Diagnosing polymyalgia rheumatica on 18 F-FDG PET/CT: typical uptake patterns
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Diagnosing polymyalgia rheumatica on 18F-FDG PET/CT: typical uptake patterns Shunsuke Yuge1 · Koya Nakatani1 · Kumiko Yoshino1 · Takashi Koyama1 Received: 29 April 2018 / Accepted: 4 June 2018 © The Japanese Society of Nuclear Medicine 2018
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 18 F-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 18FFDG 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 18FFDG 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. Keywords Polymyalgia rheumatica · 18F-FDG PET/CT · Spinous processes · Interspinous bursa · Sternoclavicular joints
Introduction Polymyalgia rheumatica (PMR) is a rheumatic disease characterized by widespread aching and stiffness. It tends to affect elderly people. The symptoms of PMR seem to be related to synovitis of proximal joints and extra-articular synovial structures [1]. The diagnosis is often challenging, because the clinical features and laboratory findings can also be observed in other various inflammatory conditions, such as elderly onset rheumatoid arthritis (RA), * Koya Nakatani [email protected] 1
Department of Diagnostic Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
spondyloarthropathy (SpA), remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome, and several infect
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