pyrophosphate and Spondylitis--Ankylosing

Scintigraphic examination of the joints and spine was performed in 42 children with Bekhterev's disease and rheumatoid arthritis to establish different accumulation of 99mTc-pyrophosphate. In Bekhterev's disease, elevated concentration of the radio-indicator was detected was detected in the joints of the lower limbs, including hip joints, in the sacroiliac parts of the spine and in heels. In rheumatoid arthritis, it was mainly detectable in the joints of the upper limbs and sometimes in the cervical part of the spine. Scintigraphy of the joints may be helpful in differential diagnosis of the above-indicated disease entities.

Topics: Adolescent; Arthritis, Rheumatoid; Child; Diagnosis, Differential; Diphosphates; Female; Humans; Male; Radionuclide Imaging; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Pyrophosphate

In 576 patients quantitative scintigraphy of the sacroiliac joints and the spinal cord with 99mTc-Pyrophosphate was performed. 328 were patients with proven ankylosing spondylitis according to the New-York criteria. 120 were patients with a clinically and roentgenologically suspected ankylosing spondylitis and 128 persons formed a healthy control group. The count rate in small regions of interest (ROI) in the sacroiliac joints, the spinal cord and the os sacrum were compared on the basis of indexes. The scintigraphic data of patients with ankylosing spondylitis were compared with healthy control group and with the radiographic findings and radiologic staging of the disease: In a longitudinal follow-up study during 1 to 6 years these investigations were continued together with clinical and roentgenological checks. Quantitative bone scintigraphy provides characteristic indexes for ankylosing spondylitis, indicating the increased mineral metabolism of the sacroiliac joints and the spinal chord. Skeletal scintigraphy is recommended for early detection and monitoring of ankylosing spondylitis.

Topics: Diphosphates; Humans; Radiography; Radionuclide Imaging; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Pyrophosphate

A patient with AA amyloidosis secondary to ankylosing spondylitis showed intense liver uptake of Tc-99m MDP on bone imaging. The biopsy showed hepatic amyloid deposition. A repeat bone scan with Tc-99m MDP 1 year later was negative, although the clinical signs and liver function tests of the patient had not changed. A mechanism might exist, other than the affinity of amyloid to calcium, which would explain the extraosseous uptake of pyrophosphates and diphosphonates in organs and soft tissues affected by systemic amyloidosis.

Topics: Amyloidosis; Diphosphates; Humans; Liver; Liver Diseases; Male; Middle Aged; Radiography; Radionuclide Imaging; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Topics: Diphosphates; Humans; Radionuclide Imaging; Sacroiliac Joint; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Pyrophosphate

Thirteen patients with systemic lupus erythematosus, 8 patients with polymyositis, and 6 patients with spondylitis ankylopoetica (Bechterew's disease) underwent clinical cardiologic examination and scintigraphy of the myocardium (99mTc-pyrophosphate), ECG, echocardiography, polygraphy, and their blood pressure was taken. The aim of the study was to ascertain how such a combination of non-invasive examinations can help in recognizing a cardiac involvement. In systemic lupus erythematosus cases one or more positive findings were revealed in 9 patients (69%), in 4 patients all examinations were negative (31%). Four patients (50%) with polymyositis had positive findings. In patients with spondylitis ankylopoetica positive findings occurred in 2 cases (33%). The study has shown that a combination of non-invasive cardiologic methods increases the probability of detecting cardiac involvement in systemic connective tissue diseases.

Topics: Cardiomyopathies; Connective Tissue Diseases; Diphosphates; Electrocardiography; Humans; Lupus Erythematosus, Systemic; Myositis; Radionuclide Imaging; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Bone and Bones; Diagnosis, Differential; Diphosphates; Female; Humans; Radiography; Radionuclide Imaging; Spine; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Pyrophosphate; Tuberculosis, Spinal

Topics: Bone and Bones; Diphosphates; Humans; Radionuclide Imaging; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Pyrophosphate

Radionuclide joint imaging with the technetium-99m-labeled phosphates is a sensitive technique for the detection of inflammatory articular disease, although it is nonspecific as to the cause of the increased uptake and offers poor resolution in comparison to conventional radiography. There does not appear to be any place for the routine use of joint imaging of the peripheral joints, as there is little evidence that it benefits patient management. Scintigraphy is of benefit in the detection of osteomyelitis, Legg-Perthes' disease, and osteonecrosis, where changes may antedate roentgenologic abnormalities. Technetium-99m-phosphates may have an increasing role in the evaluation of knee and hip prosthetic joint loosening and infection, especially regarding the femoral components. Scintigraphy may be useful in excluding synovitis and allaying concern in selected patients with chronic articular pain in whom a conventional diagnostic evaluation is unrewarding. Attempts have been made to use radionuclide joint imaging to quantitate the degree of synovitis present in individual joints, particularly the sacroiliac joints. To date, reliable methods that distinguish normal from abnormal joints have not been established, although this remains an area of potential usefulness and active research. Scintigraphy with 99mTc-phosphates is useful in the detection of spinal fracture and pseudoarthrosis in individuals with ankylosing spondylitis.

Topics: Adult; Arthritis; Bone Neoplasms; Child; Diphosphates; Diphosphonates; Female; Gallium Radioisotopes; Humans; Joint Diseases; Legg-Calve-Perthes Disease; Male; Middle Aged; Osteoarthritis; Osteomyelitis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spondylitis, Ankylosing; Synovitis; Technetium; Technetium Compounds; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Topics: Diphosphates; Humans; Radionuclide Imaging; Sacroiliac Joint; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Pyrophosphate

Since ankylosing spondylitis (S.a.) tends to be milder and less progressive in women than in men, there are great difficulties in diagnosing S.a. in female patients. The role of scintiscanning for investigation of S.a. in women is discussed by few examiners only, especially there are no investigations of quantitative sacroiliac scintigraphy in large groups of female patients. Quantitative sacroiliac scintigraphy was performed in 19 female patients with S.a. and in 30 control subjects. The sacroiliac/sacrum ratio (Index ISG/sacrum) was calculated. Significantly increased uptakes were found in the patient group compared with the controls. Especially in the early periods of S.a. the activity index was highest. When history and physical examination lead to a suspicion of S.a. and there is no verification by roentgenographic studies, sacroiliac joint scintigraphy is indicated. If clinical and laboratory findings are respected in each patient, quantitative sacroiliac scintigraphy is useful for the early diagnosis of S.a. in female patients.

Topics: Adult; Diphosphates; Diphosphonates; Female; Humans; Middle Aged; Radiography; Radionuclide Imaging; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Four cases of ankylosing spondylitis are presented in which radionuclide bone studies indicated focal abnormalities of the spine. In three patients, the area of abnormal nuclide uptake corresponded to a site of pseudarthrosis, and in the fourth an acute fracture was present. As such focal lesions on bone scans are unusual in cases of chronic ankylosing spondylitis in which a complication is not apparent, their presence can be a useful finding.

Topics: Aged; Diphosphates; Diphosphonates; Fractures, Bone; Humans; Male; Middle Aged; Pseudarthrosis; Radiography; Radionuclide Imaging; Spinal Injuries; Spine; Spondylitis, Ankylosing; Technetium; Technetium Compounds; Technetium Tc 99m Pyrophosphate

Bone scintigraphy of the sacroiliac joints and the lumbar spine was performed in 35 patients with ankylosing spondylitis and 30 control subjects. The scans were evaluated by qualitative and quantitative assessment. The sacroiliac/sacrum ratio (index ISG/sacrum), the sacroiliac/lumbar spine ratio (index ISG/LWS), and the left sacroiliac joint/right sacroiliac joint ratio (index li. ISG/re. ISG) were calculated. The visual interpretation of colour scans proved to be unreliable. The index ISG/sacrum was more sensitive than the index ISG/LWS. The index li. ISG/re ISG was helpful as an additional criterion. When digital sacroiliac joint scintigraphy is well standardized it can be considered as a useful technique in early diagnosis of ankylosing spondylitis.

Topics: Adult; Diphosphates; Diphosphonates; Humans; Radionuclide Imaging; Sacroiliac Joint; Spondylitis, Ankylosing; Technetium; Technetium Compounds; Technetium Tc 99m Pyrophosphate

Although ankylosing spondylitis (AS) has been considered rare in women, we believe that its incidence is underestimated. In our case studies of 12 women with AS the characteristic clinical features of the disease included onset before the age of 30 (12 patients); night pain and morning stiffness (12 patients); intermittent, migratory joint pain (9 patients); and history of uveitis (2 patients). Spine mobility was decreased in all patients. Sacroiliac (SI) (8 patients) and circumthoracic (5 patients) tenderness were common findings. If these pertinent clues are present, further diagnostic studies are indicated. Histocompatibility testing for the HLA-B27 antigen, which is reported to be present in over 90% of patients with AS, is useful in detecting early and mild forms of the disease. We found the antigen in 10 of 11 patients tested. Radioisotope (RI) scanning can show early inflammation of the SI joints long before changes are evident on standard roentgenograms: In 3 cases, SI films were reported as normal but RI scans revealed abnormal uptake and ratios. Early detection of AS prevents inappropriate treatment of patients and mislabeling them as functional complainers.

Topics: Adolescent; Adult; Aged; Diphosphates; Female; HLA Antigens; Humans; Middle Aged; Radionuclide Imaging; Sacroiliac Joint; Sex Factors; Spondylitis, Ankylosing; Technetium; Time Factors

Scintigraphic and radiometric investigation with 99mTc-pyrophosphate was carried out on the sacro-iliac joints of 79 patients: 48 with positive form of Behterev disease, 26 -- with probable form of the disease, 2 -- with Reiter syndrome and 2 -- with rheumatoid arthritis. Scintigraphy was combined with radiometric investigation (determination of sacro-iliac -- sacral index) with a view to obtaining quantitative information about the degree of accumulation of pyrophosphate in sacro-iliac joints. The data from the scintigraphic and radiometric investigations were juxaposed to clinical laboratory and X-ray investigations. Forty of the patients examined were HLA-B27 positive and 38 of them-HLA-B27 negative. Sacro-iliac index, determined in 13 healthy subjects (26 sacro-iliac joints) was within the limits of 1.18 +/- 0.094. The average value of the index of the 78 patients examined was 1.41 +/- 0.20. The index, during the first and second X-ray stage was 1.43 +/- 0.13 and 1.45 +/- 0.19 resp. The values decreased to 1.39 +/- 0.18 during the third X-ray stage, whereas in the fourth stage with completely ankylosis of the joints, the index was 1.20 +/- 0.07, being close to that of the control group of healthy subjects.

Topics: Adolescent; Adult; Arthritis, Reactive; Arthritis, Rheumatoid; Diphosphates; Female; HLA Antigens; Humans; Male; Middle Aged; Radionuclide Imaging; Sacroiliac Joint; Spondylitis, Ankylosing; Technetium

Bone scintigraphs obtained with both Technetium-99m polyphosphate and Technetium-99m pyrophosphate have been abnormal at the sacroiliac joints of 44 patients with definite ankylosing spondylitis (AS). Because of the normal registration of the sacroiliac joints on bone scintigraphy, it has been necessary to develop a profile-scan technique to quantify the abnormality that proves to be significantly different from the normal finding. In 17 patients with a strong clinical suspicion of AS but normal radiographs, the sacroiliac joints have frequently been abnormal. This finding is meaningful because there is a common occurence in this group of the histocompatibility antigen HL A-B27, known to be a marker of AS. We also note the frequency of abnormal sacroiliac scinitigrams in 26 patients with rheumatoid arthritis and in a group of other diseases-Crohn's disease, uveitis, psoriasis, ulcerative colitis, and Reiter's disease-all of which share some of the manifestations of AS.

Topics: Adult; Animals; Arthritis, Reactive; Arthritis, Rheumatoid; Cats; Colitis, Ulcerative; Crohn Disease; Diphosphates; Evaluation Studies as Topic; Humans; Psoriasis; Radionuclide Imaging; Sacroiliac Joint; Spondylitis, Ankylosing; Technetium; Uveitis

The authors report the results they obtained by bone scintigraphy using technetium pyrophosphate. In a study of 142 patients with cancer, the authors show, as others have done, that bone scintigraphy makes it possible to find bone metastases that are radiologically undetectable and they emphasize the importance of this discovery. In 7 patients with spondylodiscitis, of whom 1 was without radiological signs at the time the scintigraphy was carried out, the authors always observed localized vertebral hyperfixation and they noted that this examination can be valuable for distinguishing spondylodiscitis from pseudo-Pott's discarthroses and from the lesions of vertebral epiphysitis, which in their experience do not result in isotopic hyperfixation. In 7 patients with epiphyseal osteonecrosis, the authors observed isotopic hyperfixation before the appearance of radiological signs. In 12 patients with osteoporosis, the authors observed hyperfixation in bone in certain compressed vertebrae, whereas other vertebrae that had probably been compressed some considerable time earlier did not fix the isotope excessively. They never observed hyperfixation in vertebrae that were not compressed. Among 5 patients with ankylosing spondylitis with radiological signs of sacro-iliac arthritis, the authors observed sacro-iliac hyperfixation in only 3 cases. Two other patients who had signs indicating ankylosing spondylarthritis, but were without radiological signs of sacro-iliac arthritis did not show sacro-iliac hyperfixation of the isotope. Among 7 patients with Paget's disease, the authors observed hyperfixation in all the bones with radiological signs of disease; in addition, in 3 patients, there was also hyperfixation in certain bones that were radiologically clear.

Topics: Bone Diseases; Bone Neoplasms; Diphosphates; Epiphyses, Slipped; Humans; Joint Diseases; Knee Joint; Neoplasm Metastasis; Osteitis Deformans; Osteoarthritis; Osteoporosis; Radiography; Radionuclide Imaging; Spinal Diseases; Spondylitis; Spondylitis, Ankylosing; Technetium

Seriological and scintigraphic activity was compared in 29 patients with spondylarthritis ankylopoietica (Bechterew's disease). Among our cases, 11 serologically active patients also had positive scans. the details being: cervical vertebral column in 5, thoracic vertebral column in 7 cases and the lumbar vertebral column and iliosacral joint in all 11 patients. In the group of 16 serologically inactive patients, 12 cases could be confirmed radiologically, in the remaining 4 early detection of ankylosing spondylarthritis was possible from the scintigraphic findings in combination with the clinical symptoms. The clinically suspected diagnosis of an incipient Bechterew's disease could not be justified in the remaining 2 patients who had no positive scintigraphic or serological results.

Topics: Adolescent; Adult; Aged; Diphosphates; Female; Humans; Male; Middle Aged; Pelvic Bones; Radionuclide Imaging; Sacroiliac Joint; Serologic Tests; Spine; Spondylitis, Ankylosing; Technetium

The anatomy and pathology of the radiocarpal compartment of the adult wrist are described in a study of human cadavers and 50 consecutive patients with radiocarpal joint abnormalities. The most frequently encountered diseases were adult onset rheumatoid arthritis (42) and calcium pyrophosphate deposition disease (22%). Features allowing radiographic diagnosis included the degree of symmetry and the presence of demineralization, sclerosis, joint space narrowing, subchondral cysts and erosions. Evaluation of abnormalities in other compartments of the wrist and the ulnar styloid is mandatory.

Topics: Adult; Aged; Arthritis; Arthritis, Juvenile; Arthritis, Rheumatoid; Carpal Bones; Diphosphates; Female; Gout; Humans; Male; Middle Aged; Psoriasis; Radiography; Radius; Spondylitis, Ankylosing; Wrist Joint

Scintigraphic exploration of the sacroiliac (S.I.) joints by 99 m-technetium pyrophosphate is simple and free of all danger. The fixation of the isotope in the right sacroiliac (R.S.I.) and the "normal" limits of the fixation ratios R.S.I./L.R. and the lumbar rachis (L.R.), visible on the same film. A series of 28 controls having made it possible to calculate the "normal" limits of the fixation ratios R.S.I./L.R. and L.S.I./L.R., the isotopic fixation was measured in 25 patients with sacroiliac inflammation, 21 of whom were rheumatic, 3 infectious. It was shown that scintigraphy could yield useful information on the evolution of sacroiliac inflammation, making an early diagnosis possible, and also contributing to differentiation between rheumatic and infectious inflammation.

Topics: Adult; Aged; Arthritis, Reactive; Back Pain; Bacterial Infections; Bone and Bones; Diphosphates; Female; Humans; Ilium; Joint Diseases; Male; Middle Aged; Osteoarthritis; Psoriasis; Radionuclide Imaging; Rheumatic Diseases; Sacroiliac Joint; Sacrum; Spinal Diseases; Spondylitis, Ankylosing; Staphylococcal Infections; Technetium; Tuberculosis, Spinal

Topics: Adult; Arthritis; Bone Diseases; Diphosphates; Female; Humans; Male; Middle Aged; Phosphates; Radionuclide Imaging; Sacroiliac Joint; Spine; Spondylitis, Ankylosing; Sternoclavicular Joint; Sternum; Strontium Radioisotopes; Technetium; Tomography, X-Ray; Zinc

Topics: Ankle Joint; Arthritis, Rheumatoid; Bone and Bones; Breast Neoplasms; Diphosphates; Female; Humans; Kinetics; Knee Joint; Male; Phosphates; Prostatic Neoplasms; Radionuclide Imaging; Rheumatic Fever; Spondylitis, Ankylosing; Strontium Radioisotopes; Technetium; Whole-Body Counting

Topics: Arthritis, Rheumatoid; Diphosphates; Humans; Methods; Spondylitis, Ankylosing; Strontium Radioisotopes; Subtraction Technique; Technetium

Topics: Antibodies, Antinuclear; Arthritis, Rheumatoid; Biopsy; Connective Tissue; Dermatomyositis; Diphosphates; Gout; Humans; Hyperparathyroidism; Inflammation; Joint Diseases; Lupus Erythematosus, Systemic; Neutrophils; Polyarteritis Nodosa; Psoriasis; Rheumatoid Factor; Salicylates; Sarcoidosis; Spondylitis, Ankylosing; Synovial Fluid; Synovial Membrane; Uric Acid

Topics: Bone and Bones; Bone Development; Diphosphates; Humans; Osteogenesis; Spondylitis, Ankylosing