Whole-body fluorodeoxyglucose positron emission tomography/computed tomography in patients with active polymyalgia rheumatica: evidence for distinctive bursitis and large-vessel vasculitis.
OBJECTIVE
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.
Division of Rheumatic Diseases, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan. hiroyuki_yjp2005@yahoo.co.jp
Hiroyuki
H
Yamashita
Kazuo
K
Kubota
Yuko
Y
Takahashi
Ryogo
R
Minaminoto
Miyako
M
Morooka
Kimiteru
K
Ito
Toshikazu
T
Kano
Hiroshi
H
Kaneko
Hiroshi
H
Takashima
Akio
A
Mimoiri
D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging / Q000473:pathology; D001158:Arteries / Q000000981:diagnostic imaging* / Q000473:pathology; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000000981:diagnostic imaging; D001528:Behcet Syndrome / Q000150:complications / Q000000981:diagnostic imaging; D002062:Bursitis / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D011111:Polymyalgia Rheumatica / Q000150:complications / Q000000981:diagnostic imaging*; D017285:Polymyositis / Q000150:complications / Q000000981:diagnostic imaging; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D016706:Still's Disease, Adult-Onset / Q000150:complications / Q000000981:diagnostic imaging; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014657:Vasculitis / Q000150:complications / Q000000981:diagnostic imaging*
D019788:Fluorodeoxyglucose F18