Whole-body and site specific [¹⁸F]FDG uptake patterns on PET/CT have limited value in differentiating between polymyalgia rheumatica and other inflammatory diseases: two cohorts of treatment-naïve suspected polymyalgia rheumatica.

IF 3.1 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

EJNMMI Research Pub Date : 2025-04-30 DOI:10.1186/s13550-025-01233-7

Andreas Wiggers Nielsen, Gijs D van Praagh, Kornelis S M van der Geest, Ib Tønder Hansen, Berit Dalsgaard Nielsen, Søren Geill Kjær, Jesper Blegvad-Nissen, Kate Rewers, Christian Møller Sørensen, Elisabeth Brouwer, Ellen-Margrethe Hauge, Lars Christian Gormsen, Riemer H J A Slart, Kresten Krarup Keller

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引用次数: 0

Abstract

Background: It has been hypothesized that 2-[¹⁸F]fluoro-2-deoxy-D-glucose ([¹⁸F]FDG) positron emission tomography (PET) computed tomography (CT) can distinguish polymyalgia rheumatica (PMR) from non-PMR patients based on the [¹⁸F]FDG-uptake patterns. Nevertheless, a comprehensive assessment of whole-body [¹⁸F]FDG-patterns across all uptaking musculoskeletal sites, as well as site-specific [¹⁸F]FDG-uptake patterns, has not been conducted. Therefore, this study aimed to investigate both the overall whole-body [¹⁸F]FDG-uptake patterns and the specific uptake patterns at individual sites in patients suspected of having PMR.

Methods: 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 [¹⁸F]FDG-PET/CT scans. The [¹⁸F]FDG-uptake was then assessed across 34 different anatomical sites. Furthermore, the site-specific [¹⁸F]FDG-uptake pattern within each anatomical site was categorized according to its shape.

Results: Patients with PMR were more likely than non-PMR patients to have bilateral [¹⁸F]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 [¹⁸F]FDG-uptake pattern. Furthermore, site-specific [¹⁸F]FDG-uptake patterns were similar in patients with PMR and non-PMR.

Conclusion: Assessing whole-body or site-specific [¹⁸F]FDG-uptake patterns does not improve the diagnostic accuracy in distinguishing PMR from other inflammatory diseases. Consequently, [¹⁸F]FDG-PET/CT should mainly be used to rule out a clinical diagnosis of PMR.

Trial registration: ClinicalTrials.gov (NCT04519580). Registered 17th of August 2020.

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PET/CT的全身和部位特异性[18F]FDG摄取模式在鉴别风湿性多肌痛和其他炎症性疾病方面价值有限：两组treatment-naïve疑似风湿性多肌痛患者。

背景：假设2-[18F]氟-2-脱氧-d -葡萄糖（[18F]FDG）正电子发射断层扫描（PET）计算机断层扫描（CT）可以根据[18F]FDG摄取模式区分多肌痛风湿病（PMR）和非PMR患者。然而，尚未对所有摄取肌肉骨骼部位的全身[18F] fdg模式以及特定部位的[18F] fdg摄取模式进行全面评估。因此，本研究旨在研究疑似PMR患者的整体全身[18F] fdg摄取模式和个别部位的特定摄取模式。方法：前瞻性纳入来自丹麦和荷兰的两个不同的疑似PMR患者队列，分别包括66/27和36/21 PMR/非PMR患者。该队列由treatment-naïve患者组成，他们接受了治疗前[18F]FDG-PET/CT扫描。然后评估34个不同解剖部位的fdg摄取[18F]。此外，根据每个解剖部位的形状对其部位特异性[18F] fdg摄取模式进行分类。结果：与坐骨结节（91%/41%）、肩关节（86%/45%）、髋关节（83%/52%）和腰椎突（70%/30%）相比，PMR患者比非PMR患者更有可能双侧[18F] fdg摄取等于或高于肝脏。然而，一项比较非PMR患者与PMR患者其他炎症状况的亚组分析显示，一些非PMR患者表现出类似的全身fdg摄取模式[18F]。此外，PMR和非PMR患者的部位特异性[18F] fdg摄取模式相似。结论：评估全身或部位特异性[18F] fdg摄取模式并不能提高PMR与其他炎性疾病的诊断准确性。因此，[18F]FDG-PET/CT应主要用于排除PMR的临床诊断。试验注册：ClinicalTrials.gov （NCT04519580）。注册于2020年8月17日。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

EJNMMI Research RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING&nb-

CiteScore

5.90

自引率

3.10%

发文量

审稿时长

13 weeks

期刊介绍： EJNMMI Research publishes new basic, translational and clinical research in the field of nuclear medicine and molecular imaging. Regular features include original research articles, rapid communication of preliminary data on innovative research, interesting case reports, editorials, and letters to the editor. Educational articles on basic sciences, fundamental aspects and controversy related to pre-clinical and clinical research or ethical aspects of research are also welcome. Timely reviews provide updates on current applications, issues in imaging research and translational aspects of nuclear medicine and molecular imaging technologies. The main emphasis is placed on the development of targeted imaging with radiopharmaceuticals within the broader context of molecular probes to enhance understanding and characterisation of the complex biological processes underlying disease and to develop, test and guide new treatment modalities, including radionuclide therapy.