Claire E Owen1,2, Aurora M T Poon3,4, Victor Yang5, Christopher McMaster5, Sze Ting Lee3,4,6, David F L Liew5,3, Jessica L Leung5,3, Andrew M Scott3,4,6, Russell R C Buchanan5,3. 1. Department of Rheumatology, Austin Health - Repatriation Campus, Level 1, North Wing, 300 Waterdale Road, Heidelberg West, VIC, 3081, Australia. claire.owen@austin.org.au. 2. Department of Medicine, University of Melbourne, Parkville, VIC, Australia. claire.owen@austin.org.au. 3. Department of Medicine, University of Melbourne, Parkville, VIC, Australia. 4. Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, VIC, Australia. 5. Department of Rheumatology, Austin Health - Repatriation Campus, Level 1, North Wing, 300 Waterdale Road, Heidelberg West, VIC, 3081, Australia. 6. Olivia Newton-John Cancer Research Institute, and School of Cancer Medicine, La Trobe University, Heidelberg, VIC, Australia.
Abstract
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 18F-FDG 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.
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 18F-FDG 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.
Authors: K S M van der Geest; G Treglia; A W J M Glaudemans; E Brouwer; F Jamar; R H J A Slart; O Gheysens Journal: Eur J Nucl Med Mol Imaging Date: 2020-12-28 Impact factor: 9.236
Authors: Lien Moreel; Lennert Boeckxstaens; Albrecht Betrains; Maarten Van Hemelen; Steven Vanderschueren; Koen Van Laere; Daniel Blockmans Journal: Front Med (Lausanne) Date: 2022-09-21
Authors: Kornelis S M van der Geest; Yannick van Sleen; Pieter Nienhuis; Maria Sandovici; Nynke Westerdijk; Andor W J M Glaudemans; Elisabeth Brouwer; Riemer H J A Slart Journal: Rheumatology (Oxford) Date: 2022-03-02 Impact factor: 7.580