• Claire E Owen, Aurora M T Poon, Victor Yang, Christopher McMaster, LeeSze TingSTDepartment of Medicine, University of Melbourne, Parkville, VIC, Australia.Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, VIC, Australia.Olivia Newton-John Cancer Research Institute, and School of Cancer Medicine, La , LiewDavid F LDFLDepartment of Rheumatology, Austin Health - Repatriation Campus, Level 1, North Wing, 300 Waterdale Road, Heidelberg West, VIC, 3081, Australia.Department of Medicine, University of Melbourne, Parkville, VIC, Australia., Jessica L Leung, Andrew M Scott, and Russell R C Buchanan.
• Department of Rheumatology, Austin Health - Repatriation Campus, Level 1, North Wing, 300 Waterdale Road, Heidelberg West, VIC, 3081, Australia. claire.owen@austin.org.au.
• Eur. J. Nucl. Med. Mol. Imaging. 2020 Sep 1; 47 (10): 2461-2468.

PurposeTo evaluate the sensitivity and specificity of PET/CT findings in PMR and generate a diagnostic algorithm utilizing a minimum number of musculoskeletal sites.MethodsSteroid-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.ResultsThirty-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.ConclusionsThe 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 RegistrationClinical Trial Registration: Australian New Zealand Clinical Trials Registry, http://www.anzctr.org.au , ACTRN1261400696695.

16 keywords...

hide…