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.
References
Salvarani C, Cantini F, Hunder GC. Polymyalgia rheumatica and giant-cell arteritis. Lancet. 2008; 372: 234–45.
Beckers C, Ribbens C, Andre B, Marcelis S, Kaye O, Mathy L, et al. Assessment of disease activity in rheumatoid arthritis with 18F-FDG PET. J Nucl Med 2004: 45; 956–64.
Yamashita H, Kubota K, Mimori A. Clinical value of whole-body PET/CT in patients with active rheumatic diseases. Arthritis Res Ther. 2014;16:423.
Lin E. Baastrup’s disease (kissing spine) demonstrated by FDG PET/CT. Skeletal Radiol. 2008;37:173–5.
Dasgupta B, Cimmino MA, Maradit-Kremers H, Schmidt WA, Schirmer M, Salvarani C, et al. 2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis. 2012;71:484–92.
Bird HA, Esselinckx W, Dixon ASTJ., Mowat AG, Wood PHN. An evaluation of criteria for polymyalgia rheumatica. Ann Rheum Dis. 1979;38:434–9.
Yamashita H, Kubota K, Takahashi Y, Minaminoto R, Morooka M, Ito K, et al. Whole-body fluorodeoxyglucose positron emission tomography/computed tomography in patients with active polymyalgia rheumatic: evidence for distinctive bursitis and large-vessel vasculitis. Mod Rheumatol. 2012;22:705–11.
Wandler E, Kramer EL, Sherman O, Babb J, Scarola J, Rafii M. Diffuse FDG shoulder uptake on PET is associated with clinical findings of osteoarthritis. AJR. 2005;185:797–803.
Lehman VT, Murthy NS, Diehn FE, Verdoorn JT, Maus TP. The posterior ligamentous complex inflammatory syndrome: spread of fluid and inflammation in the retrodural space of Okada. Clin Radiol. 2015;70:528–35.
Nishimatsu K, Nakamoto Y, Ishimori T, Togashi K. FDG uptake observed around the lumbar spinous process: relevance to Baastrup disease. Ann Nucl Med. 2015;29:766–71.
Acknowledgements
The authors wish to thank Dr. Kenta Misaki, Department of Rheumatology, Kita-Harima medical center, for the advice on the clinical diagnoses.
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no potential conflicts of interest to disclose.
Rights and permissions
About this article
Cite this article
Yuge, S., Nakatani, K., Yoshino, K. et al. Diagnosing polymyalgia rheumatica on 18F-FDG PET/CT: typical uptake patterns. Ann Nucl Med 32, 573–577 (2018). https://doi.org/10.1007/s12149-018-1269-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12149-018-1269-5