Clinical correlation of metabolic parameters on 18F-FDG PET/CT in idiopathic frozen shoulder

Kyoung Sook Won; Du Hwan Kim; Duk Hyun Sung; Bong-Il Song; Hae Won Kim; Kwang-Soon Song; Si-Wook Lee; Chul-Hyun Cho

doi:10.1007/s12149-016-1147-y

Clinical correlation of metabolic parameters on ¹⁸F-FDG PET/CT in idiopathic frozen shoulder

Ann Nucl Med. 2017 Apr;31(3):211-217. doi: 10.1007/s12149-016-1147-y. Epub 2017 Feb 6.

Authors

Kyoung Sook Won¹, Du Hwan Kim², Duk Hyun Sung³, Bong-Il Song¹, Hae Won Kim¹, Kwang-Soon Song⁴, Si-Wook Lee⁴, Chul-Hyun Cho⁵

Affiliations

¹ Department of Nuclear Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, South Korea.
² Department of Rehabilitation Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, South Korea.
³ Department of Physical and Rehabilitation Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea.
⁴ Department of Orthopedic Surgery, Pain Research Center, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 41931, South Korea.
⁵ Department of Orthopedic Surgery, Pain Research Center, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 41931, South Korea. oscho5362@dsmc.or.kr.

Abstract

Objective: Because positron emission tomography/computed tomography (PET/CT) using fluorine-18-fluorodeoxyglucose (¹⁸F-FDG) can be used to visualize inflammation of the musculoskeletal system, it may help elucidate the pathophysiology of frozen shoulder (FS). The purpose of this study was to characterize the uptake pattern on ¹⁸F-FDG PET/CT in patients with idiopathic FS and to determine if there is a correlation between its metabolic parameters and clinical findings.

Methods: ¹⁸F-FDG PET/CT was conducted to 35 patients with unilateral idiopathic FS. Clinical data including pain, functional scores, and passive range of motion (ROM) were collected. Maximum standardized uptake values (SUVmax) were measured at the four regions of interest (ROIs): rotator interval (RI), anterior joint capsule (AJC), axillary recess (AR), and posterior joint capsule (PJC) from the attenuation-corrected axial images.

Results: Mean SUVmax values for four ROIs of the affected shoulder were significantly higher than those of the unaffected shoulder. Mean SUVmax values of RI and AR were significantly higher than those of AJC and PJC and mean SUVmax of AJC was significantly higher than that of PJC in the affected side. Three recognizable patterns of increased uptake were noted: (1) AR dominant type (15 patients); (2) RI dominant type (9 patients); (3) both RI and AR dominant type (11 patients). The SUVmax of AR showed negative correlation with abduction and forward flexion. The SUVmax of RI showed negative correlation with external rotation and internal rotation. The SUVmax of AJC showed negative correlation with all ROMs. However, there was no significant correlation between the SUVmax of PJC and any ROM.

Conclusion: Our study demonstrates that the anterior-inferior capsular portion, including RI and AR, is the main pathologic site of idiopathic FS and reveals significant correlations between ROM and metabolic parameters on ¹⁸F-FDG PET/CT. These results imply that AR and RI lesions are related to elevational limitations and rotational limitations, respectively.

Keywords: 18F-FDG PET/CT; Axillary recess; Frozen shoulder; Pathophysiology; Rotator interval.

MeSH terms

Bursitis / diagnostic imaging*
Female
Fluorodeoxyglucose F18 / chemistry*
Humans
Image Processing, Computer-Assisted / methods
Male
Middle Aged
Pain Measurement
Positron Emission Tomography Computed Tomography*
Prospective Studies
Radiopharmaceuticals / chemical synthesis
Range of Motion, Articular
Reproducibility of Results

Substances

Radiopharmaceuticals
Fluorodeoxyglucose F18