Nielsen Andreas Wiggers, van Praagh Gijs D, van der Geest Kornelis S M, Hansen Ib Tønder, Nielsen Berit Dalsgaard, Kjær Søren Geill, Blegvad-Nissen Jesper, Rewers Kate, Sørensen Christian Møller, Brouwer Elisabeth, Hauge Ellen-Margrethe, Gormsen Lars Christian, Slart Riemer H J A, Keller Kresten Krarup
Department of Rheumatology, Aarhus University Hospital, Led- Og Bindevævssygdomme, Palle Juul-Jensens Boulevard 59, 8200, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
EJNMMI Res. 2025 Apr 30;15(1):51. doi: 10.1186/s13550-025-01233-7.
It has been hypothesized that 2-[F]fluoro-2-deoxy-D-glucose ([F]FDG) positron emission tomography (PET) computed tomography (CT) can distinguish polymyalgia rheumatica (PMR) from non-PMR patients based on the [F]FDG-uptake patterns. Nevertheless, a comprehensive assessment of whole-body [F]FDG-patterns across all uptaking musculoskeletal sites, as well as site-specific [F]FDG-uptake patterns, has not been conducted. Therefore, this study aimed to investigate both the overall whole-body [F]FDG-uptake patterns and the specific uptake patterns at individual sites in patients suspected of having PMR.
Two distinct cohorts of patients with suspected PMR from Denmark and the Netherlands were prospectively included, encompassing 66/27 and 36/21 PMR/non-PMR patients, respectively. The cohorts consisted of treatment-naïve patients, who underwent pre-treatment [F]FDG-PET/CT scans. The [F]FDG-uptake was then assessed across 34 different anatomical sites. Furthermore, the site-specific [F]FDG-uptake pattern within each anatomical site was categorized according to its shape.
Patients with PMR were more likely than non-PMR patients to have bilateral [F]FDG-uptake equal to or above liver compared at the ischial tuberosities (91%/41%), shoulder joints (86%/45%), hip joints (83%/52%), and along the lumbar spinal processes (70%/30%). However, a subgroup analysis comparing non-PMR patients with other inflammatory conditions to patients with PMR revealed that several non-PMR patients exhibited a similar whole-body [F]FDG-uptake pattern. Furthermore, site-specific [F]FDG-uptake patterns were similar in patients with PMR and non-PMR.
Assessing whole-body or site-specific [F]FDG-uptake patterns does not improve the diagnostic accuracy in distinguishing PMR from other inflammatory diseases. Consequently, [F]FDG-PET/CT should mainly be used to rule out a clinical diagnosis of PMR.
ClinicalTrials.gov (NCT04519580). Registered 17th of August 2020.
据推测，2-[F]氟-2-脱氧-D-葡萄糖（[F]FDG）正电子发射断层扫描（PET）计算机断层扫描（CT）可根据[F]FDG摄取模式区分风湿性多肌痛（PMR）患者与非PMR患者。然而，尚未对所有摄取[F]FDG的肌肉骨骼部位的全身[F]FDG模式以及特定部位的[F]FDG摄取模式进行全面评估。因此，本研究旨在调查疑似患有PMR的患者的全身整体[F]FDG摄取模式以及各个部位的特定摄取模式。
前瞻性纳入了来自丹麦和荷兰的两个不同队列的疑似PMR患者，分别包括66/27例和36/21例PMR/非PMR患者。这些队列由未经治疗的患者组成，他们接受了治疗前的[F]FDG-PET/CT扫描。然后在34个不同的解剖部位评估[F]FDG摄取情况。此外，每个解剖部位内特定部位的[F]FDG摄取模式根据其形状进行分类。
与非PMR患者相比，PMR患者在坐骨结节（91%/41%）、肩关节（86%/45%）、髋关节（83%/52%）以及腰椎棘突沿线（70%/30%）更有可能出现双侧[F]FDG摄取等于或高于肝脏。然而，一项将非PMR患者与其他炎症性疾病患者与PMR患者进行比较的亚组分析显示，一些非PMR患者表现出类似的全身[F]FDG摄取模式。此外，PMR患者和非PMR患者特定部位的[F]FDG摄取模式相似。
评估全身或特定部位的[F]FDG摄取模式并不能提高区分PMR与其他炎症性疾病的诊断准确性。因此，[F]FDG-PET/CT主要应用于排除PMR的临床诊断。
ClinicalTrials.gov（NCT04519580）。2020年8月17日注册。
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