[18F]FDG-PET/CT in Polymyalgia Rheumatica: An Update and Future Aspects

IF 4.6 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Seminars in nuclear medicine Pub Date : 2024-05-01 DOI:10.1053/j.semnuclmed.2023.10.003
Olivier Gheysens MD, PhD , Marie Péan de Ponfilly MD, PhD , Gaetane Nocturne MD, PhD , Raphaële Seror MD, PhD , Florent L. Besson MD, PhD , François Jamar MD, PhD
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Abstract

Polymyalgia rheumatica (PMR) is an inflammatory disorder usually diagnosed in patients older than 50 years of age. It is characterized by sudden onset pain and prolonged morning stiffness in the scapular and/or pelvic girdle, sometimes debilitating and accompanied by constitutional symptoms such as weight loss. In approximately 20% of the cases, it is linked to giant cell arteritis (GCAV) representing a disease continuum. The diagnosis is mainly clinical and noninvasive imaging such as ultrasound of joints may be helpful. In atypical PMR cases, whole body imaging using [18F]FDG-PET/CT may be useful. First, to confirm or rule out the diagnosis of PMR, secondly, to assess the coexistence of a GCA, and thirdly to establish the differential diagnosis with other types of arthritides encountered in this age group, such as elderly-onset rheumatoid arthritis, spondyloarthropathies, crystal-induced arthropathies or the rare remittent seronegative symmetrical synovitis with pitting edema. Relatively typical patterns of [18F]FDG-PET/CT are well known, based on the clinical distribution of the disease (eg, scapular and pelvic girdle, interspinous bursae, sterno-costoclavicular joints, entheses), especially the hypermetabolism at the interspinous lumbar bursae that has shown the best post-test likelihood ratio in a meta-analysis. This article focuses on the differential diagnosis and on the visual and semi-quantitative tools that can be used to guide to the correct diagnosis of PMR as an add-on to the clinical picture. Further, we briefly discuss the options that can improve molecular imaging in the future for inflammatory rheumatisms in elderly.

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[18]刘海涛,刘海涛。FDG-PET/CT在风湿病多肌痛诊断中的应用。
风湿性多肌痛(PMR)是一种炎症性疾病,通常在50岁以上的患者中诊断出来。其特征是突然发作的疼痛和肩胛骨和/或骨盆带长时间的晨僵硬,有时使人虚弱,并伴有体重减轻等体质症状。在大约20%的病例中,它与巨细胞动脉炎(GCAV)有关,代表了疾病的连续性。诊断主要是临床和无创成像,如关节超声可能有帮助。在非典型PMR病例中,使用[18F]FDG-PET/CT进行全身成像可能是有用的。首先,确认或排除PMR的诊断,其次,评估GCA的共存,第三,建立与该年龄组遇到的其他类型关节炎的鉴别诊断,如老年发作的类风湿关节炎、脊椎关节病、晶体性关节病或罕见的弛缓血清阴性对称滑膜炎伴点状水肿。根据疾病的临床分布(如肩胛骨和骨盆带、棘间滑囊、胸骨-肋锁关节、囊),FDG-PET/CT的相对典型模式[18F]是众所周知的,尤其是棘间腰椎滑囊的高代谢,在meta分析中显示出最佳的验后似然比。本文的重点是鉴别诊断和视觉和半定量工具,可用于指导PMR的正确诊断,作为临床图片的补充。此外,我们简要地讨论了可以改善老年炎症性风湿病分子成像的选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Seminars in nuclear medicine
Seminars in nuclear medicine 医学-核医学
CiteScore
9.80
自引率
6.10%
发文量
86
审稿时长
14 days
期刊介绍: Seminars in Nuclear Medicine is the leading review journal in nuclear medicine. Each issue brings you expert reviews and commentary on a single topic as selected by the Editors. The journal contains extensive coverage of the field of nuclear medicine, including PET, SPECT, and other molecular imaging studies, and related imaging studies. Full-color illustrations are used throughout to highlight important findings. Seminars is included in PubMed/Medline, Thomson/ISI, and other major scientific indexes.
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