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
{"title":"[18F]FDG-PET/CT in Polymyalgia Rheumatica: An Update and Future Aspects","authors":"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","doi":"10.1053/j.semnuclmed.2023.10.003","DOIUrl":null,"url":null,"abstract":"<div><p><span><span><span><span>Polymyalgia rheumatica<span> (PMR) is an inflammatory disorder usually diagnosed </span></span>in patients older than 50 years of age. It is characterized by sudden onset pain and prolonged </span>morning stiffness in the scapular and/or </span>pelvic girdle<span>, sometimes debilitating and accompanied by constitutional symptoms<span> such as weight loss. In approximately 20% of the cases, it is linked to giant cell arteritis<span> (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 [</span></span></span></span><sup>18</sup><span><span>F]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<span>, spondyloarthropathies, crystal-induced </span></span>arthropathies<span> or the rare remittent seronegative symmetrical synovitis with pitting edema. Relatively typical patterns of [</span></span><sup>18</sup><span><span>F]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 </span>molecular imaging<span> in the future for inflammatory rheumatisms in elderly.</span></span></p></div>","PeriodicalId":21643,"journal":{"name":"Seminars in nuclear medicine","volume":null,"pages":null},"PeriodicalIF":4.6000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Seminars in nuclear medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0001299823000831","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
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.
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.