheumatica (diagnostic imaging, metabolism)
• Positron Emission Tomography Computed Tomography
• Retrospective Studies