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European Journal of Nuclear Medicine and Molecular Imaging

Open Access 02-04-2024 | Polymyalgia Arteritica | Original Article

The effect of prednisolone and a short-term prednisolone discontinuation for the diagnostic accuracy of FDG-PET/CT in polymyalgia rheumatica—a prospective study of 101 patients

Authors: Andreas Wiggers Nielsen, Ib Tønder Hansen, Berit Dalsgaard Nielsen, Søren Geill Kjær, Jesper Blegvad-Nissen, Kate Rewers, Christian Møller Sørensen, Ellen-Margrethe Hauge, Lars Christian Gormsen, Kresten Krarup Keller

Published in: European Journal of Nuclear Medicine and Molecular Imaging

Abstract

Purpose

2-[18F]Fluoro-2-deoxy-D-glucose (FDG)–positron emission tomography (PET)/computed tomography (CT) has been suggested as an imaging modality to diagnose polymyalgia rheumatica (PMR). However, the applicability of FDG-PET/CT remains unclear, especially following glucocorticoid administration. This study aimed to investigate the diagnostic accuracy of FDG-PET/CT before and during prednisolone treatment, as well as following short-term prednisolone discontinuation.

Methods

Treatment naïve suspected PMR patients were clinically diagnosed at baseline and subsequently had an FDG-PET/CT performed. Patients diagnosed with PMR were administered prednisolone following the first FDG-PET/CT and had a second FDG-PET/CT performed after 8 weeks of treatment. Subsequently, prednisolone was tapered with short-term discontinuation at week 9 followed by a third FDG-PET/CT at week 10. An FDG-PET/CT classification of PMR/non-PMR was applied, utilizing both the validated Leuven score and a dichotomous PMR score. The final diagnosis was based on clinical follow-up after 1 year.

Results

A total of 68 and 27 patients received a final clinical diagnosis of PMR or non-PMR. A baseline FDG-PET/CT classified the patients as having PMR with a sensitivity/specificity of 86%/63% (Leuven score) and 82%/70% (dichotomous score). Comparing the subgroup of non-PMR with inflammatory diseases to the PMR group demonstrated a specificity of 39%/54% (Leuven/dichotomous score). After 8 weeks of prednisolone treatment, the sensitivity of FDG-PET/CT decreased to 36%/41% (Leuven/dichotomous score), while a short-term prednisolone discontinuation increased the sensitivity to 66%/60%.

Conclusion

FDG-PET/CT has limited diagnostic accuracy for differentiating PMR from other inflammatory diseases. If FDG-PET/CT is intended for diagnostic purposes, prednisolone should be discontinued to enhance diagnostic accuracy.

Trial registration

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

Available only for authorised users

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Title: The effect of prednisolone and a short-term prednisolone discontinuation for the diagnostic accuracy of FDG-PET/CT in polymyalgia rheumatica—a prospective study of 101 patients
Authors: Andreas Wiggers Nielsen
Ib Tønder Hansen
Berit Dalsgaard Nielsen
Søren Geill Kjær
Jesper Blegvad-Nissen
Kate Rewers
Christian Møller Sørensen
Ellen-Margrethe Hauge
Lars Christian Gormsen
Kresten Krarup Keller
Publication date: 02-04-2024
Publisher: Springer Berlin Heidelberg
Keywords: Polymyalgia Arteritica
Polymyalgia Arteritica
Prednisolone
Computed Tomography
Computed Tomography
Giant Cell Arteritis
Giant Cell Arteritis
Positron Emission Tomography
Published in: European Journal of Nuclear Medicine and Molecular Imaging
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-024-06697-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The effect of prednisolone and a short-term prednisolone discontinuation for the diagnostic accuracy of FDG-PET/CT in polymyalgia rheumatica—a prospective study of 101 patients

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

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