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Title: Abnormalities at three musculoskeletal sites on whole-body positron emission tomography/computed tomography can diagnose polymyalgia rheumatica with high sensitivity and specificity.
Austin Authors: Owen, Claire E ;Poon, Aurora M T ;Yang, Victor;McMaster, Christopher ;Lee, Sze Ting ;Liew, David F L ;Leung, Jessica L Y ;Scott, Andrew M ;Buchanan, Russell R C 
Affiliation: Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Victoria, Australia
School of Cancer Medicine, La Trobe University, Heidelberg, Victoria, Australia
Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
Issue Date: Sep-2020 2020-02-23
Publication information: European Journal of Nuclear Medicine and Molecular Imaging 2020; 47(10): 2461-2468
Abstract: To evaluate the sensitivity and specificity of PET/CT findings in PMR and generate a diagnostic algorithm utilizing a minimum number of musculoskeletal sites. Steroid-naïve patients with newly diagnosed PMR (2012 EULAR/ACR classification criteria) were prospectively recruited to undergo whole-body 18F-FDG PET/CT. Each PMR case was age- and sex-matched to four PET/CT controls. Control scan indication, diagnosis and medical history were extracted from the clinical record. Qualitative and semi-quantitative scoring (maximum standardized uptake value [SUVmax]) of abnormal 18F-FDG uptake at 21 musculoskeletal sites was undertaken for cases and controls. Results informed the development of a novel PET/CT diagnostic algorithm using a classification and regression trees (CART) method. Thirty-three cases met the inclusion criteria and were matched to 132 controls. Mean age was 68.6 ± 7.4 years for cases compared with 68.2 ± 7.3 for controls, and 54.5% were male. Median CRP was 49 mg/L (32-65) and ESR 41.5 mm/h (24.6-64.4) in the PMR group. The predominant control indication for PET/CT was malignancy (63.6%). Individual musculoskeletal sites proved insufficient for diagnostic purposes. A novel algorithm comprising 18F-FDG uptake ≥ 2 adjacent to the ischial tuberosities in combination with either abnormalities at the peri-articular shoulder or interspinous bursa achieved a sensitivity of 90.9% and specificity of 92.4% for diagnosing PMR. The presence of abnormal 18F-FDG uptake adjacent to the ischial tuberosities together with findings at the peri-articular shoulder or interspinous bursa on whole-body PET/CT is highly sensitive and specific for a diagnosis of PMR. Clinical Trial Registration: Australian New Zealand Clinical Trials Registry,, ACTRN1261400696695.
DOI: 10.1007/s00259-020-04731-z
ORCID: 0000-0002-2694-5411
PubMed URL: 32090280
Type: Journal Article
Subjects: Diagnosis
Polymyalgia rheumatica
Whole-body positron emission tomography/computed tomography
Appears in Collections:Journal articles

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