sodium-pertechnetate-tc-99m and Synovitis

Since the minimal effective dosage for radiosynovectomy is not known, we have performed a doubleblind controlled trial of 1 mCi vs. 5 mCi 198Au in 60 knees of 46 patients with persistent rheumatoid synovitis. The therapeutic effect was assessed with a clinical score, 99mTc pertechnetate uptake measurements and plain X-rays. With regard to clinical parameters no statistical differences between the two groups were found, but results indicate a trend towards a better outcome in patients treated with 5 mCi. 99mTc uptake improved significantly in patients treated with the higher dose and not in the low dose group. Weighing ease of treatment and risk of side effects against the small difference in effectiveness, we conclude that the use of less than 5 mCi of 198Au may be justified. During the study the injection technique was changed, enabling a comparison of two methods. Leakage to lymph nodes and liver decreased when the needle was flushed with normal saline after administration of the radiocolloid.

Topics: Aged; Aged, 80 and over; Arthritis, Rheumatoid; Clinical Trials as Topic; Dose-Response Relationship, Drug; Double-Blind Method; Female; Gold Radioisotopes; Humans; Injections, Intra-Articular; Knee Joint; Male; Middle Aged; Radionuclide Imaging; Random Allocation; Sodium Pertechnetate Tc 99m; Synovitis

Topics: Anti-Inflammatory Agents, Non-Steroidal; Arthritis; Diclofenac; Female; Gamma Cameras; Humans; Methotrexate; Middle Aged; Prednisolone; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Synovitis; Temporomandibular Joint Disorders

The potential of scintigraphy with technetium 99m-labelled J001 (99mTc-J001) to detect synovitis was studied in 15 rabbits with osteoarthritis (OA) of the right knee (section of cruciate ligaments), in five sham-operated rabbits and in four non-operated rabbits. J001 is a non-pyrogenic, acylated poly (1,3) galactoside isolated from the membrane of a non-pathogenic strain of Klebsiella pneumoniae which is able to bind selectively to macrophages via the binding to CD11b and CD14 molecules. The results of 99mTc-J001 scintigraphy were compared with those of scintigraphy with 99mTc-labelled methylene diphosphonate (99mTc-MDP) and GC-APG (a derivative of J001 unable to bind macrophages in vitro). The mean scintigraphic ratios (diseased healthy knee) of 99mTc-J001 were significantly higher in OA rabbits than in sham- and non-operated rabbits, from as early as day 18 until day 90. 99mTc-J001 scintigraphy demonstrated earlier increased uptake than 99mTc-MDP scintigraphy. The mean scintigraphic ratios of 99mTc-J001 were significantly higher than those of 99mTc-GC-APG (which remained normal) in OA rabbits. The normal scintigraphic ratios of 99mTc-J001 in sham-operated and non-operated rabbits, as well as of 99mTc-GC-APG in OA rabbits, suggested that the increased uptake demonstrated with 99mTc-J001 in OA rabbits, as early as day 18 corresponded to imaging of synovitis via elective macrophage targeting. These results showed that 99mTc-J001 scintigraphy should be a specific method of detecting synovitis in OA.

Topics: Animals; Anterior Cruciate Ligament; CD11 Antigens; Lipopolysaccharide Receptors; Macrophages; Male; Osteoarthritis; Posterior Cruciate Ligament; Rabbits; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Synovitis; Technetium Tc 99m Medronate

Sixteen patients with primary fibromyalgia syndrome were assessed blindly by multiphase skeletal scintigraphy to detect possible subclinical synovitis and uptake abnormalities at tender point sites. Results were normal in 14 of the 16 patients. Mild and localized abnormalities were found in 2 patients and were possibly due to the trauma of overuse. Our multiphase skeletal scintigraphy study showed that synovitis, other evidence of arthritis, or abnormalities at tender point sites were not increased above normal expectation among our sample of patients studied with fibromyalgia.

Topics: Adolescent; Adult; Bone Diseases; Child; Connective Tissue Diseases; Female; Fibromyalgia; Humans; Male; Radionuclide Imaging; Single-Blind Method; Sodium Pertechnetate Tc 99m; Synovitis; Technetium Tc 99m Medronate

The diffuse form of pigmented villonodular synovitis of eight knee joints of eight patients was treated by intra-articular injection of 185 MBq yttrium-90 silicate (90Y). Six patients had a recurrence of disease after one or two surgical synovectomies. After treatment with 90Y once or twice four knees showed clinical improvement with an accompanying decrease of the inflammatory activity as measured by the technetium-99m pertechnetate (99mTcO4-) uptake ratio and the severity of the diseased synovial tissue. Arthroscopy was performed before and six months after each 90Y treatment. The ratio of 99mTcO4- uptake in the inflamed compared with the normal knee joint correlated well with the macroscopical grading of pigmented villonodular synovitis. In all cases areas of persistent synovitis were found after the 90Y injection and this was confirmed both by histological examination and 99mTcO4- uptake measurements. Biopsy specimens taken from the diseased synovial areas showed histologically mostly less prominent and less numerous villi. The cartilage damage was slightly increased in only two cases. No radiological deterioration was found during follow up (mean 24 months, range 12-41). No complications of the radiosynoviortheses were noted.

Topics: Adolescent; Adult; Arthroscopy; Brachytherapy; Female; Humans; Injections, Intra-Articular; Knee Joint; Male; Middle Aged; Prospective Studies; Sodium Pertechnetate Tc 99m; Synovial Fluid; Synovitis; Synovitis, Pigmented Villonodular; Yttrium Radioisotopes

One hundred eight knees of 93 patients with seropositive rheumatoid arthritis and persistent synovitis of the knee were treated with an intraarticular injection of 270 mCi of dysprosium 165 bound to ferric hydroxide macroaggregate. Leakage of radioactivity from the injected joint was minimal. Mean leakage to the venous blood 3 hours after injection was 0.11% of the injected dose; this corresponds to a mean whole body dose of 0.2 rads. Mean leakage to the liver 24 hours after injection was 0.64% of the injected dose; this corresponds to a mean liver dose of 3.2 rads. In 7 additional patients examined, there was negligible or near negligible activity found in the draining inguinal lymph nodes. One-year followup was possible for 74 knees (63 patients). Sixty-one percent of the knees had good results, 23% had fair results, and 16% had poor results. There was a direct correlation between the radiographic stage and response to treatment. In knees with stage I radiographic changes, 72% showed good results; 93% showed improvement. In knees with stage II changes, 59% showed good results; 81% showed improvement. These preliminary results indicate that dysprosium 165-ferric hydroxide macroaggregate is an effective agent for radiation synovectomy. The low leakage rates observed offer a definite advantage over agents previously used.

Topics: Adult; Aged; Arthritis, Rheumatoid; Dysprosium; Evaluation Studies as Topic; Female; Ferric Compounds; Follow-Up Studies; Half-Life; Humans; Injections, Intra-Articular; Iron; Knee Joint; Liver; Lymph Nodes; Male; Middle Aged; Pilot Projects; Radioisotopes; Radionuclide Imaging; Radiotherapy Dosage; Sodium Pertechnetate Tc 99m; Synovitis; Time Factors

Twenty-eight knees with chronic arthritis and effusion were treated with intra-articular 90Y. Synovial activity was assessed by measuring 99mTc pertechnetate uptake. There was a significant difference in uptake between controls and patients. Those who had a good response to 90Y (15 patients) showed a significant decrease in uptake, not seen in those who failed to respond. The pattern of 90Y distribution was examined and appeared to correspond to areas of increased synovial activity; these patterns and their significance have not been previously reported. Factors which could help to predict response to 90Y are discussed.

Topics: Aged; Arthritis, Rheumatoid; Female; Humans; Knee Joint; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Synovitis; Technetium; Yttrium Radioisotopes

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

In 6 out of 48 non-hinged knee joint replacements in 35 patients, 99mTc04- uptake values were clearly increased compared with a control group. Measurements were performed an average of 3 years (range 9 months - 4 1/2 years) after operation. Four of the six cases showed loosening of the prosthesis at arthrotomy and one showed an infection. Tests for hypersensitivity to the different components of the prosthesis and cement were normal. Histology and immunofluorescence of the synovial membrane obtained at arthrotomy in the four operated patients showed no recurrence of the synovitis. This study indicates that there is no recurrence or only a slight recurrence of rheumatoid synovitis after total knee joint replacement of the geometric type.

Topics: Aged; Arthritis, Rheumatoid; Female; Follow-Up Studies; Humans; Knee Prosthesis; Male; Middle Aged; Radionuclide Imaging; Recurrence; Sodium Pertechnetate Tc 99m; Synovial Membrane; Synovitis; Technetium; Time Factors

Topics: Arthritis, Rheumatoid; Diagnosis, Computer-Assisted; Diphosphonates; Humans; Joints; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Synovitis; Technetium; Technetium Tc 99m Medronate