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 3 authors assessed methodological quality using modified QUADAS-2 criteria. Results: 26 studies of 2370 patients were evaluated: ten ultrasound scanning studies; six magnetic resonance imaging (MRI) studies; one USS and MRI study; seven 18- fluorodeoxyglucose-positron emission tomography (PET) studies; one plain radiography and one technetium scintigraphy study. In 4 ultrasound studies, subacromial-subdeltoid bursitis had sensitivity 80% (95%CI 55%-93%) and specificity 68% (95%CI 60%-75%), whereas bilateral subacromial-subdeltoid bursitis had sensitivity 66% (95%CI 43%-87%) and specificity 89% (95%CI 66%-97%). Sensitivity for ultrasound detection of trochanteric 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 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.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)