CLINICAL IMAGE
Giant cell arteritis with polymyalgia rheumatica on FDGPET/CT Akira Baba1,2 , Kimiichi Uno2, Yumi Okuyama1, Yohei Munetomo1, Shintaro Nakajima1, Kennosuke Mizushina3 & Hideto Kameda3 1
Department of Radiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan Gaien Higashi Clinic, Tokyo, Japan 3 Department of Rheumatology, Toho University Medical Center Ohashi Hospital, Tokyo, Japan 2
Correspondence Akira Baba, Department of Radiology, Tokyo Dental College Ichikawa General Hospital, Sugano 5-11-13 Ichikawa, 272-8513 Chiba, Japan. Tel: 81-047-322 -0151(ext:1486); Fax: 81-047-325-4456; E-mail: [email protected]
Key Clinical Message
Funding Information No sources of funding were declared for this study.
Keywords
If there is no pain in the temporal artery, the diagnosis of giant cell arteritis (GCA) may be delayed and blindness may occur. Therefore, FDG-PET/CT is important as a modality for diagnosis of GCA. When GCA is suspected and F-18 FDG-PET/CT is performed, it is worthwhile to pay attention to shoulder and hip joints as polymyalgia rheumatica commonly presents with GCA.
FDG-PET/CT, giant cell arteritis, polymyalgia rheumatica.
Received: 26 October 2016; Revised: 21 February 2017; Accepted: 13 April 2017 Clinical Case Reports 2017; 5(7): 1186–1187 doi: 10.1002/ccr3.994
An 80-year-old woman presented with a two-month history of general malaise and bilateral shoulder and hip
(1)
pain with morning stiffness. Her past history was pertinent with chronic subdural hematoma. Laboratory
(2)
Figures 1 and 2. F-18 FDG-PET/CT showed increased FDG uptake in the wall of aorta, bilateral subclavian arteries (1 and 2, arrows), and shoulders and hip joints (1 and 2, arrowheads).
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ª 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
A. Baba et al.
investigations revealed increased C-reactive protein level (5.67 mg/dL) only and no other abnormal results. Contrast-enhanced CT images revealed wall thickening of aorta, suggesting the aortitis. F-18 FDG-PET/CT confirmed the diagnosis of giant cell arteritis (GCA), with increased FDG uptake in the wall of aorta and bilateral subclavian arteries (Figs 1 and 2, arrows). It also showed the increased uptake in shoulders and hip joints (Figs 1 and 2, arrowheads), which was compatible with the diagnosis of polymyalgia rheumatica (PMR). She underwent oral steroid and methotrexate treatment, and both symptoms and radiological signs improved. If patients presented without headache or scalp tenderness, like our case, clinicians may not suspect GCA, and visual loss may occur because of the delayed diagnosis [1]. Therefore, FDG-PET/ CT is important as a tool for diagnosis of GCA. It is known that patients with PMR are often accompanied with GCA [2]. In our case, PET/CT successfully captured the simultaneous active inflammation at typical sites for GCA and PMR: major arteries and proximal joints, including hip joints. F-18 FDG-PET/CT is useful to diagnose both GCA and PMR, and it is worthy to check proximal joints along with major blood vessels [2, 3].
ª 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
GCA with PMR on FDG-PET/CT
Authorship AB: drafted the article. All authors: participated in critical review and revision of the article, gave the final approval of the article, and have accountability for all aspects of the work.
Conflict of Interest None declared. Reference 1. Ezeonyeji, A. N., F. A. Borg, and B. Dasgupta. 2011. Delays in recognition and management of giant cell arteritis: results from a retrospective audit. Clin. Rheumatol. 30:259– 262. 2. Kermani, T. A., and K. J. Warrington. 2013. Polymyalgia rheumatica. Lancet 381:63–72. 3. Camellino, D., and M. A. Cimmino. 2012. Imaging of polymyalgia rheumatica: indications on its pathogenesis, diagnosis and prognosis. Rheumatology 51:77–86.
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Giant cell arteritis with polymyalgia rheumatica on FDGPET/CT Akira Baba1,2 , Kimiichi Uno2, Yumi Okuyama1, Yohei Munetomo1, Shintaro Nakajima1, Kennosuke Mizushina3 & Hideto Kameda3 1
Department of Radiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan Gaien Higashi Clinic, Tokyo, Japan 3 Department of Rheumatology, Toho University Medical Center Ohashi Hospital, Tokyo, Japan 2
Correspondence Akira Baba, Department of Radiology, Tokyo Dental College Ichikawa General Hospital, Sugano 5-11-13 Ichikawa, 272-8513 Chiba, Japan. Tel: 81-047-322 -0151(ext:1486); Fax: 81-047-325-4456; E-mail: [email protected]
Key Clinical Message
Funding Information No sources of funding were declared for this study.
Keywords
If there is no pain in the temporal artery, the diagnosis of giant cell arteritis (GCA) may be delayed and blindness may occur. Therefore, FDG-PET/CT is important as a modality for diagnosis of GCA. When GCA is suspected and F-18 FDG-PET/CT is performed, it is worthwhile to pay attention to shoulder and hip joints as polymyalgia rheumatica commonly presents with GCA.
FDG-PET/CT, giant cell arteritis, polymyalgia rheumatica.
Received: 26 October 2016; Revised: 21 February 2017; Accepted: 13 April 2017 Clinical Case Reports 2017; 5(7): 1186–1187 doi: 10.1002/ccr3.994
An 80-year-old woman presented with a two-month history of general malaise and bilateral shoulder and hip
(1)
pain with morning stiffness. Her past history was pertinent with chronic subdural hematoma. Laboratory
(2)
Figures 1 and 2. F-18 FDG-PET/CT showed increased FDG uptake in the wall of aorta, bilateral subclavian arteries (1 and 2, arrows), and shoulders and hip joints (1 and 2, arrowheads).
1186
ª 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
A. Baba et al.
investigations revealed increased C-reactive protein level (5.67 mg/dL) only and no other abnormal results. Contrast-enhanced CT images revealed wall thickening of aorta, suggesting the aortitis. F-18 FDG-PET/CT confirmed the diagnosis of giant cell arteritis (GCA), with increased FDG uptake in the wall of aorta and bilateral subclavian arteries (Figs 1 and 2, arrows). It also showed the increased uptake in shoulders and hip joints (Figs 1 and 2, arrowheads), which was compatible with the diagnosis of polymyalgia rheumatica (PMR). She underwent oral steroid and methotrexate treatment, and both symptoms and radiological signs improved. If patients presented without headache or scalp tenderness, like our case, clinicians may not suspect GCA, and visual loss may occur because of the delayed diagnosis [1]. Therefore, FDG-PET/ CT is important as a tool for diagnosis of GCA. It is known that patients with PMR are often accompanied with GCA [2]. In our case, PET/CT successfully captured the simultaneous active inflammation at typical sites for GCA and PMR: major arteries and proximal joints, including hip joints. F-18 FDG-PET/CT is useful to diagnose both GCA and PMR, and it is worthy to check proximal joints along with major blood vessels [2, 3].
ª 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
GCA with PMR on FDG-PET/CT
Authorship AB: drafted the article. All authors: participated in critical review and revision of the article, gave the final approval of the article, and have accountability for all aspects of the work.
Conflict of Interest None declared. Reference 1. Ezeonyeji, A. N., F. A. Borg, and B. Dasgupta. 2011. Delays in recognition and management of giant cell arteritis: results from a retrospective audit. Clin. Rheumatol. 30:259– 262. 2. Kermani, T. A., and K. J. Warrington. 2013. Polymyalgia rheumatica. Lancet 381:63–72. 3. Camellino, D., and M. A. Cimmino. 2012. Imaging of polymyalgia rheumatica: indications on its pathogenesis, diagnosis and prognosis. Rheumatology 51:77–86.
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