Abstract
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Introduction: Introduction: polymyalgia rheumatica (PMR) can be difficult to diagnose. Whole body 18F FDG PET/CT combines functional and anatomical values for a comprehensive assessment of articular and extra-articular structures affected by PMR.
Objective: Evidence suggests that the majority of patients with PMR have increased 18F-FDG uptake in 12 skeletal regions with different proposed scoring systems that might affect the management plan. The aim of our study is to investigate the value of the F18 FDG PET/CT uptake pattern and Leuven score in evaluating known PMR patients with atypical clinical presentation.
Methods: a retrospective study of 150 patients (42 male; mean age 72 ± 8 years) with clinical suspicion of PMR coupled with abnormal blood analysis (score 1-5) were referred by a certified rheumatologist for 18F-FDG PET/CT before they started the treatment. 18F FDG uptake was systematically scored by 2 certified nuclear medicine physicians in 12 skeletal regions (score 0-2), and the total skeletal score was calculated as per the original Leuven scoring system.
Receiver operating characteristics analysis was performed to determine the optimal cutoff to diagnose active PMR and for a management plan.
A negative scan was considered for a good clinical response to treatment on at least 6 months follow-up.
Results: 110 patients were considered to have a true PMR, and 40 patients had another diagnosis by 18F FDG findings. A clinical score of > 4 has a sensitivity of 75%, specificity of 97%, positive predictive value of 95% and negative predictive value of 65%. A total skeletal score of ≥16 has shown a sensitivity of 94%, specificity of 98%, PPV of 99% and NPV of 85%.
Conclusions: 18F-FDG PET/CT might be an important tool in patients with clinical suspicion of PMR, supporting the diagnosis, guiding management plan and evaluating the response to treatment. We are still in need of procedural recommendations and standardized reporting criteria in guidelines.
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