The Value Of MRI In The Diagnosis And Differential Diagnosis Of Polymyalgia Rheumatica Shoulder Joint Disease

Objective:To explore the MRI features of patients with polymyalgia rheumatica(PMR)shoulder joint disease and analyze its value in distinguishing patients with rheumatoid arthritis(RA)and frozen shoulder(FS).Methods:A total of new-onset 46 patients with PMR who fullfilled 2012 ACR/EULAR diagnostic criteria,65 patients with RA,and 68 patients with FS were retrospectively analyzed.All patients underwent MRI scans before starting treatment and visual semiquantitative scoring system was used to score MRI features:0=no apparent abnormalities,absent;1=sufficient accumulation to allow visualization,mild;2=moderate;3=severe.The following MRI findings were evaluated:bone marrow edema(BME)in humeral head,subacromial-subdeltoid(SA-SD)bursitis,subcoracoid(SC)bursitis,effusion in the tendon sheath of long head of the biceps tendon(LHBT),abnormalities of the supraspinatus(SS)tendon,effusion in and around the glenohumeral joint~Δ,abnormal hyperintensity in the axillary recess and rotator interval(RI),injuries of remain rotator tendons and acromioclavicular arthritis.Indicators values of erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and platelet count in laboratory examinations of all patients were collected.Spearman correlation analysis was used to evaluate the relationship between MRI imaging features with laboratory examinations indexes in PMR patients.Results:The most common MRI findings of the shoulder in PMR patients were SA-SD bursitis(87.0%),followed by BME in the humeral head(82.6%),abnormalities of the SS tendon(69.6%)and effusion the glenohumeral joint~Δ(65.2%).There were statistically significant differences in the scores of BME in the humeral head,SA-SD bursitis,effusion in the tendon sheath of LHBT,effusion the glenohumeral joint~Δ,abnormalities of the SS tendon and remain rotator cuff tendons,abnormal hyperintensity in the axillary recess and RI among the three groups(P<0.05).The post-hoc analysis indicated that the scores of BME in the humeral head,abnormalities of the SS tendon and remain rotator cuff tendons,effusion the glenohumeral joint~Δin the PMR group were higher than those in the RA group and the FS group,and the difference was statistically significant(P<0.05).The SA-SD bursitis score in the PMR group was higher than that of the FS group,and the difference was statistically significant(P<0.05),but there was no statistically significant difference between the PMR group and the RA group(P>0.05).The effusion in the tendon sheath of LHBT score haven’t statistically difference between three groups after adjustment(P>0.05).There was no significant correlation between the semi-quantitative scores of shoulder MRI imaging features with the ESR,CRP,platelet counts in laboratory examination indexes in patients with PMR(P>0.05).Conclusion:(1)The most common MRI findings of the shoulder in PMR patients were SA-SD bursitis,followed by BME in the humeral head,abnormalities of the SS tendon and effusion the glenohumeral joint~Δ.(2)BME in the humeral head,abnormalities of rotator cuff tendons and effusion the glenohumeral joint~Δare good indicators for the diagnosis of PMR.MRI has important clinical value for the diagnosis and differential diagnosis of PMR.(3)There was no significant correlation between the semi-quantitative scores of shoulder MRI imaging features with the ESR,CRP,platelet counts in laboratory examination indexes in patients with PMR.