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Abnormalities at three musculoskeletal sites on whole-body positron emission tomography/computed tomography can diagnose polymyalgia rheumatica with high sensitivity and specificity.
European Journal of Nuclear Medicine and Molecular Imaging ( IF 9.1 ) Pub Date : 2020-02-23 , DOI: 10.1007/s00259-020-04731-z
Claire E Owen 1, 2 , Aurora M T Poon 2, 3 , Victor Yang 1 , Christopher McMaster 1 , Sze Ting Lee 2, 3, 4 , David F L Liew 1, 2 , Jessica L Leung 1, 2 , Andrew M Scott 2, 3, 4 , Russell R C Buchanan 1, 2
Affiliation  

Purpose

To evaluate the sensitivity and specificity of PET/CT findings in PMR and generate a diagnostic algorithm utilizing a minimum number of musculoskeletal sites.

Methods

Steroid-naïve patients with newly diagnosed PMR (2012 EULAR/ACR classification criteria) were prospectively recruited to undergo whole-body 18FFDG PET/CT. Each PMR case was age- and sex-matched to four PET/CT controls. Control scan indication, diagnosis and medical history were extracted from the clinical record. Qualitative and semi-quantitative scoring (maximum standardized uptake value [SUVmax]) of abnormal 18F-FDG uptake at 21 musculoskeletal sites was undertaken for cases and controls. Results informed the development of a novel PET/CT diagnostic algorithm using a classification and regression trees (CART) method.

Results

Thirty-three cases met the inclusion criteria and were matched to 132 controls. Mean age was 68.6 ± 7.4 years for cases compared with 68.2 ± 7.3 for controls, and 54.5% were male. Median CRP was 49 mg/L (32–65) and ESR 41.5 mm/h (24.6–64.4) in the PMR group. The predominant control indication for PET/CT was malignancy (63.6%). Individual musculoskeletal sites proved insufficient for diagnostic purposes. A novel algorithm comprising 18F-FDG uptake ≥ 2 adjacent to the ischial tuberosities in combination with either abnormalities at the peri-articular shoulder or interspinous bursa achieved a sensitivity of 90.9% and specificity of 92.4% for diagnosing PMR.

Conclusions

The presence of abnormal 18F-FDG uptake adjacent to the ischial tuberosities together with findings at the peri-articular shoulder or interspinous bursa on whole-body PET/CT is highly sensitive and specific for a diagnosis of PMR.

Trial registration

Clinical Trial Registration: Australian New Zealand Clinical Trials Registry, http://www.anzctr.org.au, ACTRN1261400696695



中文翻译:

全身正电子发射断层扫描/计算机断层扫描的三个肌肉骨骼部位异常可以诊断风湿性多肌痛,具有很高的灵敏度和特异性。

目的

为了评估PMR中PET / CT发现的敏感性和特异性,并利用最少数量的肌肉骨骼部位生成诊断算法。

方法

前瞻性招募未接受过类固醇的初诊断为PMR(2012 EULAR / ACR分类标准)的患者,进行全身18 F - FDG PET / CT检查。每个PMR病例的年龄和性别均与四个PET / CT对照匹配。从临床记录中提取对照扫描指示,诊断和病史。对病例和对照者在21个骨骼肌肉部位异常摄取18 F-FDG进行定性和半定量评分(最大标准化摄取值[SUV max ])。结果为使用分类和回归树(CART)方法开发新型PET / CT诊断算法提供了信息。

结果

符合纳入标准的33例病例与132例对照者匹配。病例的平均年龄为68.6±7.4岁,对照组为68.2±7.3,男性为54.5%。PMR组中位CRP为49 mg / L(32–65),ESR为41.5 mm / h(24.6–64.4)。PET / CT的主要对照适应症是恶性肿瘤(63.6%)。单个肌肉骨骼部位证明不足以用于诊断。结合坐骨结节附近18 F-FDG摄取≥2的新算法,结合关节周围肩周或棘突囊异常,诊断PMR的敏感性为90.9%,特异性为92.4%。

结论

坐骨结节附近存在异常的18 F-FDG摄取以及在全身PET / CT上的关节周围肩部或棘突间滑囊处的发现非常敏感,并且对PMR的诊断具有特异性。

试用注册

临床试验注册:澳大利亚新西兰临床试验注册处,http://www.anzctr.org.au,ACTRN1261400696695

更新日期:2020-02-23
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