Polymyalgia rheumatica in 18-fluorodeoxyglucose-positron-emission-tomography/computed tomography

Witte, Felicitas; Hj, Lakomek; Holzinger, Jens; Wd, Reinbold

doi:10.1007/s00393-021-01133-w

Cited by 3 publications

(2 citation statements)

References 31 publications

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“…This exposure, however, can be minimized by using, for example, low-dose CT. There is a theoretical advantage of using 18F-FDG PET-CT for a potential discovery of malignoma which may mimic PMR symptoms [ 21 ]. However, malignomas are rather rarely discovered when searching for the cause of PMR symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…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 ].…”

Section: Introductionmentioning

confidence: 99%

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Magnetresonanztomographie bei Polymyalgia rheumatica – Kontrastverstärkung ist nicht immer erforderlich

et al. 2023

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Background Extracapsular inflammation at entheseal sites in the pelvic girdle as demonstrated by magnetic resonance imaging (MRI) was shown to be useful as an additional tool for diagnosing polymyalgia rheumatica (PMR). However, it is unclear whether MRI needs to be performed with contrast enhancement or whether oedema-sensitive sequences are sufficient. Objective To evaluate the performance of T2w TIRM (turbo inversion recovery magnitude) imaging compared to fat-saturated contrast-enhanced (ce) T1w at predefined pelvic sites to detect extracapsular inflammation in patients with PMR. Methods A total of 120 pelvic MRIs of patients with pelvic girdle pain, 40 with clinically diagnosed PMR and 80 controls, were retrospectively scored by three blinded radiologists separately evaluating the MRI with and without contrast enhancement at 19 previously defined pelvic structures. The intra- and interrater reliability and the diagnostic performance of both techniques were statistically analysed and evaluated. Results The detection of inflammatory MRI signals correlated moderately between both techniques (Cohen’s κ 0.583). With ceT1w imaging 20.7% more sites were detected as inflamed compared to T2w TIRM in PMR patients. Inter- and intrareader reliability was superior with ceT1w imaging. If the inflammatory signal was detected at three sites bilaterally including the origin of the rectus femoris muscle or adductor longus muscle, the sensitivity and specificity was 100% and 97.1% by ceT1w imaging vs. 80.8% and 93.3% by T2w TIRM, respectively. Conclusion Contrast enhancement is superior to oedema-sensitive MRI in the detection of extracapsular inflammation in PMR. However, using T2w TIRM also detects many but not all PMR cases.

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Section: Discussionmentioning

confidence: 99%