Gadolinium-enhanced MR improves diagnostic accuracy and predicts polymyalgia rheumatica

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Gadolinium-enhanced MR improves diagnostic accuracy and predicts polymyalgia rheumatica

Press releases may be edited for formatting or style | November 13, 2019 MRI
ATLANTA -- According to new research findings presented this week at the 2019 ACR/ARP Annual Meeting, use of gadolinium-enhanced magnetic resonance imaging (MRI) in shoulders of patients with polymyalgia rheumatica may contribute to more accurate diagnosis and prediction of recurrence. Gadolinium-enhanced MRI displayed capsulitis, rotator cuff tendinitis and focal osteitis in shoulders that was relatively specific to patients with polymyalgia rheumatica (Abstract #1161).

Polymyalgia rheumatica (PMR) is a chronic musculoskeletal disorder that causes aching and stiffness about the upper arms, neck, lower back and thighs. It is a common cause of widespread aching and stiffness that affects adults over the age of 50, especially Caucasians. It may also occur with giant cell arteritis. Because PMR does not often cause swollen joints, it may be hard to recognize.

PMR is clinically diagnosed based on symptoms, but accurate diagnosis is difficult because the symptoms may occur in many other rheumatic diseases. Recent research suggests that ultrasonography used in shoulder joints could detect findings specific to PMR, such as biceps tenosynovitis and subdeltoid bursitis. While MRI may visualize bone and muscle lesions, its application in PMR has not been established, so this cross-sectional, follow-up study evaluated gadolinium-enhanced MRI findings in the shoulder of PMR patients to assess whether it could improve diagnostic accuracy and prognosis prediction.

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"The diagnosis of PMR remains challenging. Bird's Classification Criteria composed of the combination of clinical symptoms is highly sensitive to detect PMR but is low in specificity and requires careful diagnosis of exclusion," says Kazuro Kamada, MD, a rheumatologist at Tomakomai City Hospital in Japan, and the study's lead author. "The EULAR/ACR Provisional Classification Criteria using ultrasound findings improved specificity, but the sensitivity was not enough. So, we need a new diagnostic tool with high specificity and sensitivity for PMR."

Participants in the study included 175 patients with bilateral shoulder pain who fulfilled the Bird classification criteria for PMR between June 2012 and June 2018 at Tomakomai City Hospital. Out of these, 137 patients received both gadolinium-enhanced MRI and ultrasonography on their shoulders. At least two rheumatologists diagnosed PMR in 58 of the patients, and independent radiologists evaluated their MRI and ultrasonography findings. Patients diagnosed with PMR were prescribed 20 mg/day of prednisone initially, and then this dose was tapered after remission. The researchers followed patients until June 2019 to determine any recurrences of PMR symptoms.

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