Focal uptake at the rotator interval or inferior capsule of shoulder on 18 F-FDG PET/CT is associated with adhesive capsulitis

To determine if focal increased uptake at the rotator interval (RI) and/or inferior capsule (IC) on F-FDG PET/CT ("positive PET") predicts the presence of adhesive capsulitis (AC). Three populations were retrospectively examined. Group 1 included 1,137 consecutive F-FDG PET/CT studies and was used to determine the prevalence of focal uptake at the RI or IC. Group 2 included 361 cases from a 10-year period with F-FDG PET/CT and MRI of shoulder performed within 45 days of each other and was used to enrich the study group. Group 3 included 109 randomly selected patients from the same time frame as groups 1 and 2 and was used to generate the control group. The study group consisted of 15 cases from the three groups, which had positive PET findings. PET/CT images were assessed in consensus by two musculoskeletal radiologists. The reference standard for a diagnosis of AC was clinical and was made by review of the medical record by a pain medicine physician. The prevalence of focal activity at either the RI or IC ("positive PET") was 0.53%. Nine patients had a clinical diagnosis of AC and 15 patients had a positive PET. The sensitivity and specificity of PET for detection of AC was 56% and 87%, respectively. PET/CT had a positive likelihood ratio for AC of 6.3 (95% CI: 2.8-14.6). Increased uptake at the RI or IC on PET/CT confers a moderate increase in the likelihood of AC.