<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_raon-2017-0001_s_001_w2aab3b8c54b1b7b1aab1c16b1Aa"><h3>Background</h3><p>The role of <sup>18</sup>F-fluorodeoxyglucose positron emission computed tomography (<sup>18</sup>F-FDG PET/CT) is increasing in the diagnosis of polymyalgia rheumatica (PMR), one of the most common inflammatory rheumatic diseases. In addition to other locations, increased <sup>18</sup>F-FDG accumulation has been detected in the praepubic region in some patients. However, a deeper description and pathophysiological explanation of this increased praepubic accumulation has been lacking. The aim of the presented study is to confirm a decrease in praepubic <sup>18</sup>F-FDG accumulation in response to therapy and to describe potential correlations to other <sup>18</sup>F-FDG PET/CT scan characteristics during the course of disease. As a secondary objective, we describe the pathological aspects of the observed praepubic <sup>18</sup>F-FDG uptake.</p></sec><sec id="j_raon-2017-0001_s_002_w2aab3b8c54b1b7b1aab1c16b2Aa"><h3>Patients and methods</h3><p>A retrospective review of patients with newly suspected PMR undergoing baseline and follow up <sup>18</sup>F-FDG PET/CT between February 2010 and March 2016 is given. Those with a visually detected presence of praepubic <sup>18</sup>F-FDG accumulation were further analysed. The uptake was assessed visually and also semi-quantitatively in the defined region of interest by calculation of target-to-liver ratios. Other regions typical for PMR were systematically described as well (shoulders, hips, sternoclavicular joints, ischiogluteal bursae, spinous interspaces).</p></sec><sec id="j_raon-2017-0001_s_003_w2aab3b8c54b1b7b1aab1c16b3Aa"><h3>Results</h3><p>Twenty-three out of 89 screened patients (26%) presented with initial praepubic <sup>18</sup>F-FDG PET/CT positivity, 15 of whom also underwent follow up <sup>18</sup>F-FDG PET/CT examination. Five out of 15 patients presented with increased <sup>18</sup>F-FDG accumulation in large arteries as a sign of giant cell arteritis. During follow up examination, decrease in <sup>18</sup>F-FDG accumulation caused by therapeutic intervention was observed in all evaluated locations in all analysed patients and no new positivity was indicated, including periarticular, extraarticular tissues or target large vessels. Praepubical accumulation of <sup>18</sup>F-FDG was diminished in all patients (15/15, 100%) after treatment with steroids.</p></sec><sec id="j_raon-2017-0001_s_004_w2aab3b8c54b1b7b1aab1c16b4Aa"><h3>Conclusions</h3><p>Increased praepubic <sup>18</sup>F-FDG uptake in patients with PMR is relatively common and this region should be systematically evaluated during differential diagnosis of rheumatic and malignant disease. Praepubic inflammation is probably related to enthesitis and tenosynovitis at the origin of pectineus and adductor longus muscles ventrally from the pubis.</p></sec></abstract>

BackgroundThe role of 18F-fluorodeoxyglucose positron emission computed tomography (18F-FDG PET/CT) is increasing in the diagnosis of polymyalgia rheumatica (PMR), one of the most common inflammatory rheumatic diseases. In addition to other locations, increased 18F-FDG accumulation has been detected in the praepubic region in some patients. However, a deeper description and pathophysiological explanation of this increased praepubic accumulation has been lacking. The aim of the presented study is to confirm a decrease in praepubic 18F-FDG accumulation in response to therapy and to describe potential correlations to other 18F-FDG PET/CT scan characteristics during the course of disease. As a secondary objective, we describe the pathological aspects of the observed praepubic 18F-FDG uptake.Patients and methodsA retrospective review of patients with newly suspected PMR undergoing baseline and follow up 18F-FDG PET/CT between February 2010 and March 2016 is given. Those with a visually detected presence of praepubic 18F-FDG accumulation were further analysed. The uptake was assessed visually and also semi-quantitatively in the defined region of interest by calculation of target-to-liver ratios. Other regions typical for PMR were systematically described as well (shoulders, hips, sternoclavicular joints, ischiogluteal bursae, spinous interspaces).ResultsTwenty-three out of 89 screened patients (26%) presented with initial praepubic 18F-FDG PET/CT positivity, 15 of whom also underwent follow up 18F-FDG PET/CT examination. Five out of 15 patients presented with increased 18F-FDG accumulation in large arteries as a sign of giant cell arteritis. During follow up examination, decrease in 18F-FDG accumulation caused by therapeutic intervention was observed in all evaluated locations in all analysed patients and no new positivity was indicated, including periarticular, extraarticular tissues or target large vessels. Praepubical accumulation of 18F-FDG was diminished in all patients (15/15, 100%) after treatment with steroids.ConclusionsIncreased praepubic 18F-FDG uptake in patients with PMR is relatively common and this region should be systematically evaluated during differential diagnosis of rheumatic and malignant disease. Praepubic inflammation is probably related to enthesitis and tenosynovitis at the origin of pectineus and adductor longus muscles ventrally from the pubis.

PET/CT imaging in polymyalgia rheumatica: praepubic <sup>18</sup>F-FDG uptake correlates with pectineus and adductor longus muscles enthesitis and with tenosynovitis

Department of Nuclear Medicine and PET Center

Regional Center for Applied Molecular Oncology (RECAMO)

Institute of Biostatistics and Analyses, Faculty of Medicine

Rheumatology Unit, Department of Internal Medicine – Hematology and Oncology

Department of Radiation Oncology, Masaryk Memorial Cancer Institute and Faculty of Medicine

Department of Anatomy, Faculty of Medicine

Rheumatology Unit, 2nd Department of Internal Medicine

Radiology and Oncology

This article is distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

PET/CT imaging in polymyalgia rheumatica: praepubic F-FDG uptake correlates with pectineus and adductor longus muscles enthesitis and with tenosynovitis

BackgroundThe role of 18F-fluorodeoxyglucose positron emission computed tomography (18F-FDG PET/CT) is increasing in the diagnosis of polymyalgia rheumatica...

PET/CT imaging in polymyalgia rheumatica: praepubic ¹⁸F-FDG uptake correlates with pectineus and adductor longus muscles enthesitis and with tenosynovitis

Article Category: Research Article

Online veröffentlicht: 14. Jan. 2017

Seitenbereich: 8 - 14

Eingereicht: 29. Aug. 2016

Akzeptiert: 14. Dez. 2016

DOI: https://doi.org/10.1515/raon-2017-0001

© 2017 Zdenek Rehak, Andrea Sprlakova-Pukova, Zbynek Bortlicek, Zdenek Fojtik, Tomas Kazda, Marek Joukal, Renata Koukalova, Jiri Vasina, Jana Eremiasova, Petr Nemec

This article is distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

PET/CT imaging in polymyalgia rheumatica: praepubic 18F-FDG uptake correlates with pectineus and adductor longus muscles enthesitis and with tenosynovitis

Article Category: Research Article

Online veröffentlicht: 14. Jan. 2017

Seitenbereich: 8 - 14

Eingereicht: 29. Aug. 2016

Akzeptiert: 14. Dez. 2016

DOI: https://doi.org/10.1515/raon-2017-0001

© 2017 Zdenek Rehak, Andrea Sprlakova-Pukova, Zbynek Bortlicek, Zdenek Fojtik, Tomas Kazda, Marek Joukal, Renata Koukalova, Jiri Vasina, Jana Eremiasova, Petr Nemec

This article is distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

PET/CT imaging in polymyalgia rheumatica: praepubic ¹⁸F-FDG uptake correlates with pectineus and adductor longus muscles enthesitis and with tenosynovitis