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

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

doi:10.1007/s00259-024-06697-8

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

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

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

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.

Original language	English
Journal	European journal of nuclear medicine and molecular imaging
Volume	51
Issue	9
Pages (from-to)	2614-2624
Number of pages	11
ISSN	1619-7070
DOIs	https://doi.org/10.1007/s00259-024-06697-8
Publication status	Published - Jul 2024

Keywords

Diagnostic imaging
Effect of prednisolone
FDG-PET/CT
Polymyalgia rheumatica

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Nielsen, A. W., Hansen, I. T., Nielsen, B. D., Kjær, S. G., Blegvad-Nissen, J., Rewers, K., Sørensen, C. M., Hauge, E.-M., Gormsen, L. C., & Keller, K. K. (2024). 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. European journal of nuclear medicine and molecular imaging, 51(9), 2614-2624. https://doi.org/10.1007/s00259-024-06697-8

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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",

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 na{\"i}ve 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.",

keywords = "Diagnostic imaging, Effect of prednisolone, FDG-PET/CT, Polymyalgia rheumatica",

author = "Nielsen, {Andreas Wiggers} 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 Ellen-Margrethe Hauge and Gormsen, {Lars Christian} and Keller, {Kresten Krarup}",

note = "{\textcopyright} 2024. The Author(s).",

year = "2024",

month = jul,

doi = "10.1007/s00259-024-06697-8",

language = "English",

volume = "51",

pages = "2614--2624",

journal = "European journal of nuclear medicine and molecular imaging",

issn = "1619-7070",

publisher = "Springer",

number = "9",

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Nielsen, AW , Hansen, IT , Nielsen, BD, Kjær, SG, Blegvad-Nissen, J, Rewers, K, Sørensen, CM, Hauge, E-M , Gormsen, LC & Keller, KK 2024, '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', European journal of nuclear medicine and molecular imaging, vol. 51, no. 9, pp. 2614-2624. https://doi.org/10.1007/s00259-024-06697-8

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. / Nielsen, Andreas Wiggers ; Hansen, Ib Tønder ; Nielsen, Berit Dalsgaard et al.
In: European journal of nuclear medicine and molecular imaging, Vol. 51, No. 9, 07.2024, p. 2614-2624.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - 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

AU - Nielsen, Andreas Wiggers

AU - Hansen, Ib Tønder

AU - Nielsen, Berit Dalsgaard

AU - Kjær, Søren Geill

AU - Blegvad-Nissen, Jesper

AU - Rewers, Kate

AU - Sørensen, Christian Møller

AU - Hauge, Ellen-Margrethe

AU - Gormsen, Lars Christian

AU - Keller, Kresten Krarup

PY - 2024/7

Y1 - 2024/7

N2 - 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.

AB - 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.

KW - Diagnostic imaging

KW - Effect of prednisolone

KW - FDG-PET/CT

KW - Polymyalgia rheumatica

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U2 - 10.1007/s00259-024-06697-8

DO - 10.1007/s00259-024-06697-8

M3 - Journal article

C2 - 38563881

SN - 1619-7070

VL - 51

SP - 2614

EP - 2624

JO - European journal of nuclear medicine and molecular imaging

JF - European journal of nuclear medicine and molecular imaging

IS - 9

ER -

Nielsen AW , Hansen IT , Nielsen BD, Kjær SG, Blegvad-Nissen J, Rewers K et al. 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. European journal of nuclear medicine and molecular imaging. 2024 Jul;51(9):2614-2624. Epub 2024 Apr 2. doi: 10.1007/s00259-024-06697-8

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

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