Abstract
Purpose
Frozen shoulder is characterized by pain and reduced passive movement capability, and the diagnose is made clinically. However, pain is the major symptom in the first stage before stiffness occurs, and the condition can be mistaken for subacromial impingement. This study explored the possibility to use positron emission tomography/computed tomography (PET/CT) with a 18F Flour-Deoxy-Glucose (FDG) tracer in the diagnostic process.
Methods
Eleven patients with frozen shoulder and 9 patients with subacromial impingement received a 18F-FDG PET/CT scan before being treated surgically. During arthroscopy, the diagnoses were confirmed. Images were blindly analyzed visually by two nuclear medicine physicians. Also, semi-quantified analysis applying a set of standard regions was performed, and standard uptake value in both shoulder regions was recorded.
Results
Both the visual description of the pictures and the semi-quantified analysis generally showed increased FDG uptake in the affected shoulder regions of patients that had frozen shoulder and no uptake in patients with subacromial impingement. Kappa for interobserver agreement in the visual assessments was 0.74. Sensitivity was 92% and specificity 93% of the visual assessment, 77% and 93%, respectively, of the semi-quantified analyses, and by combining the two types of analyses sensitivity was 100% and specificity was 93% for the distinction between frozen shoulders and subacromial impingement/unaffected shoulders.
Conclusion
18F-FDG PET/CT seems to be a valid method to diagnose frozen shoulder. This is clinically relevant in diagnostically challenging cases, for instance in the first phase of frozen shoulder, which can be difficult to distinguish from subacromial impingement.
Level of evidence
II.
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Abbreviations
- FS:
-
Frozen shoulder
- SUV:
-
Standard uptake value
- SI:
-
Subacromial impingement
- VAS:
-
Visual Analog Scale
- ROI:
-
Region of interest
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Funding
The study was funded by the Danish Rheumatism Association (Grant no. R101-A2009-B703).
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The study was planned by MRK, LF and MO. Patients were enrolled by MO and JRJ. The surgical findings were interpreted by MRK. PET/CT-scans were planned and interpreted by LDLD, LF and LS. Computer-assisted evaluations were made by LDLD. Data were interpreted by all authors. The manuscript was written by all authors.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Duchstein, L.D.L., Jakobsen, J.R., Marker, L. et al. The role of 18F-FDG PET/CT in the diagnosis of frozen shoulder. Knee Surg Sports Traumatol Arthrosc 29, 210–215 (2021). https://doi.org/10.1007/s00167-020-05937-2
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DOI: https://doi.org/10.1007/s00167-020-05937-2