Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700RB, Groningen, the Netherlands.
Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
Eur J Nucl Med Mol Imaging. 2021 Jun;48(6):1876-1889. doi: 10.1007/s00259-020-05162-6. Epub 2020 Dec 28.
Polymyalgia rheumatica (PMR) can be difficult to diagnose. Whole-body [18F]FDG-PET/CT allows for a comprehensive evaluation of all relevant articular and extra-articular structures affected by PMR. We aimed to summarize current evidence on the diagnostic value of [18F]FDG-PET/CT for a diagnosis of PMR.
PubMed/MEDLINE and the Cochrane Library database were searched from inception through May 31, 2020. Studies containing patients with PMR who underwent [18F]FDG-PET/CT were included. Screening and full-text review were performed by 3 investigators and data extraction by 2 investigators. Risk of bias was examined with the QUADAS-2 tool. Diagnostic test meta-analysis was performed with a bivariate model.
Twenty studies were included in the systematic review, of which 9 studies (n = 636 patients) were eligible for meta-analysis. [18F]FDG positivity at the following sites was associated with a diagnosis of PMR: interspinous bursae (positive likelihood ratio (LR+) 4.00; 95% CI 1.84-8.71), hips (LR+ 2.91; 95% CI 2.09-4.05), ischial tuberosities (LR+ 2.86; 95% CI 1.91-4.28), shoulders (LR+ 2.57; 95% CI 1.24-5.32) and sternoclavicular joints (LR+ 2.31; 95% CI 1.33-4.02). Negative likelihood ratios (LR-) for these sites, as well as the greater trochanters, were all less than 0.50. Composite [18F]FDG-PET/CT scores, as reported in 3 studies, provided a pooled LR+ of 3.91 (95% CI 2.42-6.32) and LR- of 0.19 (95% CI 0.10-0.36). Moderate to high heterogeneity was observed across the studies, mainly due to differences in patient selection, scanning procedures and/or interpretation criteria.
Significant [18F]FDG uptake at a combination of anatomic sites is informative for a diagnosis of PMR. [18F]FDG-PET/CT might be an important diagnostic tool in patients with suspected PMR. This study also highlights the need for adherence to published procedural recommendations and standardized interpretation criteria for the use of [18F]FDG-PET/CT in PMR.
巨细胞动脉炎（PMR）的诊断较为困难。全身[18F]FDG-PET/CT 可全面评估 PMR 累及的所有相关关节内和关节外结构。本研究旨在总结全身[18F]FDG-PET/CT 诊断 PMR 的现有证据。
检索 PubMed/MEDLINE 和 Cochrane 图书馆数据库，时间范围为建库至 2020 年 5 月 31 日。纳入包含接受[18F]FDG-PET/CT 检查的 PMR 患者的研究。由 3 名研究者进行筛选和全文评估，由 2 名研究者进行数据提取。使用 QUADAS-2 工具评估偏倚风险。采用双变量模型进行诊断试验荟萃分析。
系统评价共纳入 20 项研究，其中 9 项研究（n=636 例患者）符合荟萃分析纳入标准。以下部位[18F]FDG 阳性与 PMR 诊断相关：棘突间滑囊（阳性似然比[LR+]4.00；95%CI 1.84-8.71）、髋关节（LR+ 2.91；95%CI 2.09-4.05）、坐骨结节（LR+ 2.86；95%CI 1.91-4.28）、肩关节（LR+ 2.57；95%CI 1.24-5.32）和胸锁关节（LR+ 2.31；95%CI 1.33-4.02）。这些部位的负似然比（LR-）和大转子的 LR-均小于 0.50。3 项研究报道的综合[18F]FDG-PET/CT 评分，汇总的 LR+为 3.91（95%CI 2.42-6.32），LR-为 0.19（95%CI 0.10-0.36）。各研究间存在中度至高度异质性，主要归因于患者选择、扫描程序和/或解释标准的差异。
多个解剖部位出现显著[18F]FDG 摄取提示可能患有 PMR。全身[18F]FDG-PET/CT 可能是疑似 PMR 患者的重要诊断工具。本研究还强调，在 PMR 中使用[18F]FDG-PET/CT 时，需要遵循已发表的程序建议和标准化解释标准。
