Gadolinium-enhanced magnetic resonance imaging in shoulders contributes accurate diagnosis and predicting recurrence to patients with polymyalgia rheumatica

Nakamura, Hiroyuki; Kamada, Kazuro; Tarumi, Masato; Tanimura, Shun; Shibata, Yuhei; Horita, Tetsuya

doi:10.55563/clinexprheumatol/l0jndl

Cited by 8 publications

(11 citation statements)

References 10 publications

(15 reference statements)

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“…In our cohort, comprising 201 patients evaluated at baseline with 4 different management procedures, we found a relevant ratio of diagnostic shift, higher than 50%, during follow-up. This confirms similar findings reported in previous papers, which had assessed a change on diagnosis in up to 66% of PMR patients after long-term follow-up [ 6 , 8 , 10 , 19 , 21 ].…”

Section: Discussionsupporting

confidence: 92%

“…Therapy relies on glucocorticoids (GCs) which provide prompt relief and lead to markers of inflammation normalization. Nevertheless, despite being considered a benign, not life-threatening disease, PMR is burdened by significant morbidity, largely related to long-term GCs side effects [ 4 ], and relapses occur in up to 43–44% of patients [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although a diagnostic shift is reported in up to two thirds of patients after long-term follow-up [ 6 , 8 , 10 , 19 – 21 ], no definite clinical, laboratory or imaging finding has been identified to predict prognosis and different clinical course of PMR [ 22 , 23 ], nor the risk of further relapses [ 5 , 6 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical, laboratory and ultrasonographic findings at baseline predict long-term outcome of polymyalgia rheumatica: a multicentric retrospective study

Conticini¹,

Falsetti²,

d’Alessandro³

et al. 2023

Intern Emerg Med

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To assess the rate of PMR who, during the follow-up, undergo a diagnostic shift as well as to assess which clinical, laboratory and US findings are associated to a diagnostic shift and predict the long-term evolution of PMR. All PMR followed-up for at least 12 months were included. According to the US procedures performed at diagnosis, patients were subdivided into four subgroups. Clinical data from follow-up visits at 12, 24, 48 and 60 months, including a diagnostic shift, the number of relapses and immunosuppressive and steroid treatment, were recorded. A total of 201 patients were included. During the follow-up, up to 60% had a change in diagnosis. Bilateral LHBT was associated with persistence in PMR diagnosis, whereas GH synovitis and RF positivity to a diagnostic shift. Patients undergoing diagnostic shift had a higher frequency of GH synovitis, shoulder PD, higher CRP, WBC, PLT and Hb and longer time to achieve remission, while those maintaining diagnosis had bilateral exudative LHBT and SA-SD bursitis, higher ESR, lower Hb and shorter time to remission. Cluster analysis identified a subgroup of older patients, with lower CRP, WBC, PLT and Hb, lower PD signal or peripheral synovitis who had a higher persistence in PMR diagnosis, suffered from more flares and took more GCs. Most PMR have their diagnosis changed during follow-up. The early use of the US is associated with a lower dosage of GCs. Patients with a definite subset of clinical, laboratory and US findings seem to be more prone to maintain the diagnosis of PMR.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Clinical, laboratory and ultrasonographic findings at baseline predict long-term outcome of polymyalgia rheumatica: a multicentric retrospective study

Conticini¹,

Falsetti²,

d’Alessandro³

et al. 2023

Intern Emerg Med

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“…In a previous study, using contrast-enhanced (ce)MRI bilateral inflammation of four tendinous and capsular sites including proximal rectus femoris or adductor longus muscle origin were very characteristic for PMR and discriminated convincingly between PMR cases and controls [ 12 ]. Similar observations were recently published for the shoulder girdle [ 23 ].…”

Section: Introductionsupporting

confidence: 90%

Magnetresonanztomographie bei Polymyalgia rheumatica – Kontrastverstärkung ist nicht immer erforderlich

et al. 2023

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Background Extracapsular inflammation at entheseal sites in the pelvic girdle as demonstrated by magnetic resonance imaging (MRI) was shown to be useful as an additional tool for diagnosing polymyalgia rheumatica (PMR). However, it is unclear whether MRI needs to be performed with contrast enhancement or whether oedema-sensitive sequences are sufficient. Objective To evaluate the performance of T2w TIRM (turbo inversion recovery magnitude) imaging compared to fat-saturated contrast-enhanced (ce) T1w at predefined pelvic sites to detect extracapsular inflammation in patients with PMR. Methods A total of 120 pelvic MRIs of patients with pelvic girdle pain, 40 with clinically diagnosed PMR and 80 controls, were retrospectively scored by three blinded radiologists separately evaluating the MRI with and without contrast enhancement at 19 previously defined pelvic structures. The intra- and interrater reliability and the diagnostic performance of both techniques were statistically analysed and evaluated. Results The detection of inflammatory MRI signals correlated moderately between both techniques (Cohen’s κ 0.583). With ceT1w imaging 20.7% more sites were detected as inflamed compared to T2w TIRM in PMR patients. Inter- and intrareader reliability was superior with ceT1w imaging. If the inflammatory signal was detected at three sites bilaterally including the origin of the rectus femoris muscle or adductor longus muscle, the sensitivity and specificity was 100% and 97.1% by ceT1w imaging vs. 80.8% and 93.3% by T2w TIRM, respectively. Conclusion Contrast enhancement is superior to oedema-sensitive MRI in the detection of extracapsular inflammation in PMR. However, using T2w TIRM also detects many but not all PMR cases.

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“…Nakamura et al 59 studied 137 patients with bilateral shoulder pain caused by polymyalgia rheumatica, comparing gadobutrol MRI versus ultrasound. Regions of interest were joint capsule, rotator cuff tendon, and focal edema of humerus head.…”

Section: Results and Assessmentmentioning

confidence: 99%

Clinical Efficacy of Gadobutrol: Review of Over 25 Years of Use Exceeding 100 Million Administrations

Endrikat,

Gutberlet,

Barkhausen

et al. 2023

Invest Radiol

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Background Gadobutrol has been administered more than 100 million times worldwide, since February 1998, that is, over the last 25 years. Numerous clinical studies in a broad range of indications document the long-term experience with gadobutrol. Objective The aim of this study was to provide a literature-based overview on gadobutrol's efficacy in 9 approved indications and use in children. Materials and Methods Efficacy results in patients of all age groups including sensitivity, specificity, accuracy, and positive/negative predictive values were identified by a systematic literature search on Embase until December 31, 2022. Nine approved indications were considered: central nervous system (CNS), magnetic resonance angiography (MRA), breast, heart, prostate, kidney, liver, musculoskeletal, whole body, and various indications in children. Results Sixty-five publications (10 phase III, 2 phase IV, 53 investigator-initiated studies) reported diagnostic efficacy results obtained from 7806 patients including 271 children, at 369 centers worldwide. Indication-specific sensitivity ranges were 59%–98% (CNS), 53%–100% (MRA), 80%–100% (breast), 64%–90% (heart), 64%–96% (prostate), 71–85 (kidney), 79%–100% (liver), 53%–98% (musculoskeletal), and 78%–100% (children). Indication-specific specificity ranges were 75%–100% (CNS), 64%–99% (MRA), 58%–98% (breast), and 47%–100% (heart). Conclusions The evaluated body of evidence, consisting of 65 studies with 7806 patients, including 271 children and 7535 adults, showed that gadobutrol is an efficacious magnetic resonance imaging contrast agent for all age groups in various approved indications throughout the whole body.

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Gadolinium-enhanced magnetic resonance imaging in shoulders contributes accurate diagnosis and predicting recurrence to patients with polymyalgia rheumatica

Cited by 8 publications

References 10 publications

Clinical, laboratory and ultrasonographic findings at baseline predict long-term outcome of polymyalgia rheumatica: a multicentric retrospective study

Clinical, laboratory and ultrasonographic findings at baseline predict long-term outcome of polymyalgia rheumatica: a multicentric retrospective study

Magnetresonanztomographie bei Polymyalgia rheumatica – Kontrastverstärkung ist nicht immer erforderlich

Clinical Efficacy of Gadobutrol: Review of Over 25 Years of Use Exceeding 100 Million Administrations

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