18F-FDG-PET/CT for polymyalgia rheumatica: agreement and diagnostic accuracy of routine PET scan report vs. standardized PMR PET scores.

Kornelis S M van der Geest, Rob G J Grootelaar, Karin Bouwman, Maria Sandovici, Andor W J M Glaudemans, Elisabeth Brouwer, Riemer H J A Slart
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引用次数: 0

Abstract

Background: 18F-FDG-PET/CT may reveal widespread inflammation of musculoskeletal structures in polymyalgia rheumatica (PMR). Currently, scans are subjectively analysed based on the overall gestalt of the scan. Standardized PET scores may potentially aid the interpretation of the scans for suspected PMR. Here, we compared the agreement and diagnostic accuracy of routine PET scan reports vs. the most validated PET scores for PMR.

Methods: 68 consecutive patients with suspected PMR (treatment-naïve, n = 29; already treated, n = 39) undergoing 18F-FDG-PET/CT were included. In glucocorticoid-treated patients, complete tapering was pursued prior to the scan. Conclusions of routine PET scan reports were interpretated by three independent readers as "PMR", "not PMR" or "unclear". The Leuven and Leuven/Groningen scores were determined. Agreement of scan report interpretation, and agreement of routine scan reports and PET scores were determined. Sensitivity and specificity were determined for the routine scan report and the two scores, with the clinical diagnosis established after 6 months follow-up as the reference standard.

Results: A diagnosis of PMR was made in 45/68 patients. Routine scan reports were uniformly rated by all three readers in 54 (78%) cases. Following a consensus meeting, scans were rated as "PMR" in 43 cases, "unclear" in 10 cases and "not PMR" in 15 cases. The routine scan report showed a sensitivity of 82% and specificity of 74%, if "unclear" cases were considered negative for PMR. The Leuven and Leuven/Groningen Scores showed similar diagnostic accuracy. Agreement between the routine scan report and PET scores was good (Cohen's kappa 0.60-0.64), if "unclear" cases were excluded from the analysis. Among 8/10 "unclear" cases, the PMR PET Scores accurately distinguished between PMR/PMR-mimicking inflammatory conditions and non-inflammatory conditions. Agreement and diagnostic accuracy of routine scan reports and PET scores were better among treatment-naïve patients than those that had been treated previously.

Conclusion: Our study reveals that routine PET scan reports for suspected PMR can be interpreted differently between readers. Although the routine PET scan reports and PMR PET scores did not always agree, they demonstrated similar diagnostic accuracy, with the highest accuracy observed in treatment-naive patients. The Leuven and Leuven/Groningen score could especially be helpful for cases in which the nuclear medicine physician is uncertain.

18F-FDG-PET/CT诊断风湿性多肌痛:常规PET扫描报告与标准化PMR PET评分的一致性和诊断准确性
背景:18F-FDG-PET/CT可显示风湿性多肌痛(PMR)患者肌肉骨骼结构的广泛炎症。目前,对扫描的主观分析是基于扫描的整体格式塔。标准化PET评分可能有助于解释疑似PMR的扫描结果。在这里,我们比较了常规PET扫描报告与最有效的PMR PET评分的一致性和诊断准确性。方法:68例疑似PMR患者(treatment-naïve, n = 29;接受18F-FDG-PET/CT治疗的患者39例。在接受糖皮质激素治疗的患者中,在扫描前完全逐渐减少。常规PET扫描报告的结论被三位独立的读者解读为“PMR”、“not PMR”或“不清楚”。确定了Leuven和Leuven/Groningen评分。确定扫描报告解释的一致性,以及常规扫描报告和PET评分的一致性。确定常规扫描报告和两项评分的敏感性和特异性,随访6个月后确定临床诊断作为参考标准。结果:68例患者中有45例诊断为PMR。在54例(78%)病例中,常规扫描报告被所有三位读者统一评价。经协商一致后,扫描结果为43例“PMR”,10例“不清楚”,15例“非PMR”。常规扫描报告显示,如果“不清楚”的病例被认为是PMR阴性,则敏感性为82%,特异性为74%。Leuven和Leuven/Groningen评分显示出相似的诊断准确性。常规扫描报告和PET评分之间的一致性很好(Cohen’s kappa 0.60-0.64),如果“不清楚”的病例被排除在分析之外。在8/10“不清楚”的病例中,PMR PET评分准确区分了PMR/PMR模拟炎症和非炎症。treatment-naïve患者的常规扫描报告和PET评分的一致性和诊断准确性优于先前接受过治疗的患者。结论:我们的研究揭示了常规PET扫描报告对疑似PMR的解读在读者之间是不同的。尽管常规PET扫描报告和PMR PET评分并不总是一致,但它们显示出相似的诊断准确性,在未接受治疗的患者中观察到最高的准确性。Leuven和Leuven/Groningen评分对于核医学医师不确定的病例尤其有用。
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