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Accuracy of musculoskeletal imaging for the diagnosis of polymyalgia rheumatica: systematic review

Accuracy of musculoskeletal imaging for the diagnosis of polymyalgia rheumatica: systematic review
Accuracy of musculoskeletal imaging for the diagnosis of polymyalgia rheumatica: systematic review

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.

Journal Article
2056-5933
Mackie, Sarah Louise
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Koduri, Gouri
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Hill, Catherine L.
867cd0a0-dabc-4152-b4bf-8e9fbc0edf8d
Wakefield, Richard J.
1ffd2dc6-b9d1-44df-b212-0621f071c305
Hutchings, Andrew
adf59104-d27e-4da7-8b5c-5b100f7b29ae
Loy, Clement
f2b75f86-8d53-4c78-9e67-d6f0a156c501
Dasgupta, Bhaskar
ed3e1cf7-24a7-438b-9b47-d2503e8c541a
Wyatt, Jeremy C.
8361be5a-fca9-4acf-b3d2-7ce04126f468
Mackie, Sarah Louise
e6d6ddad-7d59-4816-98c9-2b2cac229b6f
Koduri, Gouri
f9953770-23cc-4b4b-b862-da9cf5a97b4c
Hill, Catherine L.
867cd0a0-dabc-4152-b4bf-8e9fbc0edf8d
Wakefield, Richard J.
1ffd2dc6-b9d1-44df-b212-0621f071c305
Hutchings, Andrew
adf59104-d27e-4da7-8b5c-5b100f7b29ae
Loy, Clement
f2b75f86-8d53-4c78-9e67-d6f0a156c501
Dasgupta, Bhaskar
ed3e1cf7-24a7-438b-9b47-d2503e8c541a
Wyatt, Jeremy C.
8361be5a-fca9-4acf-b3d2-7ce04126f468

Mackie, Sarah Louise, Koduri, Gouri, Hill, Catherine L., Wakefield, Richard J., Hutchings, Andrew, Loy, Clement, Dasgupta, Bhaskar and Wyatt, Jeremy C. (2015) Accuracy of musculoskeletal imaging for the diagnosis of polymyalgia rheumatica: systematic review. RMD Open, 1 (1). (doi:10.1136/rmdopen-2015-000100).

Record type: Article

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.

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Accepted/In Press date: 31 May 2015
e-pub ahead of print date: 13 August 2015
Published date: August 2015
Keywords: Journal Article

Identifiers

Local EPrints ID: 413230
URI: https://eprints.soton.ac.uk/id/eprint/413230
ISSN: 2056-5933
PURE UUID: ee75d7cd-8c45-4c01-accd-7f1a0e68210b
ORCID for Jeremy C. Wyatt: ORCID iD orcid.org/0000-0001-7008-1473

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Date deposited: 17 Aug 2017 16:31
Last modified: 14 Mar 2019 01:31

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