Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Feb 20;8(1):rkae003.
doi: 10.1093/rap/rkae003. eCollection 2024.

Characterising polymyalgia rheumatica on whole-body 18F-FDG PET/CT: an atlas

Claire E Owen  1   2 , Aurora M T Poon  3 , Bonnia Liu  1 , David F L Liew  1   2 , Lee Pheng Yap  4 , Victor Yang  1 , Jessica L Leung  1   2 , Christopher R McMaster  1   2 , Andrew M Scott  2   3   5 , Russell R C Buchanan  1   2
Affiliations
Review

Characterising polymyalgia rheumatica on whole-body 18F-FDG PET/CT: an atlas

Claire E Owen et al. Rheumatol Adv Pract. .

Abstract

The impact of modern imaging in uncovering the underlying pathology of PMR cannot be understated. Long dismissed as an inflammatory syndrome with links to the large vessel vasculitis giant cell arteritis (GCA), a pathognomonic pattern of musculotendinous inflammation is now attributed to PMR and may be used to confirm its diagnosis. Among the available modalities, 18F-fluorodeoxyglucose (18F-FDG) PET/CT is increasingly recognized for its high sensitivity and specificity, as well as added ability to detect concomitant large vessel GCA and exclude other relevant differentials like infection and malignancy. This atlas provides a contemporary depiction of PMR's pathology and outlines how this knowledge translates into a pattern of findings on whole body 18F-FDG PET/CT that can reliably confirm its diagnosis.

Keywords: diagnosis; imaging; pathology; polymyalgia rheumatica; whole-body positron emission tomography/computed tomography.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
PMR’s pathology at the peri-articular shoulder. (A) A depiction of inflammation arising from the connective tissues of the tendons and muscles (peritendineum and perimysium) to involve adjacent structures including the bursa and joint capsule. (B) A posteromedial view of the shoulder for anatomical orientation. (C) Distinctive musculotendinous manifestations of PMR at the shoulder. Bic: biceps bracii; Isp: infraspinatus; SSp: supraspinatus; SubSc: subscapularis. © Dr Levent Efe, CMI
Figure 2.
Figure 2.
PMR’s pathology at the posterior hip and knee. (A) A posterior view of the hip and knee joints for anatomical orientation. (B–F) Distinctive musculotendinous manifestations of PMR at the hip and knee. BF: biceps femoris; G: gracilis; ST: semitendinosus. © Dr Levent Efe, CMI
Figure 3.
Figure 3.
Characteristic peri-articular 18F-FDG uptake on PET/CT at the shoulders and hips in a PMR patient (white arrows). Whole-body coronal views are provided from an (A) anterior and (B) posterior aspect. *Maximal intensity projection (MIP); #CT windowing with bone only; ^CT windowing with muscle and bone
Figure 4.
Figure 4.
Shoulder involvement on PET/CT in PMR: abnormal 18F-FDG uptake (white arrows) at the shoulders appreciated in (A) sequential axial views and (B–D) coronal views
Figure 5.
Figure 5.
Hip involvement on PET/CT in PMR: abnormal 18F-FDG uptake (white arrows) at the hips appreciated in (A) sequential axial views, including at the trochanteric regions (red arrows), and (B–D) coronal views, with yellow arrows also indicating 18F-FDG avidity adjacent to the ischial tuberosities
Figure 6.
Figure 6.
Biceps involvement on PET/CT in PMR: (A) sequential axial views tracking the biceps down the arm to the elbow (white arrows); 18F-FDG avidity of the distal triceps is also appreciated in the olecranon fossa (red arrow); (B, C) coronal views
Figure 7.
Figure 7.
Interspinous involvement on PET/CT in PMR: abnormal 18F-FDG uptake (white arrows) at (A) the cervical spine and (B) the lumbar spine. (C, D) Correlation of lumbar spine findings on T1-weighted fat saturated (T1FS) post-contrast MRI demonstrating interspinous and supraspinous ligament enhancement at L4–5
Figure 8.
Figure 8.
Hamstring involvement on PET/CT in PMR: abnormal 18F-FDG uptake (white arrows) adjacent to (A) the ischial tuberosities and at (B) the posteromedial knee; (C, D) coronal views
Figure 9.
Figure 9.
Hand involvement on PET/CT in PMR: (A) a volar pattern of abnormal 18F-FDG (white arrows) uptake at the hand; (B) confirmation of flexor tenosynovitis as the corresponding abnormality on T1FS post-contrast MRI; (C–E) coronal views
Figure 10.
Figure 10.
Concomitant LV-GCA (red arrows) detected on PET/CT in a PMR patient with characteristic involvement of the peri-articular shoulders and hips, sternoclavicular joints and left posteromedial knee (white arrows). *Maximal Intensity projection (MIP); #CT windowing with bone only; ^CT windowing with muscle and bone
Figure 11.
Figure 11.
Differences in the whole-body appearance of PET/CT in (A) PMR compared with the relevant differential diagnoses of (B) seropositive RA and (C) dermatomyositis. In RA, 18F-FDG avidity is appreciated in an intra-articular distribution, while in dermatomyositis, abnormalities are localized to the muscle (white arrows). *Maximal intensity projection (MIP); #CT windowing with bone only; ^CT windowing with muscle and bone
Figure 12.
Figure 12.
Differences in the axial appearance of 18F-FDG PET/CT in (A) PMR, (B) seropositive RA and (C) dermatomyositis (white arrows). Views are taken at the level of the shoulders, hips, ischial tuberosities and knees for direct comparison
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Owen CE, Liew DFL, Buchanan RRC.. Musculotendinous inflammation: the defining pathology of polymyalgia rheumatica? J Rheumatol 2019;46:1552–5. - PubMed
    1. van der Geest KSM, van Sleen Y, Nienhuis P. et al. Comparison and validation of FDG-PET/CT scores for polymyalgia rheumatica. Rheumatology (Oxford) 2021;61:1072–82. - PMC - PubMed
    1. Mowat AG. Strathpeffer Spa: Dr William Bruce and polymyalgia rheumatica. Ann Rheum Dis 40:503–6. - PMC - PubMed
    1. Koski JM. Ultrasonographic evidence of synovitis in axial joints in patients with polymyalgia rheumatica. Br J Rheumatol 1992;31:201–3. - PubMed
    1. Meliconi R, Pulsatelli L, Uguccioni M. et al. Leukocyte infiltration in synovial tissue from the shoulder of patients with polymyalgia rheumatica. Quantitative analysis and influence of corticosteroid treatment. Arthritis Rheumatol 1996;39:1199–207. - PubMed

LinkOut - more resources