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.

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

doi:10.1186/s13550-025-01233-7

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.

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

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Article number	51
Journal	EJNMMI Research
Volume	15
Issue number	1
DOIs	https://doi.org/10.1186/s13550-025-01233-7
Publication status	Published - 30 Apr 2025
Externally published	Yes

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Nielsen, A. W., van Praagh, G. D., van der Geest, K. S. M., Hansen, I. T., Nielsen, B. D., Kjær, S. G., Blegvad-Nissen, J., Rewers, K., Sørensen, C. M., Brouwer, E., Hauge, E.-M., Gormsen, L. C., Slart, R. H. J. A., & Keller, K. K. (2025). 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. EJNMMI Research, 15(1), Article 51. https://doi.org/10.1186/s13550-025-01233-7

@article{df61ced69d2e44768172e08c42acf0b6,

title = "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-na{\"i}ve suspected polymyalgia rheumatica.",

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-na{\"i}ve 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.",

author = "Nielsen, {Andreas Wiggers} and {van Praagh}, {Gijs D} and {van der Geest}, {Kornelis S M} and Hansen, {Ib T{\o}nder} and Nielsen, {Berit Dalsgaard} and Kj{\ae}r, {S{\o}ren Geill} and Jesper Blegvad-Nissen and Kate Rewers and S{\o}rensen, {Christian M{\o}ller} and Elisabeth Brouwer and Ellen-Margrethe Hauge and Gormsen, {Lars Christian} and Slart, {Riemer H J A} and Keller, {Kresten Krarup}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025.",

year = "2025",

month = apr,

day = "30",

doi = "10.1186/s13550-025-01233-7",

language = "English",

volume = "15",

journal = "EJNMMI Research",

issn = "2191-219X",

publisher = "Springer Berlin",

number = "1",

}

Nielsen, AW, van Praagh, GD, van der Geest, KSM, Hansen, IT, Nielsen, BD, Kjær, SG, Blegvad-Nissen, J, Rewers, K, Sørensen, CM, Brouwer, E, Hauge, E-M, Gormsen, LC, Slart, RHJA & Keller, KK 2025, '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.', EJNMMI Research, vol. 15, no. 1, 51. https://doi.org/10.1186/s13550-025-01233-7

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. / Nielsen, Andreas Wiggers; van Praagh, Gijs D; van der Geest, Kornelis S M et al.
In: EJNMMI Research, Vol. 15, No. 1, 51, 30.04.2025.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Whole-body and site specific [18F]FDG uptake patterns on PET/CT have limited value in differentiating between polymyalgia rheumatica and other inflammatory diseases

T2 - two cohorts of treatment-naïve suspected polymyalgia rheumatica.

AU - Nielsen, Andreas Wiggers

AU - van Praagh, Gijs D

AU - van der Geest, Kornelis S M

AU - Hansen, Ib Tønder

AU - Nielsen, Berit Dalsgaard

AU - Kjær, Søren Geill

AU - Blegvad-Nissen, Jesper

AU - Rewers, Kate

AU - Sørensen, Christian Møller

AU - Brouwer, Elisabeth

AU - Hauge, Ellen-Margrethe

AU - Gormsen, Lars Christian

AU - Slart, Riemer H J A

AU - Keller, Kresten Krarup

PY - 2025/4/30

Y1 - 2025/4/30

N2 - 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.

AB - 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.

U2 - 10.1186/s13550-025-01233-7

DO - 10.1186/s13550-025-01233-7

M3 - Article

C2 - 40307615

SN - 2191-219X

VL - 15

JO - EJNMMI Research

JF - EJNMMI Research

IS - 1

M1 - 51

ER -

Nielsen AW, van Praagh GD, van der Geest KSM, Hansen IT, Nielsen BD, Kjær SG et al. 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. EJNMMI Research. 2025 Apr 30;15(1):51. doi: 10.1186/s13550-025-01233-7