A Case of Clinical Uncertainty Solved: Giant Cell Arteritis with Polymyalgia Rheumatica Swiftly Diagnosed with Long Axial Field of View PET

Abstract

The clinical presentation of giant cell arteritis (GCA) is often nonspecific. Differentiating GCA from infectious, malignant, or other autoimmune pathology based on signs, symptoms, and laboratory parameters may therefore be difficult. Fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) imaging is an established tool in the diagnostic workup of GCA. An advantage of 18F-FDG-PET/CT is its ability to assist in the differential diagnosis by being able to demonstrate infection, inflammation, and malignancy when used in conjunction with clinical and laboratory data. Downsides to the use of 18F-FDG-PET/CT include its relatively low spatial resolution, associated radiation exposure, and the relatively long duration of imaging, causing limited availability and patient inconvenience. The advent of long axial field-of-view (LAFOV) PET/CT systems allows for PET imaging at a reduced imaging time or reduced tracer dose while maintaining high image quality. Here, we provide the first reported case of a patient with GCA and polymyalgia rheumatica (PMR) diagnosed using LAFOV PET/CT imaging. The patient presented in this case report had already been experiencing nonspecific symptoms for several years for which no cause was found. Lab investigations showed increased inflammatory parameters as well as persistent anemia. 18F-FDG LAFOV PET/CT attained high-quality images with clear signs of GCA and PMR even at 1 min of scan duration.