PET-CT findings in patients with polymyalgia rheumatica without symptoms of cranial ischaemia

Dan Med J. 2017 Oct;64(10):A5410.

Abstract

Introduction: Polymyalgia rheumatica (PMR) is an inflammatory disorder that affects the elderly. At present, evidence is limited regarding the usefulness of positron emission tomography-computed tomography (PET-CT) in the diagnosis of PMR. This study aimed to compare patient characteristics and symptoms with PET-CT findings in a Danish population of PMR patients without clinical symptoms of giant cell arteritis.

Methods: The medical records of 50 Danish PET-CT-scanned patients with PMR were reviewed. Symptoms, characteristics and PET-CT findings were registered from the medical records.

Results: Fluorodeoxyglucose (FDG) uptake was seen at the shoulders and/or hips of about 80%, and at the spinous processes of about 50% of the patients. Furthermore, 14% of the patients showed no FDG uptake at any of the studied locations. A sensitivity of 79% for PMR was found if there was FDG uptake at any two of the following three locations: the shoulder, the hip and the spinous processes. Vascular FDG uptake was seen in 7% of the patients. No significant correlations between any symptoms and any PET-CT findings were found. C-reactive protein level was significantly lower in patients receiving glucocorticoids, and completely normal scans were seen significantly more often in patients receiving steroid treatment.

Conclusions: PET-CT is a sensitive imaging technique in PMR patients. Symptoms and PET-CT findings do not correlate in PMR. Steroid treatment prior to PET-CT reduces the scan's ability to demonstrate inflammation in PMR patients.

Funding: none.

Trial registration: not relevant.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • C-Reactive Protein / analysis
  • Denmark
  • Female
  • Fluorodeoxyglucose F18*
  • Hip / diagnostic imaging
  • Humans
  • Male
  • Middle Aged
  • Polymyalgia Rheumatica / diagnostic imaging*
  • Positron Emission Tomography Computed Tomography / statistics & numerical data*
  • Radiopharmaceuticals*
  • Retrospective Studies
  • Sensitivity and Specificity
  • Shoulder / diagnostic imaging
  • Spine / diagnostic imaging

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18
  • C-Reactive Protein