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Modern Rheumatology

, Volume 22, Issue 5, pp 705–711 | Cite as

Whole-body fluorodeoxyglucose positron emission tomography/computed tomography in patients with active polymyalgia rheumatica: evidence for distinctive bursitis and large-vessel vasculitis

  • Hiroyuki YamashitaEmail author
  • Kazuo Kubota
  • Yuko Takahashi
  • Ryogo Minaminoto
  • Miyako Morooka
  • Kimiteru Ito
  • Toshikazu Kano
  • Hiroshi Kaneko
  • Hiroshi Takashima
  • Akio Mimoiri
Original Article

Abstract

Objectives

To investigate fluorodeoxyglucose (FDG) accumulation in large joints, bursas, and large vessels in patients with polymyalgia rheumatica (PMR) using 18-FDG positron emission tomography/computed tomography (PET/CT) and to differentiate PMR from similar diseases.

Methods

Fourteen untreated patients with active PMR and 17 control patients with rheumatoid arthritis (n = 11) or other active rheumatic diseases (n = 6) underwent 18-FDG PET/CT. FDG uptake in large joints, bursas and vertebral spinous processes was evaluated by calculating maximum standardised uptake values and by visual scoring (scale 0–4). PET scan images were scored in seven vascular regions, and total vascular scores (range 0–21) were calculated.

Results

Polymyalgia rheumatica patients showed increased FDG uptake in ischial tuberosities, greater trochanters, and lumbar spinous processes. Positive results at two or more of these sites showed high sensitivity (85.7%) and specificity (88.2%) for the diagnosis of PMR, and shoulder or hip-joint involvement showed low disease specificity. High FDG accumulations were found in the aortas and subclavian arteries of two PMR patients who were asymptomatic for temporal arteritis and scanty synovium and perisynovium, based on FDG uptake. PET/CT images of the 12 PMR patients without apparent vascular involvement showed synovitis and/or perisynovitis.

Conclusions

Fluorodeoxyglucose-PET/CT may be useful for the detection of PMR lesions, which are difficult to identify using other methods.

Keywords

Polymyalgia rheumatica 18-FDG positron emission tomography/computed tomography Bursitis Synovitis Vasculitis 

Notes

Acknowledgments

We thank Dr. Jun Tomio, Assistant Professor at the Department of Public Health, Graduate School of Medicine, University of Tokyo, for his invaluable assistance with the statistical analyses conducted for this study.

Conflict of interest

None.

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Copyright information

© Japan College of Rheumatology 2011

Authors and Affiliations

  • Hiroyuki Yamashita
    • 1
    Email author
  • Kazuo Kubota
    • 2
  • Yuko Takahashi
    • 1
  • Ryogo Minaminoto
    • 2
  • Miyako Morooka
    • 2
  • Kimiteru Ito
    • 2
  • Toshikazu Kano
    • 1
  • Hiroshi Kaneko
    • 1
  • Hiroshi Takashima
    • 3
  • Akio Mimoiri
    • 1
  1. 1.Division of Rheumatic DiseasesNational Center for Global Health and MedicineShinjuku-ku, TokyoJapan
  2. 2.Department of RadiologyNational Center for Global Health and MedicineTokyoJapan
  3. 3.Department of Neurology and GeriatricsKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan

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