technetium-tc-99m-medronate and Arthritis--Rheumatoid

Bone scintigraphy is an important tool for staging and follow-up in patients with rheumatoid arthritis, and is part of the training for board certified physicians in nuclear medicine in Germany. Bone scintigraphy uses the accumulation of i.v. injected technetium-99m labeled phosphonates imaged with a gamma camera. Different phases can be defined: perfusion phase (0-60 s p. i.), blood pool phase (2-5 min p. i.), and bone (turnover) phase (2-5 h p. i.). The blood pool phase allowes judgement of inflammatory (soft tissue) components of joint disease ("arthritis"), the bone (turnover) phase of longer lasting bone processes ("arthrosis"). The technical details including documentation of the scintigraphic results are presented according to the procedure guidelines of the German Society of Nuclear Medicine (www.nuklearmedizin. de).

Topics: Arthritis, Rheumatoid; Bone and Bones; Bone Density; Follow-Up Studies; Gamma Cameras; Humans; Organotechnetium Compounds; Osteoarthritis; Radionuclide Imaging; Sensitivity and Specificity; Technetium; Technetium Tc 99m Medronate

To investigate the efficacy and safety of technetium-99 conjugated with methylene diphosphonate (. A total of 120 patients with active RA were randomly divided into three groups: Group A (receiving oral meloxicam tablets); Group B (receiving intravenous drip of. After 14 days of treatment, American College of Rheumatology 20 response was 15.62%, 34.04% and 48.78% in the three groups, respectively. The incidence of adverse events in three groups were 3.13%, 8.51% and 9.76% respectly, and has no significant difference. In addition, biochemical markers of bone metabolism including bone alkaline phosphatase (BAP), tartrate resistant acid phosphatase (TRAP) and dickkopf-1 (DKK-1), all improved in the three groups, although more significant in Group B than Group A, and more significant in the combination group than monotherapy groups.

Topics: Administration, Oral; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Rheumatoid; Biomarkers; Bone Remodeling; China; Female; Humans; Infusions, Intravenous; Male; Meloxicam; Middle Aged; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thiazines; Thiazoles; Time Factors; Treatment Outcome; Young Adult

To what extent lateral retinacular release done in total knee arthroplasty compromises patellar viability has been debated. This study is a prospective study to assess patellar viability using Technetium-99m methylene diphosphate (Tc-99m MDP) scintigraphy. Between 2005 and 2006, 59 patients (72 knees) who underwent primary total knee arthroplasty were studied, of which 36 required lateral release. All patients underwent regional bone scan using Tc-99m MDP before and 1 to 3 weeks after the surgery. Two nuclear medicine consultants using both qualitative and quantitative assessment interpreted the scans independently. Fourteen knees with lateral release showed scintigraphic signs of hypovascularity in the early postoperative period that normalized in 8-week postoperative period. This study documents the greater incidence of transient patellar hypovascularity associated with lateral release.

Topics: Aged; Aged, 80 and over; Arthritis, Rheumatoid; Arthroplasty, Replacement, Knee; Female; Fractures, Bone; Humans; Ischemia; Knee Joint; Knee Prosthesis; Male; Middle Aged; Osteoarthritis, Knee; Osteonecrosis; Patella; Prospective Studies; Radionuclide Imaging; Risk Factors; Technetium Tc 99m Medronate; Treatment Outcome

The aim of this study was to assess the effectiveness of radiation synovectomy (RSV) in the treatment of recurrent joint effusions, using 90Y in patients with chosen inflammatory joint diseases. The group of treated patients consisted of 30 people. Qualification for the treatment was based on clinical assessment, three-phase bone scintigraphy (BS3) and biochemical analysis. Intra-articular injection of 90Y was performed. Biochemical analysis was repeated after 48 h, 4 and 24 weeks, whereas BS3 was repeated after 24 weeks. Changes in the second phase of BS3 were assessed visually, using a four-degree scale and in the third phase, semiquantitatively with J/B ratio. The changes in the blood pool phase before RSV were 3.4 +/- 0.6 and after the therapy 2.00 +/- 0.8 (P < 0.001). The J/B ratio was: before RSV 2.58 +/- 08; after treatment 2.09 +/- 0.9 (P < 0.05). RSV is an effective method to treat recurrent effusions in patients with RA and SPA.

Topics: Adult; Aged; Arthritis, Rheumatoid; Citrates; Female; Humans; Injections, Intra-Articular; Knee Joint; Male; Middle Aged; Organometallic Compounds; Radioisotopes; Radionuclide Imaging; Spondylarthropathies; Synovial Fluid; Synovial Membrane; Technetium Tc 99m Medronate; Treatment Outcome

The aim of this study was to compare Tc-99m human immunoglobulin (HIG) and three-phase Tc-99m MDP bone scintigraphy for the assessment of the efficacy of Y-90 silicate therapy in rheumatoid knee synovitis.. Fifteen patients with rheumatoid arthritis and chronic persistent synovitis in 23 knee joints had radionuclide synovectomy with Y-90 silicate. The patients underwent imaging before and 3, 6, 9, and 12 months after therapy using clinical evaluation, Tc-99m HIG scintigraphy, and three-phase Tc-99m MDP bone scintigraphy.. In the 13 of 23 knee joints that showed successful clinical results with Y-90 therapy, the Tc-99m HIG index values obtained 3 months after radionuclide synovectomy were significantly lower than the pretreatment index values (P < 0.001). In the same 13 joints, the Tc-99m MDP index values (in the blood-pool and delayed phases) before and 3 months after therapy were statistically similar. Six months after injection, these values were significantly lower in both the blood-pool (P < 0.001) and late (P < 0.05) phases in all 13 joints. In the other 10 of 23 knee joints that did not respond to treatment, the Tc-99m MDP and Tc-99m HIG index values were statistically similar before and after Y-90 therapy.. Based on these findings, Tc-99m HIG scintigraphy appears to be a valuable method that complements clinical assessment of the efficacy of Y-90 silicate therapy in rheumatoid knee synovitis, starting in the early post-treatment period. However, three-phase Tc-99m MDP bone scintigraphy may be valuable in the late postsynovectomy period.

Topics: Adult; Arthritis, Rheumatoid; Female; Follow-Up Studies; Humans; Immunoglobulins; Knee Joint; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Silicates; Synovial Membrane; Synovitis; Technetium; Technetium Tc 99m Medronate; Treatment Outcome; Yttrium

We previously described a novel radiolabelled monoclonal antibody (1.2B6), which reacts with porcine E-selectin, for targeting activated endothelium as a means of imaging inflammatory disorders, and presented initial clinical work based on (111)In-labelled antibody. The aim of the present study was to evaluate a Fab fragment of 1.2B6 labelled with (99m)Tc in patients with rheumatoid arthritis (RA) by comparison with (i) (111)In-labelled 1.2B6 F(ab')(2) and (ii) conventional bone scanning.. (99m)Tc-1.2B6-Fab ( approximately 440 MBq) and (111)In-1.2B6-F(ab')(2) ( approximately 27 MBq) were compared in 10 patients using a double-isotope protocol. Images were obtained 4 and 20-24 h after injection. Two normal volunteers were also imaged. In a separate group of 16 patients, (99m)Tc-1.2B6-Fab and (99m)Tc-oxidronate ((99m)Tc-HDP) ( approximately 740 MBq) were compared on the basis of visual and semi-quantitative analysis of joint uptake (joint/soft tissue ratios) 4 h after injection. The respective biodistributions and blood clearances of the two 1.2B6 fragments were also compared.. Image contrast was slightly better with (99m)Tc-Fab at 4 h but equal for the two tracers at 24 h. Diagnostic accuracy, taking joint tenderness or swelling as the clinical endpoint, was 76% for both fragments at 24 h. Plasma clearance of (99m)Tc-Fab was faster than that of (111)In-F(ab')(2) (t(1/2) 142 vs 421 min; P<0.0001). (99m)Tc-Fab appeared somewhat unstable in vivo, as shown by activity in the thyroid gland and bowel. The diagnostic accuracy of (99m)Tc-Fab was 88%, higher than that of (99m)Tc-HDP (57%) as a result of the low specificity of the latter in RA. Receiver operating characteristic (ROC) curve analysis using joint/soft tissue ratios as a variable cut-off showed that (99m)Tc-Fab discriminates better than (99m)Tc-HDP between actively inflamed and silent joints (Z=4.72; P<0.0001). No uptake of (99m)Tc-Fab was observed by inactive or normal joints, whereas (99m)Tc-HDP was taken up by all joints to a variable degree, making the decision as to whether a particular joint is actively involved or chronically damaged very difficult.. (99m)Tc-anti-E-selectin-Fab scintigraphy can be used successfully to image synovitis with better specificity than (99m)Tc-HDP bone scanning. The advantages over (111)In-1.2B6-F(ab')(2) are easier availability of the radionuclide, improved physical properties and optimal imaging 4 h after injection.

Topics: Adult; Aged; Arthritis, Rheumatoid; E-Selectin; Female; Humans; Immunoglobulin Fab Fragments; Male; Middle Aged; Probability; Prospective Studies; Radioisotopes; Radionuclide Imaging; ROC Curve; Sensitivity and Specificity; Technetium; Technetium Tc 99m Medronate

To correlate the therapeutic efficacy of radiosynoviorthesis (RSO) to radiation doses achieved.. In 20 patients with known rheumatoid arthritis, radiosynoviorthesis was performed in 36 joints. Arthritis disease activity was assessed by "blood pool scintigraphy" (n = 29) score after injection of 370 MBq 99mTc-MDP, before and at 1, 2, and 5 months after the RSO in 12 patients. For semiquantitative measurements, a region-of-interest technique was applied. Synovial thickness and response to the RSO were evaluated by joint ultrasonography. Pain levels were evaluated semiquantitatively. Dosimetry (n = 20) was calculated using planar quantification according to the MIRD scheme.. The mean radiation absorbed dose of 186Re-sulfate to the whole body was 5.3+/-2.7 cGy, liver 10.0+/-8.1 cGy, spleen 20.3+/-22.9 cGy, kidneys 9.4+/-11.4 cGy, and at the injected joints of the shoulder 120.5+/-32.2 Gy, hand 130.0+/-12.6 Gy, elbow 83.6+/-38.7 Gy, and talar/subtalar joint 84.1+/-30.7 Gy. In 7 cases, where mandatory immobilization of the joint was not possible, the dose to the lymph nodes (n = 25) was 25.9+/-53.8 Gy (maximum 189 Gy) and to single lymph nodes 14.6+/-11.2 Gy (maximum 63 Gy). The reduced doses to the synovia (at 40% leakage) were: 169Er-citrate 73.10+/-25.25 Gy; 90Y-citrate 59.25+/-46.45 Gy; 186Re-sulfate 65.40+/-32.55 Gy. In cases of complete immobilization, the dose to the lymph nodes was negligible: 169Er-citrate (n = 7), whole body dose 0.4 cGy, lymph nodes 2.3 Gy, finger joints 132.3+/-34.3 Gy; 90Y-citrate (n = 6), whole body dose 15.5 cGy, liver dose 26.5 cGy, splenic dose 11.9 cGy, kidney dose 67 cGy, joint knee joint dose 130.1 Gy. Regarding therapeutic effect, mean reduction of the 99mTc-MDP blood pool activity was 41% at first month, 48% at second month, 48% at the fifth month, 48% in larger joints, and 63% in finger joints. Three and 6 months after RSO, sonography showed a mean reduction in synovial swelling: in the knee joint 1.67 and 4.38 mm, respectively; in the larger joints (shoulder, elbow, hand, talar/subtalar) 0.88/1.93 mm; and in finger joints 0.53/1.76 mm. Clinically, best results were observed in the finger joints.. 1. We observed a significantly higher radiation absorbed dose to the lymph nodes and lower dose to the synovia in the absence of joint immobilization. Immobilization of the joint is essential. 2. At 2 months after treatment, a significant reduction of blood pool activity and synovial swelling was observed, with further improvement in the following months, especially in the finger joints. 3. There is a strong correlation between the reduction of blood pool activity, synovial swelling, and improvement of pain.

Topics: Arthritis, Rheumatoid; Dose-Response Relationship, Radiation; Erbium; Female; Humans; Immobilization; Joints; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Rhenium; Synovial Membrane; Synovitis; Technetium Tc 99m Medronate; Tissue Distribution; Treatment Outcome; Yttrium Radioisotopes

33 consecutive patients (18 arthrosis, 15 rheumatoid arthritis), operated on with total knee arthroplasty and randomized to cemented (18 knees) or cementless fixation (15 knees), were investigated with scintimetry 3, 6, 12, and 24 months postoperatively. Migration was evaluated with simultaneous roentgen stereophotogrammetric (RSA) examinations. The scintimetric activity in the ipsilateral femoral diaphysis decreased and the activity in the tibial diaphysis increased during the observation period. Constant and low activity was recorded in front of the femoral component. This region was chosen as a reference. Three months after surgery, high activity was noted under the tibial component in knees with a preoperative varus deformity. After 2 years, the activity had decreased to the same level as in the patients with a valgus deformity. Diagnosis and mode of fixation did not influence the activity. Low postoperative activity was recorded in the tibial metaphyses if no rotatory displacement of the tibial component occurred.

Topics: Adult; Aged; Arthritis, Rheumatoid; Data Interpretation, Statistical; Female; Femur; Foreign-Body Migration; Humans; Knee Joint; Knee Prosthesis; Male; Middle Aged; Osteoarthritis; Photogrammetry; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

Immune checkpoint inhibitors can revive exhausted helper T-cells, and inflammatory cell reactivation may cause autoimmune disease-like conditions. Drug-induced arthritis is an immune-related adverse event, but the diagnostic approach is undefined. We present the diagnostic utility of 99m Tc-MDP bone scintigraphy for nivolumab-induced inflammatory arthritis. A 67-year-old man with hypopharyngeal carcinoma presented bilateral multiple metacarpophalangeal joint pain and swelling at each nivolumab administration. Regular imaging findings were atypical for inflammatory arthritis and did not fulfill the criteria for rheumatoid arthritis. We diagnosed nivolumab-induced inflammatory arthritis based on clinical symptoms and the symmetrical moderate uptake of the affected joints on 99m Tc-MDP bone scintigraphy.

Topics: Aged; Arthritis, Rheumatoid; Humans; Male; Nivolumab; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

The purpose of this study was to investigate the efficiency of quantitative parameters of bone scintigraphy in detecting clinically active joint and high disease activity in patients with rheumatoid arthritis.. We retrospectively enrolled 65 patients with rheumatoid arthritis who underwent bone scintigraphy for diagnostic work-up. Quantitative analysis of bone scintigraphy images was conducted using an in-house software, and joint uptake ratio of 28 joints was measured for the calculation of the disease activity score of 28 joints using erythrocyte sedimentation rate (DAS28-ESR). The relationship between joint uptake ratio and clinical findings and the efficiency of joint uptake ratio in detecting clinically active joint and high disease activity were assessed.. Clinically active joint (tender and/or swollen joints) showed significantly higher joint uptake ratio than did other non-affected joints (p < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of joint uptake ratio for identifying clinically active joint were 78.7%, 52.0%, 32.9%, and 89.1%, respectively, and those of the summed joint uptake ratio for detecting high disease activity were 92.9%, 66.8%, 43.3%, and 97.1%, respectively; the joint uptake ratio showed high detection ability, especially for active joints of the elbow, wrist, and metacarpo-phalangeal joint areas. The summed joint uptake ratio of 28 joints showed a significantly strong positive correlation with DAS28-ESR (p < 0.001; correlation coefficient, 0.725).. Quantitative parameters of bone scintigraphy showed high sensitivity and NPV for detecting clinically active joint and high disease activity in patients with rheumatoid arthritis.

Topics: Adult; Aged; Arthritis, Rheumatoid; Blood Sedimentation; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Radiographic Image Interpretation, Computer-Assisted; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Severity of Illness Index; Technetium Tc 99m Medronate

Seven patients with mandibular osteonecrosis (three osteoradionecrosis, three medication-related osteonecrosis of the jaw (MRONJ), and one rheumatoid arthritis) underwent SPECT/CT at 4 hours after injection of technetium 99m hydroxymethylene diphosphonate. The SPECT/CT parameters SUV

Topics: Aged; Aged, 80 and over; Arthritis, Rheumatoid; Bisphosphonate-Associated Osteonecrosis of the Jaw; Female; Humans; Male; Mandibular Diseases; Middle Aged; Osteoradionecrosis; Radiopharmaceuticals; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate; Whole Body Imaging

We report the case of a 74-year-old man with seropositive rheumatoid arthritis (RA) and radiographic osteoarthritis (OA) who underwent dual-phase high-resolution Tc-MDP SPECT/CT. Early radiotracer enhancement was noted in 2 RA joints of the right hand, both presenting with a ring-like uptake pattern around the joint, consistent with synovitis. Insignificant early enhancement was noted at the first carpometacarpal joint, despite presentation of CT features of OA. The delayed-phase enhancement patterns were distinct, showing asymmetry in RA joints, but a symmetric, joint-centered pattern for the OA joint.

Topics: Aged; Arthritis, Rheumatoid; Humans; Male; Osteoarthritis; Technetium Tc 99m Medronate; Time Factors; Tomography, Emission-Computed, Single-Photon

To validate 99mTc-labeled arginylglycylaspartic acid (99mTc-3PRGD2) scintigraphy as a means to image synovial neoangiogenesis in joints afflicted by rheumatoid arthritis and to investigate its potential in the early detection and management of rheumatoid arthritis.. Rheumatoid arthritis and osteoarthritis were generated in Sprague Dawley rats by type II collagen immunization and papain injection, respectively. Rats were imaged with 99mTc-3PRGD2 and 99mTc- methyl diphosphonate (99mTc MDP). X-ray images were also obtained and assessed by a radiologist. Immunohistochemistry of αvβ3 and CD31confirmed the onset of synovial neoangiogenesis. The effect of bevacizumab on rheumatoid arthritis was followed with 99mTc-3PRGD2 scintigraphy. A patient with rheumatoid arthritis and a healthy volunteer were scanned with 99mTc-3PRGD2.. Two weeks after immunization, a significant increase in 99mTc-3PRGD2 was observed in the joints of the rheumatoid arthritis model though uptake in osteoarthritis model and untreated controls was low. 99mTc-MDP whole body scans failed to distinguish early rheumatoid arthritis joints from healthy controls. The expression of αvβ3 and CD31was significantly higher in the joints of rheumatoid arthritis rats compared to normal controls. In serial 99mTc-3PRGD2 scintigraphy studies, 99mTc-3PRGD2 uptake increased in parallel with disease progression. Bevacizumab anti-angiogenetic therapy both improved the symptoms of the rheumatoid arthritis rats and significantly decreased 99mTc-3PRGD2 uptake. Significantly higher 99mTc-3PRGD2 accumulation was also observed in rheumatoid arthritis joints in the patient.. Our findings indicate that 99mTc-3PRGD2 scintigraphy could detect early rheumatoid arthritis by imaging the associated synovial neoangiogenesis, and may be useful in disease management.

Topics: Animals; Arthritis, Rheumatoid; Bevacizumab; Collagen Type II; Disease Models, Animal; Early Diagnosis; Humans; Integrin alphaVbeta3; Male; Organotechnetium Compounds; Osteoarthritis; Papain; Peptides, Cyclic; Platelet Endothelial Cell Adhesion Molecule-1; Radionuclide Imaging; Radiopharmaceuticals; Rats; Rats, Sprague-Dawley; Technetium Tc 99m Medronate

γδ T cells exhibit important functions in the pathogenesis of rheumatoid arthritis (RA). In recent years, numerous studies harnessed the γδ T cell-activating capacity of aminobiphosphonates for the treatment of malignant tumors. As (99) Tc-methylene diphosphonate ((99) Tc-MDP) has long been widely used for the treatment of RA in China with good efficacy, we are interested in whether this drug exerts its therapeutic effect on RA by modulating peripheral γδ T cells of RA patients.. To investigate the effect of (99) Tc-MDP on the frequency of γδ T cells and CD4(+) CD25(+) Foxp3(+) Tregs in the peripheral blood of patients with active RA.. Nineteen patients with active RA were treated with (99) Tc-MDP intravenously at a dose of 20 μg/day consecutively for 10-14 days. Before and after treatment, the main clinical and laboratory parameters for each patient were evaluated. The frequency of CD3(+) γδ(+) T cells and CD4(+) CD25(+) Foxp3(+) Tregs was detected by flow cytometry. Serum levels of interferon (IFN)-γ, tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10 and transforming growth factor (TGF)-β were measured with enzyme-linked immunosorbent assay.. After intravenous (99) Tc-MDP therapy, the frequency of peripheral CD3(+) γδ(+) T cells and CD4(+) CD25(+) Foxp3(+) Tregs were significantly elevated, paralleled with decreased serum levels of TNF-α and IL-6 and increased level of serum TGF-β. The elevation of peripheral CD3(+) γδ(+) T cells was positively correlated with increased serum TGF-β and decreased disease activity.. (99) Tc-MDP may improve the activity of RA through upregulating the frequency of peripheral γδ T cells and CD4(+) CD25(+) Foxp3(+) Tregs as well as affecting the serum cytokine environment by increasing TGF-β and decreasing TNF-α and IL-6.

Topics: Administration, Intravenous; Aged; Arthritis, Rheumatoid; Case-Control Studies; Cytokines; Drug Administration Schedule; Female; Forkhead Transcription Factors; Humans; Interleukin-2 Receptor alpha Subunit; Male; Middle Aged; Phenotype; Radiopharmaceuticals; Receptors, Antigen, T-Cell, gamma-delta; T-Lymphocytes, Regulatory; Technetium Tc 99m Medronate; Time Factors; Treatment Outcome

Clinical differentiation of psoriatic arthritis (PsA) and rheumatoid arthritis (rA) based on the pattern of joint involvement can be difficult; the frequent form of PsA with polyarthritis of the peripheral joints may sometime resemble rA. We investigated a metabolic joint asymmetry score (MJAS), reflecting the overall asymmetric joint involvement on conventional bone scintigraphy, for differentiating PsA from rA in patients presenting with peripheral polyarthritis.. 106 patients (n = 61, PsA; n = 45, rA) with peripheral polyarthritis (≥ 5 joints) as well as 26 control subjects with no history of chronic joint disorders were analyzed. The intensity of articular 99mTc-MDP uptake in 40 peripheral joint pairs was scored regarding the bilateral difference of each joint based on a scale of 0-2 (no significant, moderate, and marked asymmetry, respectively). The patient's MJAS was defined as the sum of uptake difference scores of all joint pairs. The association of MJAS with the underlying condition (Psoriasis criteria, Revised Criteria of the ACR) was examined.. 5280 peripheral joint pairs were investigated. There was no significant difference in the total number of involved joints in PsA 15.0 ± 8.2 versus rA 17.5 ± 8.8 patients (p = 0.132), but significantly less involvement in the control group (6.7 ± 5.0, p < 0.001). MJAS was markedly higher in PsA (17.0 ± 9.6) than in rA (4.8 ± 3.9, p < 0.001), and correlated with the total number of involved joints in PsA (r = 0.516, p < 0.001), but not in rA (r = 0.078, p = 0.380). The MJAS disparity between PsA and rA persisted after exclusion of the DIP joints (14.4 ± 7.7 vs. 4.4 ± 3.3; p<0.001).. The new reproducible semi-quantification method for the asymmetry of metabolic joint involvement permits differentiation of psoriatic from rheumatoid peripheral arthritis with MJAS being markedly higher in patients with PsA as compared to rA patients. The score may offer an effective complementary tool for characterizing patients with peripheral polyarthritis.

Topics: Adult; Aged; Arthritis, Psoriatic; Arthritis, Rheumatoid; Bone and Bones; Computer Simulation; Diagnosis, Differential; Female; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Male; Middle Aged; Models, Biological; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Software; Technetium Tc 99m Medronate

This study aimed to explore the usefulness of 99mTechnetium methylenediphosphonate (99mTc-MDP) bone imaging in diagnosticating rheumatoid arthritis (RA). In 66 patients with RA, 99mTc-MDP whole body bone imaging, feet and hands regional bone imaging and ROI were performed. And from each patient, X-ray film, rheumatoid factor (RF), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were taken for examination. By the use of 99mTc-MDP, abnormal bone images were observed in 55 cases of RA; the total positive rate of incidence (83.3%) was significantly higher than those by use of X-ray (45.5%), RF (51.5%), CRP (63.6%) and ESR (69.7%); the positive rates of imaging with 99mTc-MDP in the 55 cases of RA (divided into 4 groups according to the course of disease; namely, < 1,1-, 5- and >10-year groups) were 75.0%, 88.9%, 92.3% and 100.0% respectively, whereas the positive rates of those year-groups by use of X-ray were 10.7%, 33.3%, 84.6%, 100.0% respectively; comparison of the two methods, showed statistically significant difference: P<0.01 (< 5-year group); P >0.05 (> 5-year group). In 177 joint lesions detected by bone images, 144 lesions (81.4%) were symmetric, and 33 lesions (18.6%) were single. The most frequently detected lesions were at metacarpophalangeal joints or interphalangeal and wrist joints, metatarsophalangeal or ankle joints, and knee joints. We have noticed that 99mTc-MDP bone imaging can elevate the detectability at the early stage of RA, so it is of value for the treatment of RA.

Topics: Arthritis, Rheumatoid; Early Diagnosis; Female; Humans; Male; Middle Aged; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Leflunomide (LEF) is indicated in adults for the treatment of active rheumatoid arthritis (RA). LEF inhibits dehydroorotate dehydrogenase, a key enzyme of the pyrimidine synthesis in activated lymphocytes. Among rare adverse effects, fatal interstitial lung disease has been recently reported during treatment of RA with LEF in Japan. Clinical trials outside Japan do not suggest that LEF causes an excess of pulmonary adverse effects. Development and increase of peripheral rheumatoid nodules in typical sites of RA patients following LEF therapy has been recently reported.. Two cases with new and accelerated development of rheumatoid lung nodulosis during LEF therapy were described in this study.. LEF treatment was administered to two male patients (77 and 66 years old) with long-standing active seropositive nodular RA with failure of multiple second line drugs and without lung involvement. Clinical and laboratory assessment using the American College of Rheumatology response criteria, chest computed tomography (CT), quantification of serum rheumatoid factor (RF), and monocyte count of peripheral blood along with routine laboratory follow up were performed on both patients before and during therapy. In case 1, a bone scan was performed due to sustained limbs pain. Open lung biopsy was performed in case 1 and core lung biopsy in case 2.. Both patients achieved full clinical remission during 2 months of LEF therapy. In case 1, the first complaints were limbs pain after 10 months of treatment associated with intensive bone uptake on a bone scan consistent with hypertrophic pulmonary osteopathy. Productive cough developed after 3 months of the therapy in case 2. Initially, these complaints were not attributed to therapy. New lung disease was present on CT with cherry-like progressive cavitary nodules, predominantly involving the basal segments of the right lung. The first lung lesions were found by CT 13 months (case 1) and 7 months (case 2) after the beginning of therapy and were erroneously related to bronchiectasia in case 2. In both cases, the lung biopsy showed necrosis surrounded by epithelioid mononuclear inflammation with giant cells, consistent with rheumatoid lung node. The time that elapsed between the beginning of the first symptoms to LEF discontinuation was very long: 13 months in case 1 and 24 months in case 2. Discontinuation of LEF therapy was followed by an arrest in growth of lung nodules, resolution of limb pain, and gradual improvement of bone scan. A significant decrease of monocyte count and RF level in peripheral blood was observed during LEF therapy in both cases.. For the first time, we described rheumatoid lung nodulosis as complication of successful LEF therapy for RA. Hypertrophic pulmonary osteopathy with severe limbs pain and dry cough were the first manifestations of the lung nodulosis. Monocytopenia during LEF therapy is proposed to be involved in pathogenesis of this rare complication of LEF therapy.

Topics: Aged; Antirheumatic Agents; Arthritis, Rheumatoid; Humans; Isoxazoles; Leflunomide; Lung Diseases; Male; Osteoarthropathy, Secondary Hypertrophic; Radionuclide Imaging; Radiopharmaceuticals; Rheumatoid Nodule; Technetium Tc 99m Medronate

To explore the effect of technetium-99 conjugated with methylene diphosphonate (99 TcMDP) on IgM-RF, IgG-RF and IgA-RF (RFs), 47 cases were selected for study, including 33 patients with rheumatoid arthritis (RA) and 15 patients with joint pain/arthritis. After 99Tc-MDP for drips model being given to the patients by intravenous drip 0.2 g daily for 5 days, the injection A and B models of 99Tc-MDP were used to the patients by intravenous injection one set daily for 10 days, that was one course of treatment. The next course started after 10 days. Each case used it from 2 to 4 courses of treatment. The RFs in serum were determined by the method of enzyme-linked immunoabsorption assay (ELISA) before and after 2 and 4 courses of treatment. In the patients with RA, the concentrations of IgM-RF were 296.2 +/- 108.4 IU/ml, 189.5 +/- 92.3 IU/ml and 107.8 +/- 72.5 IU/ml; the concentrations of IgG-RF were 325.6 +/- 126.2 IU/ml, 209.7 +/- 98.2 IU/ml and 160.2 +/- 80.8 IU/ml; the concentrations of IgA-RF were 330.4 +/- 136.3 IU/ml, 210.7 +/- 89.2 IU/ml and 148.8 +/- 72.2 IU/ml before and after 2 and 4 courses of treatment, respectively. The concentrations of the above RFs were significantly lower after 2 and 4 courses than those before treatment (P < 0.05 and P < 0.01). There was no significant difference in RFs concentrations in the patients with joint pain/arthritis before and after use of 99Tc-MDP. In the patients with positive RFs before treatment, the RFs concentrations were decreased significantly after 2 and 4 courses of treatment (P < 0.05 and P < 0.01). There was no obvious change of RFs concentrations in the patients with negative RFs after treatment of 99Tc-MDP. It was concluded that 99 Tc-MDP could obviously reduce the abnormally high concentrations of RFs, but not influence the normal RFs, which indicated that 99Tc-MDP has an important effect on controlling the activities of RA.

Topics: Adult; Arthritis, Rheumatoid; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Immunoglobulins; Male; Rheumatoid Factor; Technetium Tc 99m Medronate

To study the immune mechanism of 99Tc-MDP in the treatment of patients with rheumatoid arthritis (RA).. In vitro, 99Tc-MDP was added to the cultures of peripheral blood mononuclear cells (PBMC) derived from healthy subjects and RA patients. The levels of IL-1 and sIL-2R from PBMC affected by 99Tc-MDP were determined with enzyme linked immunosorbert assays (ELISA).. The IL-1 production by PBMC of RA, either in the medium alone (spontaneously) or in the presence of lipopolysacchride (LPS) stimulation, was suppressed by 99Tc-MDP; and the sIL-2R by PBMC of RA, either in the medium alone (spontaneously) or in the presence of phytohemagglutinin (PHA) induction, was inhibited by 99Tc-MDP.. 99Tc-MDP acts on PBMC and a possible immune activity by 99Tc-MDP is related to the suppression of IL-1 and sIL-2R in RA patients.

Topics: Adjuvants, Immunologic; Adult; Arthritis, Rheumatoid; Cells, Cultured; Female; Humans; Interleukin-1; Leukocytes, Mononuclear; Male; Receptors, Interleukin-2; Technetium Tc 99m Medronate

Topics: Arthritis, Rheumatoid; Bone and Bones; Carcinoma, Renal Cell; Humans; Kidney Neoplasms; Male; Middle Aged; Neoplasm Invasiveness; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Vena Cava, Inferior

Radiation synovectomy by intra-articular injection of beta-emitting radionuclides is a reliable and easy-to-perform therapy without harmful side effects for the treatment of inflammatory rheumatoid as well as degenerative joint diseases. The indication for radiation synovectomy is based on both clinical symptoms and on proven hyperperfusion, with active synovitis being seen on a pre-therapeutic three-phase bone scan. In this study, the clinical response after 6-18 months, evaluated by a standardized questionnaire, was compared with the reduction of synovitis seen on three-phase bone scintigraphy after treatment of 475 joints in 151 patients. The best clinical results were obtained in cases of true rheumatoid arthritis (73.4%), with less in other kinds of arthritis (48.8%) such as psoriatic or reactive arthritis. Because of the inflamed synovium being the main target tissue, clinical results in osteoarthritis with severe bone destruction are poorer (33.9%). However, synovitis can be markedly reduced (in approximately 70%), regardless of the underlying diagnosis, as shown by post-therapeutic three-phase bone scanning. Radiation synovectomy can be recommended in all kinds of arthritis. It should also be considered in cases of osteoarthritis as a last therapeutic option prior to joint replacement.

Topics: Adult; Aged; Aged, 80 and over; Arthritis, Rheumatoid; Bone and Bones; Female; Follow-Up Studies; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Synovial Membrane; Synovitis; Technetium Tc 99m Medronate

The authors report a case of methotrexate osteopathy as revealed by Tc-99m HDP bone scintigraphy in a patient with rheumatoid arthritis. Methotrexate is used widely in high doses as a chemotherapeutic agent. Lower doses are given in rheumatoid and psoriatric arthritis. Methotrexate affects bone metabolism, resulting in methotrexate osteopathy, characterized by osteoporosis, osseus pain, and even spontaneous (micro)fractures. Radiographic visualization of microfractures is difficult. Tc-99m HDP bone scans have been shown to be very sensitive in the visualization of changes in bone metabolism as a result of methotrexate osteopathy.

Topics: Antirheumatic Agents; Arthritis, Rheumatoid; Bone Diseases, Metabolic; Humans; Male; Methotrexate; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia

Because of a similar tracer accumulation, we assumed to get the same information about synovitis in arthritic joint disease with HIG scintigraphy and bloodpool scintigraphy using HDP. Therefore, we compared retrospectively 23 patients.. In HIG scintigraphy, synovitis was diagnosed according to increasing activity from early to late image. In bloodpool scintigraphy according to an increased activity in comparison to the surrounding tissues.. In 694 joints comparison of both scintigraphic modalities was possible, resulting in a 2 x 2 kappa coefficient of 0.93 or 0.97 by using late-phase bone scintigraphy as an anatomical marker. For intra- and interobserver agreement, 2 x 2 kappa coefficients of 0.93 and 0.88 in HIG scintigraphy, respectively 0.96 and 0.90 in blood-pool scintigraphy were calculated.. This study shows an excellent agreement in the visualization of synovitis by HIG and bloodpool scintigraphy. Because of its higher objectivity and lower cost, investigation of synovitis should be performed by bloodpool scintigraphy.

Topics: Adult; Aged; Arthritis; Arthritis, Psoriatic; Arthritis, Rheumatoid; Bone and Bones; Female; Gamma Cameras; Humans; Immunoglobulins; Lyme Disease; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Medronate

Tc-99m polyclonal immunoglobulin-G has been shown to be a successful agent in the depiction of active inflammation in rheumatoid arthritis (RA). The objective of this study was to compare the uptake behaviors of Tc-99m HIG and Tc-99m MDP in RA and variants of rheumatoid arthritis (VRA). Seventeen patients with RA and 8 patients with VRA presenting with active inflammation were included in this study. Ten subjects with well-diagnosed degenerative joint disease constituted the control group. All joints in patients were also imaged with Tc-99m HSA to evaluate the vascularization status of the joints. Tc-99m HIG and HSA scans were obtained at 2, 4 and 24 hours after the injection of 555 MBq Tc-99m HIG and 296 MBq Tc-99m HSA. Conventional bone scans were performed 4 hours after the injection of 740 MBq Tc-99m MDP. Target-to-background (T/B) ratios were obtained exclusively over the joint regions. Tc-99m HIG T/B ratios of the active joints in RA were significantly higher than those of the non-active joints and the control group (p < 0.05). Tc-99m HIG T/B ratios in active joints showed a progressive increase between 2 and 24 hour images (p < 0.05). In contrast, Tc-99m HSA T/B ratios decreased in all active joints significantly (p < 0.05) except the ankle joint region (p > 0.05). The T/B ratios in Tc-99m MDP bone scans were higher in all active joints than in non-active RA joints and joints of controls but significantly differences were only detected in wrist and elbow joints. All clinically active joints in VRA patients accumulated Tc-99m HIG and HSA, and showed increased Tc-99m MDP uptake. These joints had a very similar Tc-99m HIG retention pattern to the RA joints. The detection rate of active joint inflammation with Tc-99m HIG was much higher than that with Tc-99m MDP. The increasing Tc-99m HIG uptake ratio between 2 and 24 hours in contrast to Tc-99m HSA indicates the presence of other binding mechanisms besides increased vascularity in RA.

Topics: Adolescent; Adult; Arthritis, Rheumatoid; Female; Humans; Immunoglobulins; Joints; Male; Metabolic Clearance Rate; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Medronate

Pinhole SPECT can generate sectional nuclear images of a normal and morbid ankle and hindfoot with remarkably enhanced resolution by portraying the topography and pathological alterations in great detail.. Pinhole SPECT was performed using a commercially available single-head, rotating gamma camera system by replacing the parallel-hole collimator used for planar SPECT with a pinhole collimator. The images were reconstructed in the same way as in planar SPECT by using the filtered back-projection algorithm and a Butterworth filter. First, we compared the scan resolution between the planar and pinhole SPECT images of a thyroid phantom and a normal ankle and hindfoot by working out pinhole SPECT anatomy with CT validation. Second, the clinical usefulness was assessed in one case each of fracture, reflex sympathetic dystrophy syndrome and rheumatoid arthritis of the ankle with radiographic correlation. The resolution of the pinhole SPECT and planar pinhole images was compared for these diseases.. The resolution of the pinhole SPECT of a thyroid phantom and of a normal ankle and hindfoot was significantly enhanced compared to the planar SPECT although image distortion was seen in the periphery of the field-of-view. The pinhole SPECT resolution was such that most of the anatomical landmarks were sharply delineated in the ankle and hindfoot and some useful diagnostic signs in the diseased ankle were visible.. Pinhole SPECT can be performed using a single-head gamma camera system and filtered back-projection algorithm. It generates sectional scan images of both normal and morbid ankle and hindfoot with enhanced resolution portraying many anatomical landmarks and pathological signs in useful detail.

Topics: Adult; Algorithms; Ankle; Ankle Joint; Arthritis, Rheumatoid; Female; Fractures, Bone; Heel; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Phantoms, Imaging; Radiopharmaceuticals; Reflex Sympathetic Dystrophy; Sodium Pertechnetate Tc 99m; Talus; Technetium Tc 99m Medronate; Thyroid Gland; Tomography, Emission-Computed, Single-Photon

It was the aim of this study to evaluate different markers of inflammation such as 99mTc-labelled human immunoglobulin G and 99mTc-nanocolloid with respect to their ability to detect inflammatory or degenerative affections of small joints of hand and fingers. While conventional bone scanning reveals good agreement with clinical findings it is not well suited for screening of inflammatory processes due to its poor specificity. In small joints conventional three-phase bone scan with information of perfusion, bloodpool and accumulation is not suitable due to the small ROI, low count rate with high statistics. Therefore we used inflammatory markers to overcome this problem. Immunoglobulin G was true positive in case of inflammatory lesions in 69%, and false positive in case of degenerative lesions in 24%, while nanocolloid was true positive in 72% and false positive in 14%, respectively. Significant differences were found between markers of inflammation and the bone scanning agent while both inflammatory markers, immunoglobulin G and nanocolloid demonstrated significant correlation. While bone scanning tracers detect all kinds of joint affections, immunoglobulin G and nanocolloid accumulate preferentially in inflammatory joints and therefore might be useful to differentiate between inflammatory and degenerative lesions.

Topics: Adult; Aged; Arthritis, Rheumatoid; Finger Joint; Humans; Immunoglobulins; Middle Aged; Osteoarthritis; Radionuclide Imaging; Sensitivity and Specificity; Technetium; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Medronate; Wrist Joint

We have reviewed the results of 99mtech-netium-methylene diphosphonate (Tc-MDP) bone scintigrams performed on patients following total knee arthroplasty. In addition, 67gallium (Ga) citrate scintigrams were carried out sequentially on 29 patients. Three groups of patients were identified: those with asymptomatic knees (undergoing scans for other reasons); those with aseptic or septic loosening; and those with pain without radiologic evidence of loosening. There was good correlation between the results of the scans and the final outcome. We conclude that sequential 99mTc-MDP and 67Ga citrate scintigrams are useful for demonstrating the presence of aseptic and septic loosening in knee prostheses, and pain with a normal scan appearance is probably not due to loosening or infection.

Topics: Aged; Arthritis, Rheumatoid; Citrates; Citric Acid; Gallium Radioisotopes; Humans; Knee Joint; Knee Prosthesis; Middle Aged; Osteoarthritis; Postoperative Complications; Radionuclide Imaging; Reoperation; Technetium Tc 99m Medronate; Treatment Outcome

The objective of this work was to study in more detail the human/murine SCID arthritis model with special emphasis on characteristic features initiated by rheumatoid arthritis (RA) synovial membrane (SM) as compared to appropriate control tissues. Small tissue samples from RA-SM, healthy lymph node, healthy SM, and granulomatous tissue of human origin were implanted into the left knee joint of mice with severe combined immunodeficiency (SCID), and the joints were analysed histologically after 7 days. In addition, a time course study, including non-invasive monitoring by serological parameters (human IgM, IgG, and IL-6) and Tc-99m-scintigraphy, was performed for up to 4 weeks on RA-SM recipients. All tissue implants induced transient exudative joint inflammation while RA-SM initiated a characteristic arthritis with pannus tissue of high cellular density, erosion, multinuclear giant cells, lining cell hyperplasia, fibroblast-like cell layers, chondroideal metaplasia, and fibrin deposits. Significantly elevated levels of human immunoglobulin and characteristic signs of chronic inflammation persisted for more than 4 weeks. We conclude that the hu/mu SCID arthritis with RA-SM implants comprises features of non-specific inflammation which is also transiently seen with control tissues but develops characteristic features of chronic RA-like synovitis thereafter.

Topics: Animals; Arthritis, Rheumatoid; Disease Models, Animal; Granuloma; Humans; Immunoglobulin G; Immunoglobulin M; Immunohistochemistry; Inflammation; Interleukin-6; Knee Joint; Lymph Nodes; Mice; Mice, SCID; Radionuclide Imaging; Synovial Membrane; Technetium Tc 99m Medronate; Time Factors; Transplantation Chimera

The ability of technetium-99m-labelled polyclonal human immunoglobulin G (99mTc-IgG) scintigraphy to predict joint destruction in patients with rheumatoid arthritis (RA) was investigated in this study. The progression of radiographically determined joint destruction in wrists, hands and feet was compared with the results of physical and laboratory examination, as well as 99mTc-IgG scintigraphy, measured at the beginning of a year-long study on 30 patients with RA of recent onset. The sensitivity of joint swelling in predicting the progression of radiographically determined joint destruction ranged between 57% and 74%. The sensitivity of 99mTc-IgG scintigraphy ranged between 71% and 100%. The specificity and positive predictive value both of joint swelling and 99mTc-IgG scintigraphy were low. Multiple regression analysis showed that for the total joint score, and for the metacarpophalangeal and forefeet joints, progression of radiographically determined joint destruction was primarily predicted by 99mTc-IgG scintigraphy. Joint swelling, ESR and IgM rheumatoid factor did not contribute to this prediction. We concluded that 99mTc-IgG scintigraphy is superior to conventional clinical and laboratory measurements in RA with respect to prediction of joint destruction.

Topics: Adult; Aged; Arthritis, Rheumatoid; Disease Progression; Female; Humans; Joints; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Regression Analysis; Technetium Tc 99m Medronate

The ability of scintigraphy with technetium 99m-labelled polyclonal human immunoglobulin G (99mTc-IgG) to detect and quantify arthritis activity was studied in 24 patients with RA and in 10 patients with OA. The results of 99mTc-IgG scintigraphy were compared with those of scintigraphy with 99mTc-labelled hydroxymethylene-diphosphonate (HDP). The mean joint scores of 99mTc-IgG scintigraphy in RA patients with active disease were significantly higher (P < 0.001) than the mean scores in patients with inactive disease. The mean joint scores were also higher in patients with erosions compared to those in patients without erosions (P < 0.05). For 99mTc-HDP scintigraphy no significant differences were found between the mean joint scores of these patient groups. Comparison of scintigraphic results between patients with RA and OA revealed that the mean joint score of 99mTc-IgG scintigraphy was significantly (P < 0.001) higher in the patients with RA than in patients with OA, whereas for 99mTc-HDP scintigraphy this difference was not significant. These results show that 99mTc-IgG scintigraphy, when compared to 99mTc-HDP scintigraphy, is a more specific method of detecting synovitis and, also, shows differentiation between different degrees of arthritis activity in RA.

Topics: Adult; Aged; Aged, 80 and over; Arthritis, Rheumatoid; Female; Humans; Immunoglobulin G; Joints; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Severity of Illness Index; Synovitis; Technetium Tc 99m Medronate

The synovial and bone uptake of tracer in the knees of patients with rheumatoid arthritis (RA) was quantified using 99Tcm-hexamethyl propylene amine oxime-labelled leucocytes and 99Tcm-methylene diphosphonate (MDP), respectively. Significant neutrophil migration and MDP uptake occurred in the knees of patients with RA irrespective of the disease duration. In all but one patient neutrophil migration was reduced after intra-articular steroid injection. The change in MDP uptake after steroid injection was variable. There was a significant correlation between the percentage reduction in neutrophil migration and pain score, while the latter correlated poorly with the change in MDP uptake. The quantification of the neutrophil component of the inflammatory process is a sensitive index for monitoring RA activity and response to pharmacological interventions, while quantitative bone scintigraphy should not be employed to monitor changes in joint inflammation in patients with RA.

Topics: Aged; Anti-Inflammatory Agents; Arthritis, Rheumatoid; Cell Movement; Female; Humans; Injections, Intra-Articular; Knee Joint; Male; Middle Aged; Neutrophils; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Triamcinolone Acetonide

An increased uptake of 99m-technetium methylenediphosphonate was found in 42 knees of 24 patients afflicted with rheumatoid arthritis. All the 23 knees which were painful and the 21 knees which had synovitis showed an increased concentration of isotope. Articular space narrowing was observed in 26 joints, all but one of which were subjected to increased isotopic accumulation and synovitis. The degree of radiologic cartilage destruction correlated significantly with the isotopic uptake. In the early stages of rheumatoid arthritis, the isotopic uptake was found to be heterogeneous within the joint in one half of the cases. In the later stages, with a narrowed articular space and valgus angulation, the isotope was concentrated to the lateral side of the joint, while joints with varus angulation had a more symmetric distribution. The degree and distribution of uptake seemed to be governed by several factors, among others, inflammatory activity and mechanical load.

Topics: Adult; Arthritis, Rheumatoid; Cartilage, Articular; Female; Humans; Knee Joint; Male; Middle Aged; Radionuclide Imaging; Synovitis; Technetium Tc 99m Medronate

The value of scintigraphy in predicting development of new erosions in small peripheral joints was studied by visual evaluation of scintigrams and by three computerised methods. In 13 patients with newly diagnosed rheumatoid arthritis a total of 387 joints were examined clinically, scintigraphically, and radiographically. The follow up period was 24 months. Four eroded joints in three patients were found at the onset. Of the joints which were to become eroded, 46/47 were scintigraphically active at all the check ups. Erosions were detected earlier in foot joints than in finger joints. New erosions were especially prone to appear in joints with persisting and high scintigraphic activity. On the contrary, inactive joints by repeated scanning never eroded. Scintigraphic and clinical activity and radiographic erosiveness correlated significantly with each other. The sensitivity and specificity of visual scintigraphic assessment and the relative pixel activity method proved to be superior to the region of interest methods and clinical evaluation for prediction of erosiveness.

Topics: Adult; Arthritis, Rheumatoid; Female; Finger Joint; Humans; Joints; Male; Middle Aged; Radionuclide Imaging; Tarsal Joints; Technetium Tc 99m Medronate

Patients with rheumatoid arthritis, psoriatic arthritis, and osteoarthritis were assessed by clinical evaluation, radiography, and joint scintigraphy using technetium labelled methylene diphosphonate (MDP) and technetium labelled liposomes. Although both scanning techniques were more sensitive than radiographs in detecting joint disease, the liposomes scans were positive only in clinically active inflammatory disease. In patients with rheumatoid arthritis liposome scintigraphy was also able to discriminate between different grades of joint tenderness. In inactive inflammatory polyarthropathies, although the MDP bone scans continued to show increased activity, the liposome scans did not and were therefore a more accurate reflection of the clinical state. The increased uptake in the liposome scans may be due to incorporation of the liposomes into the phagocytic cells of the synovium. This scan may, therefore, by reflecting the activity of cells involved in the disease process, provide a useful way of assessing disease activity and progression.

Topics: Arthritis; Arthritis, Rheumatoid; Bone and Bones; Hand; Humans; Liposomes; Osteoarthritis; Psoriasis; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

99mTc-methylene diphosphonate (99mTc-MDP) scintigraphy of peripheral joints was studied by visual evaluation (Visual Assessment) of the scintigrams and by a computerized region-of-interest (ROI) method without, or with a reference region (ROI method or Corrected ROI method). Sixteen rheumatoid patients and a total of 477 peripheral joints were studied and the results compared with clinical joint activity evaluated by joint palpation. The ROI method without a reference proved to be insensitive and hence unsuitable for clinical use. The results of Visual Assessment and the Corrected ROI method correlated well with each other and with clinical joint activity. The sensitivity of the methods in detecting a clinically inflamed finger joint was: ROI 6%, Corrected ROI 71% and Visual Assessment 75%. The corresponding figures for peripheral joints of the feet were as follows: 28%, 41% and 58%. We conclude that, for clinical use, Visual Assessment of the scintigram is adequate and the method of choice.

Topics: Adult; Arthritis, Rheumatoid; Female; Finger Joint; Humans; Image Interpretation, Computer-Assisted; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Toe Joint

Topics: Adolescent; Adult; Aged; Arthritis, Rheumatoid; Bone Diseases; Bone Neoplasms; Calcinosis; Female; Humans; Male; Middle Aged; Osteonecrosis; Pain; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Arthritis, Rheumatoid; Humans; Joints; Radionuclide Imaging; Technetium Tc 99m Medronate

This retrospective study was done to determine the value of combined bone (technetium-99m methylene-diphosphonate) and gallium-67 citrate imaging in selected children with complicated clinical situations. Thirty-one children were evaluated for suspected osteomyelitis by bone scan followed within 4 days by a gallium scan. These 31 children represented a subpopulation in whom the Tc-99m scan is known to be potentially unreliable in diagnosing acute osteomyelitis. Eight children had acute osteomyelitis by strict criteria, while 23 did not. The bone scan successfully identified five of the eight with osteomyelitis but was positive in ten of the other 23. The gallium scan correctly identified all eight with osteomyelitis but was positive in seven of the other 23. The gallium scan was significantly less specific when the suspected lesion was in the extremities compared with central locations; causes of false-positive gallium scans included fracture and juvenile rheumatoid arthritis. Combined gallium and bone scanning increased accuracy of the scintigraphic diagnosis of acute osteomyelitis. Both tests may, however, be abnormal in conditions other than osteomyelitis. These findings emphasize the importance of correlating all imaging studies in detection of osteomyelitis.

Topics: Adolescent; Arthritis, Rheumatoid; Child; Child, Preschool; Fractures, Bone; Gallium Radioisotopes; Humans; Infant; Infant, Newborn; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

The hands of 10 patients with rheumatoid arthritis were investigated with diphosphonate scanning and radiology. Increased uptake of isotope can be associated with some erosions but not all and also reflects other processes more linked to acute inflammatory areas unassociated with the development of erosions. If the latter are the hallmark of active rheumatoid arthritis then bone scans are not.

Topics: Adult; Aged; Arthritis, Rheumatoid; Female; Finger Joint; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Various authors have advocated quantitative methods of evaluating bone scintigrams to detect sacroiliitis, while others have not found them useful. Many explanations for this disagreement have been offered, including differences in the method of case selection, ethnicity, gender, and previous drug therapy. It would appear that one of the most important impediments to consistent results is the variability of selecting sacroiliac joint and reference regions of interest (ROIs). The effect of ROI selection would seem particularly important because of the normal variability of radioactivity within the reference regions that have been used (sacrum, spine, iliac wing) and the inhomogeneity of activity in the SI joints. We have investigated the effect of ROI selection, using five different methods representative of, though not necessarily identical to, those found in the literature. Each method produced unique mean indices that were different for patients with ankylosing spondylitis (AS) and controls. The method of Ayres (19) proved superior (largest mean difference, smallest variance), but none worked well as a diagnostic tool because of substantial overlap of the distributions of indices of patient and control groups. We conclude that ROI selection is important in determining results, and quantitative scintigraphic methods in general are not effective tools for diagnosing AS. Among the possible factors limiting success, difficulty in selecting a stable reference area seems of particular importance.

Topics: Adult; Aged; Arthritis, Rheumatoid; Diphosphonates; Female; HLA Antigens; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Sacroiliac Joint; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Medronate; Technology, Radiologic

Topics: Acne Vulgaris; Adolescent; Arthritis, Rheumatoid; Body Weight; Diphosphonates; Fever; Humans; Male; Radiography; Radionuclide Imaging; Sacroiliac Joint; Syndrome; Technetium; Technetium Tc 99m Medronate

Bone metabolism in 21 patients with rheumatoid disease was investigated by measurement of the 24-hour whole body retention (WBR) of 99Tcm methylene diphosphonate (MDP) in parallel with clinical, radiological, and biochemical measurements (urinary excretion of hydroxyproline) of disease activity. Corticosteroid-treated patients of those with other forms of metabolic bone disease were excluded from the study. WBR was increased in the rheumatoid patients as compared with 21 age- and sex-matched controls (p less than 0.05), and there was a significant correlation in the rheumatoid group between WBR and urinary excretion of hydroxyproline (p less than 0.01) and between urinary excretion of hydroxyproline and an articular index (p less than 0.05) and global index (p less than 0.01) of disease activity. The increased WBR of the rheumatoid patients was not explicable by factors such as immobilisation, and the results are interpreted as reflecting an overall increase in bone metabolism which may occur in rheumatoid arthritis as part of the disease process.

Topics: Adult; Aged; Arthritis, Rheumatoid; Bone and Bones; Diphosphonates; Humans; Hydroxyproline; Middle Aged; Technetium; Technetium Tc 99m Medronate; Whole-Body Counting

To evaluate clinical usefulness of quantitative sacroiliac scintigraphy (QSS) in detecting sacroiliitis, we used a modified, pixel by pixel technique for calculating sacroiliac joint/sacrum uptake ratios (sacroiliac joint index - SII). We studied 90 controls, 18 selected patients with active sacroiliitis, 2 ankylosing spondylitis patients with completely ankylosed sacroiliac joints, 14 patients with nonspecific low back pain and 5 patients with rheumatoid arthritis. In the controls, we found that the SII decreases with increasing age (P less than 0.001) and is higher in males than in females (P less than 0.005). In the patients with active sacroiliitis, 9 out of 14 older than 30 had an abnormal SII; 3 of these patients showed no radiographic or CT abnormalities of the sacroiliac joints. None of the 4 patients with sacroiliitis under 30 years of age had values which fell out of the normal range for their age and sex. Only 1 of the 14 patients with non-inflammatory low back pain had an abnormally high SII. A borderline SII was found in 1 of the 5 patients with rheumatoid arthritis. QSS may be useful in detecting active sacroiliitis, sometimes even before the occurrence of radiologic abnormalities. However, because of its low sensitivity, its clinical usefulness is limited, especially in patients under 30 years of age.

Topics: Adolescent; Adult; Arthritis; Arthritis, Rheumatoid; Diphosphonates; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sacroiliac Joint; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Computerized, quantitative joint scintigraphies were performed using both 99mTc-MDP and 99mTc-pertechnetate. 17 joint pairs with asymmetric active arthritis were selected for the study. The joint activity ratio was calculated by dividing the curve peak value of the inflamed joint by the curve maximum of the contralateral symptomless joint. A very high joint activity ratio with 99mTc-MDP was observed in the case of septic arthritis with osteolytic lesions. In all the rheumatoid joints the activity ratios were higher with 99mTc-MDP than with 99mTc-pertechnetate. In reactive arthritis the mean joint activity ratio was equal with both tracers. It appears that 99mTc-MDP is more sensitive in detecting active rheumatoid arthritis than 99mTc-pertechnetate and that high 99mTc-MDP values might be prognostic of destructive changes.

Topics: Arthritis; Arthritis, Rheumatoid; Diphosphonates; Humans; Joints; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Topics: Aged; Arthritis, Infectious; Arthritis, Rheumatoid; Diphosphonates; Female; Gallium Radioisotopes; Humans; Knee Joint; Male; Middle Aged; Radionuclide Imaging; Staphylococcal Infections; Technetium; Technetium Tc 99m Medronate

Topics: Animals; Arthritis, Rheumatoid; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Male; Radioisotope Renography; Rats; Rats, Inbred Strains; Technetium; Technetium Tc 99m Medronate; Tissue Distribution

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

Topics: Arthritis, Rheumatoid; Diphosphonates; Humans; Radionuclide Imaging; Ribs; Technetium; Technetium Tc 99m Medronate