Diagnostic capability of contrast-enhanced pelvic girdle magnetic resonance imaging in polymyalgia rheumatica

Abstract

Objective There is currently no diagnostic test for PMR. A characteristic pattern of extracapsular inflammation as assessed by contrast-enhanced MRI (ceMRI) has recently been described in the pelvis of patients with PMR. We aimed to evaluate the performance of inflammatory ceMRI signals at predefined pelvic sites as a diagnostic test for PMR. Methods Pelvic MRI scans of patients with pelvic girdle pain (n = 120), including 40 patients with an expert diagnosis of PMR and 80 controls with other reasons for pelvic pain were scored by three blinded radiologists, who evaluated the degree of contrast enhancement at 19 predefined tendinous and capsular pelvic structures. Different patterns of involvement were analysed statistically. Results The frequency of bilateral peritendinitis and pericapsulitis including less common sites, such as the proximal origins of the m. rectus femoris and m. adductor longus, differed significantly between PMR cases and controls: 13.4 ± 2.7 vs 4.0 ± 2.3. A cut-off of ≥10 inflamed sites discriminated well between groups (sensitivity 95.8%, specificity 97.1%). Bilateral inflammation of the insertion of the proximal m. rectus femoris or adductor longus tendons together with ≥3 other bilaterally inflamed sites performed even better (sensitivity 100%, specificity 97.5%). Conclusion This study confirms that a distinctive MRI pattern of pelvic inflammation (bilateral peritendinitis and pericapsulitis and the proximal origins of the m. rectus femoris and m. adductor longus) is characteristic for PMR. The high sensitivity and specificity of the set of anatomical sites evaluated suggests their clinical usefulness as a confirmatory diagnostic test.

Comparison and validation of FDG-PET/CT scores for polymyalgia rheumatica

“…The incorporation of combined US of shoulders and hips improved the specificity of the 2012 EULAR/ACR criteria for PMR from 78–82% towards 81–91% [ 2 , 8 ]. Findings on contrast-enhanced, pelvic girdle MRI showed a sensitivity and specificity of >95% for PMR [ 9 ], whereas whole-body MRI provided a sensitivity of 64% and specificity of 94% [ 10 ]. However, the exact specificity of these imaging modalities remains to be further established among a group of PMR comparators: i.e.…”

Polymyalgische Beschwerden: Steckt ein Tumor dahinter?

“…Bislang gibt es keinen diagnostischen Test [3]. Vor kurzem wurde allerdings berichtet, dass bei kontrastmittelunterstützten magnetre-sonanztomografischen (MRT) Untersuchungen des Beckens ein spezifisches Muster erkennbar ist [4].…”

“…In der anschließend durchgeführten Bildgebung wurde eine deutlich Malignom-suspekte Raumforderung gefunden, die als Ursache der Beschwerden anzusehen war. PMR-typische Veränderungen wie Koxitis oder Bursitis trochanterica [4] wurden dagegen nicht beschrieben.…”

Magnetresonanztomographie bei Polymyalgia rheumatica – Kontrastverstärkung ist nicht immer erforderlich

“…Although visualisation of extracapsular inflammation by magnetic resonance imaging (MRI, [ 6 – 12 ]) and 18 F‑fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) have been shown to provide characteristic imaging findings suggestive of additional diagnostic value for PMR [ 13 – 21 ], imaging is currently not recommended in patients with a suspected diagnosis of PMR [ 22 ].…”