Whole-body [18 f]fdg pet/ct can alter diagnosis in patients with suspected rheumatic disease

Matthias Fröhlich, Sebastian Serfling, Takahiro Higuchi, Martin G. Pomper, Steven P. Rowe, Marc Schmalzing, Hans Peter Tony, Michael Gernert, Patrick Pascal Strunz, Jan Portegys, Eva Christina Schwaneck, Ottar Gadeholt, Alexander Weich, Andreas K. Buck, Thorsten A. Bley, Konstanze V. Guggenberger, Rudolf A. Werner

Research output: Contribution to journalArticlepeer-review


The 2-deoxy-d-[18 F]fluoro-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) is widely utilized to assess the vascular and articular inflammatory burden of patients with a suspected diagnosis of rheumatic disease. We aimed to elucidate the impact of [18 F]FDG PET/CT on change in initially suspected diagnosis in patients at the time of the scan. Thirty-four patients, who had undergone [18 F]FDG PET/CT, were enrolled and the initially suspected diagnosis prior to [18 F]FDG PET/CT was compared to the final diagnosis. In addition, a semi-quantitative analysis including vessel wall-to-liver (VLR) and joint-to-liver (JLR) ratios was also conducted. Prior to [18 F]FDG PET/CT, 22/34 (64.7%) of patients did not have an established diagnosis, whereas in 7/34 (20.6%), polymyalgia rheumatica (PMR) was suspected, and in 5/34 (14.7%), giant cell arteritis (GCA) was suspected by the referring rheumatologists. After [18 F]FDG PET/CT, the diagnosis was GCA in 19/34 (55.9%), combined GCA and PMR (GCA + PMR) in 9/34 (26.5%) and PMR in the remaining 6/34 (17.6%). As such, [18 F]FDG PET/CT altered suspected diagnosis in 28/34 (82.4%), including in all unclear cases. VLR of patients whose final diagnosis was GCA tended to be significantly higher when compared to VLR in PMR (GCA, 1.01 ± 0.08 (95%CI, 0.95–1.1) vs. PMR, 0.92 ± 0.1 (95%CI, 0.85–0.99), p = 0.07), but not when compared to PMR + GCA (1.04 ± 0.14 (95%CI, 0.95–1.13), p = 1). JLR of individuals finally diagnosed with PMR (0.94 ± 0.16, (95%CI, 0.83–1.06)), however, was significantly increased relative to JLR in GCA (0.58 ± 0.04 (95%CI, 0.55–0.61)) and GCA + PMR (0.64 ± 0.09 (95%CI, 0.57–0.71); p < 0.0001, respec-tively). In individuals with a suspected diagnosis of rheumatic disease, an inflammatory-directed [18 F]FDG PET/CT can alter diagnosis in the majority of the cases, particularly in subjects who were referred because of diagnostic uncertainty. Semi-quantitative assessment may be helpful in establishing a final diagnosis of PMR, supporting the notion that a quantitative whole-body read-out may be useful in unclear cases.

Original languageEnglish (US)
Article number2073
Issue number11
StatePublished - Nov 2021
Externally publishedYes


  • GCA
  • Giant cell arteritis
  • Inflammation
  • PMR
  • Polymyalgia rheumatica
  • Vasculature
  • Vasculitis
  • [ F]FDG PET/CT

ASJC Scopus subject areas

  • Clinical Biochemistry


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