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Vasculitis
Extended report
Accuracy of musculoskeletal imaging for the diagnosis of polymyalgia rheumatica: systematic review
  1. Sarah Louise Mackie1,2,
  2. Gouri Koduri3,4,
  3. Catherine L Hill5,
  4. Richard J Wakefield1,2,
  5. Andrew Hutchings6,
  6. Clement Loy7,8,
  7. Bhaskar Dasgupta9 and
  8. Jeremy C Wyatt10
  1. 1Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK and NIHR Leeds Musculoskeletal Biomedical Research Unit, UK
  2. 2Leeds Teaching Hospitals NHS Trust, Leeds, UK
  3. 3Harrogate and District NHS Foundation Trust, Harrogate, UK
  4. 4York Teaching Hospital NHS Foundation Trust, UK
  5. 5University of Adelaide, The Queen Elizabeth Hospital, Adelaide, Australia
  6. 6Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
  7. 7University of Sydney, Sydney, Australia
  8. 8Huntington Disease Service, Westmead Hospital, Sydney, Australia
  9. 9Southend University Hospitals NHS Trust, UK
  10. 10Leeds Institute of Health Sciences, University of Leeds, UK
  1. Correspondence to Dr Sarah Louise Mackie; s.l.mackie{at}leeds.ac.uk

Abstract

Objectives To review the evidence for accuracy of imaging for diagnosis of polymyalgia rheumatica (PMR).

Methods Searches included MEDLINE, EMBASE and PubMed. Evaluations of diagnostic accuracy of imaging tests for PMR were eligible, excluding reports with <10 PMR cases. Two authors independently extracted study data and three authors assessed methodological quality using modified QUADAS-2 criteria.

Results 26 studies of 2370 patients were evaluated: 10 ultrasound scanning studies; 6 MRI studies; 1 USS and MRI study; 7 18-fluorodeoxyglucose-positron emission tomography (PET) studies; 1 plain radiography and 1 technetium scintigraphy study. In four ultrasound studies, subacromial-subdeltoid bursitis had sensitivity 80% (95% CI 55% to 93%) and specificity 68% (95% CI 60% to 75%), whereas bilateral subacromial-subdeltoid bursitis had sensitivity 66% (95% CI 43% to 87%) and specificity 89% (95% CI 66% to 97%). Sensitivity for ultrasound detection of trochanteric bursitis ranged from 21% to 100%. In four ultrasound studies reporting both subacromial-subdeltoid bursitis and glenohumeral synovitis, detection of subacromial-subdeltoid bursitis was more accurate than that of glenohumeral synovitis (p=0.004). MRI and PET/CT revealed additional areas of inflammation in the spine and pelvis, including focal areas between the vertebrae and anterior to the hip joint, but the number of controls with inflammatory disease was inadequate for precise specificity estimates.

Conclusions Subacromial-subdeltoid bursitis appears to be the most helpful ultrasound feature for PMR diagnosis, but interpretation is limited by study heterogeneity and methodological issues, including variability in blinding and potential bias due to case–control study designs. Recent MRI and PET/CT case–control studies, with blinded readers, yielded promising data requiring validation within a diagnostic cohort study.

  • Polymyalgia Rheumatica
  • Ultrasonography
  • Magnetic Resonance Imaging

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/rmdopen-2015-000100

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