technetium-tc-99m-medronate and Arthritis

We report the case of a 48-year-old man who presented with an erosive, seronegative, HLA-B27-negative, peripheral polyarthritis, associated with hidradenitis suppurativa of axillae and buttocks. The pertinent literature is reviewed. This paper is the second devoted to this topic in a radiological journal and the first to document erosion of the posterior aspect of the calcaneus.

Topics: Arthritis; Calcaneus; Hidradenitis Suppurativa; HLA-B27 Antigen; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Dynamic bone imaging differs from routine multiphase bone scintigraphy by the use of time-activity curves (TACs) and quantitation of data. TACs were divided into an arterial plus blood pool phase (first 60 s at 1 frame/s) and a subsequent early bone uptake phase (24 min at 1 frame/min). Ratios of normalized integrals, from analogous regions were calculated to determine whether blood flow was abnormal. A key feature of the technique is the monitoring of the flow proximally and distally to the area of involvement. This was of importance in distinguishing between two diseases producing the same degree of local hyperemia. Dynamic bone imaging was applied to the differential diagnosis of arthritis, septic arthritis, cellulitis, osteomyelitis, tumor, avascular necrosis, Charcot joint, Legg-Perthes (LP) disease, and Osteochondritis Dissecans (OCD). Although the method is straightforward, there are technical and clinical factors that may affect interpretation of data. Asymmetries in flow may arise due to injection technique, interfering activity of bladder and/or bowel, vascular abnormalities, AV malformation, and venous backflow. The dynamic study is also sensitive to the effects of various modes of therapy. Consideration must be given to these technical and clinical factors for the avoidance of pitfalls in interpretation of the dynamic study.

Topics: Arthritis; Arthritis, Infectious; Arthropathy, Neurogenic; Bone and Bones; Bone Diseases; Bone Neoplasms; Cellulitis; Diagnosis, Differential; Humans; Legg-Calve-Perthes Disease; Osteochondritis Dissecans; Osteomyelitis; Osteonecrosis; Radionuclide Imaging; Technetium Tc 99m Medronate

Three patients with reactive arthritis and 2 with ankylosing spondylitis resistant to therapy with nonsteroidal antiinflammatory drugs were treated with enteric coated sulfasalazine in an open trial. Significant toxicity was not observed; 1 patient discontinued sulfasalazine because of gastrointestinal symptoms. As a group, statistically significant improvement was observed in 50 foot walk time, morning stiffness, and hemoglobin concentration. One patient went into complete clinical remission, 2 improved, 1 showed no change, and 1 worsened. Asymptomatic colonic inflammation was found in each of 4 patients examined before beginning therapy. Changes in bowel pathology did not parallel changes in joint symptoms. Sulfasalazine may be a safe and useful therapeutic modality in patients with chronic reactive arthritis or ankylosing spondylitis.

Topics: Adolescent; Adult; Arthritis; Female; Humans; Inflammatory Bowel Diseases; Male; Middle Aged; Spondylitis, Ankylosing; Sulfasalazine; Technetium Tc 99m Medronate

The role of imaging studies in the evaluation of patients with sacroiliitis is controversial. We aimed to evaluate the role of nanocolloid and bone scintigraphy in patients with sacroiliitis and to investigate the clinical relevance of imaging findings. Thirty-two patients with clinically sacroiliac disease (nine females, 23 males, aged 22-47 years) underwent scintigraphic and radiographic examinations and all imaging studies were performed within 2 weeks. Twenty-five subjects were also included as a control group (10 females, 15 males, aged 20-51 years) for quantitative analysis of the bone scan. The quantitative analysis was done by using regions of interest drawn over the right and left sacroiliac (SI) joint and sacrum (S) and SI/S ratios were calculated. Abnormal uptake was defined as an uptake higher than the mean +/- 2 SD of the control SI/S values. Bone scintigraphy was performed using a three-phase technique and single photon emission computed tomography (SPECT). Nanocolloid scintigraphy (NS) was performed 1 h later, after administration of 370 MBq 99mTc-nanocolloid, and evaluated visually. Each of the scintigraphic examinations was performed on separate days within the same week. Sensitivity values were 25%, 47%, 69% and 97%, and specificity values were 80%, 90%, 95% and 90% in quantitative bone scanning (QBS), 99mTc-NS, planar and SPECT bone imaging, respectively, when the clinical findings were considered as the 'gold standard'. Our results showed that bone SPECT scanning was more sensitive than planar imaging, but planar imaging was the most specific method. SPECT was also the most associated technique with clinical findings. 99mTc-NS was neither specific nor sensitive enough in the detection of sacroiliitis although it could be helpful for the confirmation of inflammation.

Topics: Adult; Arthritis; Bone and Bones; Female; Humans; Male; Middle Aged; Radiopharmaceuticals; Reference Values; Sacroiliac Joint; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Serial computer assisted quantitative sacroiliac scintiscanning (SI joint/sacrum ratios) 3 hours after low dosage (5 mCi) 99mTc methylene diphosphonate has been used as an objective index of sacroiliitis in a single blind 14-day cross-over comparison of azapropazone 600 mg b.d. and naproxen 500 mg b.d. in 18 patients with active sacroiliitis. Clinical assessments included visual analogue scales for measurement of pain and early morning stiffness, chest expansion, a modified Schober test, and goniometric measurement of thoracolumbar spinal flexion by means of an inclinometer. Statistically significant decreases in pain (p less than 0.001) and early morning stiffness (p less than 0.001) followed treatment with each NSAID, but there was no significant difference in the fall in these parameters, although 15 out of 18 patients expressed a preference for naproxen. Chest expansion and thoracolumbar flexion were not significantly affected by either drug. Serial quantitative scintigraphy showed a mean fall in joint sacrum ratios following each treatment which was statistically significant (p less than 0.02) only after naproxen. Serial quantitative scintigraphy can be used as an objective method of assessing sacroiliitis and was sufficiently sensitive to reflect the patients' subjective preference in a short-term comparison of 2 NSAID.

Topics: Adult; Apazone; Arthritis; Clinical Trials as Topic; Diphosphonates; Female; Humans; Male; Middle Aged; Naproxen; Radionuclide Imaging; Sacroiliac Joint; Technetium; Technetium Tc 99m Medronate; Triazines

Pancreatitis, panniculitis, and polyarthritis syndrome is a rare disease. A 49-year-old man recently complained of bilateral ankle and epigastric pain. An ankle x-ray showed subcutaneous soft tissue swelling. Subsequent 99mTc-MDP bone scan showed foci of abnormal activity around joints in all extremities, especially in the knees and ankles. In addition, multiple nodular calcifications in the head of the pancreas were found in the abdominal CT scan. The patient also had increased blood amylase and lipase. The symptoms were resolved after the treatment of his pancreatitis.

Topics: Abdominal Pain; Arthritis; Humans; Male; Middle Aged; Pancreatitis; Panniculitis; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

We present a novel report on the use of bone scintigraphy in pembrolizumab-induced inflammatory arthritis. A 70-year-old man with lung cancer complained about arthralgia after 7 courses of the pembrolizumab therapy. Tc-HMDP bone scintigraphy revealed symmetrically strong uptakes in the major distal joints of the upper and lower extremities, thereby clearly identifying them as the affected joints. The pattern of uptakes was not consistent with that of other pathophysiologies including bone metastases, hypertrophic osteoarthropathy, and rheumatoid arthritis. Tc-HMDP bone scintigraphy is more practical and cost-effective compared with PET to reveal the affected joints in pembrolizumab-induced inflammatory arthritis.

Topics: Aged; Antibodies, Monoclonal, Humanized; Arthritis; Bone and Bones; Humans; Inflammation; Male; Radionuclide Imaging; Technetium Tc 99m Medronate

To detect subclinical peripheral arthritis and disease activity in axial seronegative spondyloarthritis (SpA) patients using bone scintigraphy.. Seronegative SpA patients with an established diagnosis and no clinically evident arthritis at the time of the study were included. After excluding symptomatic cases, 20 patients were recruited; 18 with ankylosing spondylitis (AS) and another two with psoriatic arthritis (PsA). Conventional bone scintigraphy was performed to detect the distribution of increased uptake, blood vascular pool (vascularity) and activity.. The peripheral joints in all the patients were asymptomatic with no signs of arthritis on clinical examination. Disease activity was higher in those with hypervascularity and activity (75%) detected by scintigraphy. Scintigraphic activity of the sacroiliac joints was found in 10 patients (50%) with a mean sacroiliac joint index of 2.4 ± 0.6. Subclinical involvement of the hips, knees, shoulders, ankles, small joints of the hands, ankles and sternoclavicular joints, as well as the small joints of the feet were detected with descending frequencies (25%, 25%, 20%, 20%, 15%, 10% and 10%, respectively). Dorsal spine increased uptake was found in 35% and hypervascularity of the skull in two cases. Avascular necrosis of the hip was present in one case with hypovascularity.. The spectrum of joint involvement in seronegative SpAs should not be limited to sacroiliitis. Bone scintigraphy provides a cost-effective method for detecting the extent of involvement in this group of autoimmune systemic diseases (axial SpA) without clinical evidence of peripheral arthritis.

Topics: Adult; Arthritis; Arthritis, Psoriatic; Axis, Cervical Vertebra; Bone and Bones; Cost-Benefit Analysis; Female; Humans; Joints; Male; Middle Aged; Radionuclide Imaging; Sacroiliac Joint; Severity of Illness Index; Spine; Spondylarthritis; Spondylitis, Ankylosing; Technetium Tc 99m Medronate

We aimed to evaluate the articular involvements in pediatric patients with familial Mediterranean fever (FMF) with joint symptoms by bone scintigraphy and to correlate the involved joints with the gene mutations.. A total of 41 newly diagnosed patients in pediatric age group (28 girls and 13 boys; mean age 9.14 ± 2.91 years) with joint involvement symptoms were included in this study. Scintigraphic images were obtained at 5th min (blood pool or early phase) and starting at 3 h (late phase) after (after tracer injection) intravenous administration of technetium-99m (99mTc)-methylendiphosphonate (MDP). Genomic DNA was isolated from leukocytes using standard salting out procedure. The sequencing data were analyzed.. Of the 41 patients, arthritis was found in 21 (51.2%) patients. Of the 21 patients, there was single joint involvement in 15 (71.4%) patients and multiple joint involvement in six (28.6%) patients. The mean age of patients with joint involvement (8 ± 2.3 years) were considerably lower than the patients without joint involvement (10.35 ± 3.04 years), and this was statistically significant (p = 0.008). The most commonly involved joints were ankles and knees. Multiple joint involvements were most frequently observed in the M694V and M694I gene mutations (16.7%).. We use and recommend the bone scintigraphy in patients with FMF to determine the presence and distribution of arthritis, since bone scintigraphy is inexpensive, noninvasive, easy-to-use, and also is more sensitive in the diagnosis and distribution of arthritis than conventional radiological methods and clinical examination.

Topics: Arthritis; Child; Cytoskeletal Proteins; Familial Mediterranean Fever; Female; Humans; Male; Mutation; Pyrin; Radionuclide Imaging; Radiopharmaceuticals; Sequence Analysis, DNA; Technetium Tc 99m Medronate

Familial Mediterranean fever (FMF) is an autosomal recessively-inherited disorder typically manifested by recurrent attacks of fever and polyserositis. The articular disease occurs in 50-70% of patients. Bone scintigraphy is more sensitive in the diagnosis of arthritis than clinical examination or conventional radiological imaging, allowing earlier diagnosis through the visualization of disease in multiple sites. To assess joint involvements in FMF patients with or without joint symptoms, bone scintigraphy was performed in 36 patients with FMF and in 25 controls. There was arthritis in 72% of patients. Of these, 65% knee, 42% ankle, 50% sacroiliac, 8% elbow, 8% wrist, 4% sternoclavicular and 4% hip involvements were found. The sacroiliac joints with sacroiliac index higher than 1.34 were diagnosed as sacroiliitis, which was higher than 2 SD of normal. FMF is frequently associated with joint disease such as knee and ankle arthritis and sacroiliitis. This high incidence of sacroiliitis in our study has not been previously reported. This difference could be explained by the different methodology used for the screening of the joints. Thus, we recommend that bone scintigraphy can be used in patients with FMF to determine the presence of arthritis, especially in sacroiliac joints, even asymptomatic.

Topics: Adolescent; Adult; Arthritis; Familial Mediterranean Fever; Female; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Sacroiliac Joint; Technetium Tc 99m Medronate

Articular involvement was reported to be present in approximately 5-76% of Behçet patients. Therefore, we need a useful non-invasive method to detect articular involvement early in Behçet patients with nonspecific complaints. We aimed to evaluate the usefulness of 99mTc-methylene diphosphonate (Tc-99m-MDP) bone scintigraphy in the detection of the articular involvement of Behçet's disease (BD). Bone scintigraphy with Tc-99m-MDP was performed in 32 (17 male, 15 female) consecutive patients with BD. The sacroiliac (SI) joints with SI index higher than 1.34 were diagnosed as having sacroiliitis. Although joint complaints were present in only 8 (25%) patients, we detected joint involvement by scintigraphy in 27/32 (84.4%) Behçet patients mostly affecting the knees (62.5%), ankles (59.4%), SI joints (25%), wrists (21.9%), shoulders (18.7%), elbows (12.5%) and hips (3.1%). The articular involvement was monoarticular in four cases (12.5%) and was oligoarticular in the remaining. There was no correlation between joint involvement and age, gender, disease duration, drug usage or other clinical manifestations. Despite the fact that our patients were clinically asymptomatic and had normal pelvis radiography, sacroiliitis was found in 8 patients (25%). Bone scintigraphy is sensitive in the diagnosis of joint involvement allowing earlier diagnosis and showing the presence of articular involvement, especially in SI joints.

Topics: Adult; Arthritis; Behcet Syndrome; Cartilage, Articular; Female; Humans; Male; Osteochondritis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Whole Body Imaging

Topics: Adolescent; Adult; Aged; Arthritis; Bone and Bones; Female; Follow-Up Studies; Humans; Male; Middle Aged; Musculoskeletal Diseases; Pain; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate

Topics: Aged; Aged, 80 and over; Arthralgia; Arthritis; Bone and Bones; Female; Humans; Kidney; Kidney Diseases, Cystic; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Antibodies, Monoclonal; Antirheumatic Agents; Arthritis; Bone and Bones; Bone Neoplasms; Humans; Infliximab; Male; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Spinal Diseases; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

The aim of this study was to investigate joint scintigraphy in rabbits with 99mTc-N-[3-(triethylammonio)propyl]-15ane-N5 (NTP 15-5), a new radiopharmaceutical that specifically localizes in cartilaginous tissues.. Scans obtained after intravenous injection of the 99mTc-labeled compound in normal and arthropathy-induced rabbits were compared with those of the bone-imaging agent 99mTc-methylene diphosphonate (99mTc-MDP).. The radioactive uptake of 99mTc-NTP 15-5 was detected in cartilaginous tissues 5 min after injection and was stable for 2 h. The uptake intensity was related to age and joint disease severity, and cartilage alterations not revealed by radiography induced a significant decrease of radiotracer uptake. On the other hand, imaging performed with 99mTc-MDP did not reveal the early changes in arthrosis but was more specific for bone remodeling in advanced stages of diseases or in inflammatory processes.. Our results indicate that 99mTc-NTP 15-5 could be a good tracer for human arthrosic and arthritic cartilage detection, especially for the early diagnosis of joint diseases.

Topics: Animals; Arthritis; Cartilage, Articular; Heterocyclic Compounds, 1-Ring; Joints; Quaternary Ammonium Compounds; Rabbits; Radionuclide Imaging; Radiopharmaceuticals; Technetium; Technetium Tc 99m Medronate; Zymosan

The authors describe the clinical and bone scintigraphic findings of the SAPHO syndrome, which is characterized by synovitis, acne, palmoplantar pustulosis, hyperostosis, and osteitis. The case report illustrates the significance of bone scintigraphy in the diagnosis. It shows that Tc-99m MDP scanning can detect signs of arthritis not seen with other imaging methods, because the arthritis is inflammatory in nature and does not always cause bone erosion. Thus it is not visualized on plain radiographs. Knowledge of this disorder may help in the differential diagnosis of arthritis.. Tc-99m MDP bone scintigraphy was used to diagnose arthritic changes. Whole-body and multiple delayed spot images were obtained in a 39-year-old diabetic, hypertensive woman who had tenderness in the plantar aspect of her heels. Swelling of the small and large joints of the feet, ankles, knees, hips, right sacroiliac joints, and shoulders was noted. She also had hydradenitis suppurativa and a history of a previous episode in which the arthritis improved after surgical treatment for the hydradenitis.. All active joint lesions were visualized on the bone scan, including the arthritis, which was not detected with other imaging methods. They were all well demonstrated in the bone scintiscan. The scan findings, along with the presence of hydradenitis, led to the correct diagnosis of SAPHO syndrome.. Tc-99m MDP bone scanning may be helpful in diagnosing arthritis as associated with the SAPHO syndrome.

Topics: Acquired Hyperostosis Syndrome; Adult; Arthritis; Bone and Bones; Diagnosis, Differential; Female; Humans; Joints; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Diagnosis of sacroiliitis (SI) with bone scintigraphy may involve difficulties even with a quantitative approach. The aim of this study was to evaluate the combined use of bone and bone marrow scintigraphies for the diagnosis of active sacroiliitis. Thirty-one patients who were clinically suspected to have SI were included in the study. Bone and bone marrow scintigraphies were done after injections of 740 MBq of 99mTc-MDP (MDP) and 370 MBq of 99mTc-sulfur colloid (SC) respectively with a 2-day interval. Both visual and quantitative assessment of MDP uptake and visual assessment of SC uptake in sacroiliac joints were performed. Also sacroiliac joint radiographic findings for each patient were evaluated and graded from 0 to 4 according to the New York grading system. Patients were divided into 2 groups according to their x-ray findings (Group A: grade 0-2, Group B: grade 3-4). A total of 14 patients (10 bilateral, 4 unilateral) had increased MDP uptake with decreased/normal SC uptake. Twelve of 14 patients had grade 0-2 radiographic changes while only 2 patients had grade 3-4 radiographic changes. Increased MDP uptake with decreased/normal SC uptake is the most common scintigraphic pattern seen in acute phase SI in which radiographic findings are generally found to be normal or slightly changed. In at least in 8 patients the decreased bone marrow uptake of SC was demonstrated, supporting the diagnosis. Although our results did not reveal any significant superiority of bone marrow scintigraphy to bone scan for the detection of active sacroiliitis, combined use of bone and bone marrow scintigraphies was presented as an alternative method to characterize patients with active sacroiliitis.

Topics: Adult; Arthritis; Bone and Bones; Bone Marrow; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sacroiliac Joint; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

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

Bone scintigraphy is requested as part of the investigation of foot pain, but its contribution to clinical management has not been comprehensively documented. Previously published data are limited; the most comprehensive series identified scintigraphic abnormalities in patients with primarily orthopaedic problems and a control group was not included (Maurice HD et al. J Bone Joint Surg 1987;69B:448 52). The aim of this study was to evaluate whether bone scintigraphy may be useful in different clinical circumstances indicated by referral request details. Regions of scintigraphic abnormality were scored and compared with clinical details drawn from case notes of 60 patients with foot pain. The commonest clinical indications for scans were: confirmation of the clinical suspicion of plantar fasciitis, documentation of the extent of inflammatory arthritis and location of focal pathology. A group of 30 asymptomatic, age- and sex-matched controls were also studied. In 14 out of 19 symptomatic feet in the plantar fasciitis group, focal uptake at the medial calcaneal tubercle was present, confirming the diagnosis. In patients with non-specific, diffuse foot pain, the bone scan identified focal abnormalities in 11 out of 14 cases, thus directing the clinician to the site of pathology. Scintigraphy also proved useful in mapping local inflammatory disease. Technetium-99m methylene diphosphonate image abnormalities occurred in the control group most commonly in the midfoot (16 regions in 13 subjects) and first metatarsophalangeal joint (19 regions in 14 subjects).

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arthritis; Bone and Bones; Female; Foot Diseases; Humans; Male; Middle Aged; Pain; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

The value of quantitative sacroiliac joint scintigraphy for detecting sacroiliitis is controversial. Age and gender may contribute to this discordance. In previous reports, the number of control groups has been small and might not exactly reflect the change of sacroiliac/sacral (SI/S) ratios related to different age. In addition, the selection of control subjects was not strict. In most studies, care was not taken to ensure that control subjects did not have a history of back pain or any other relevant conditions. In addition, there was no requirement for a normal radiograph as a condition of inclusion. The aim of our study was to evaluate the consequent changes in SI/S ratios, according to age (in 10-yr intervals) and gender.. Over a period of 5 yr, 413 control subjects without a history of back pain, scoliosis, kyphosis, joint pain, arthritis, lesions within the pelvis, chemotherapy or systemic disease such as diabetes or systemic lupus erythematosus were included in this study. A posterior planar film of the pelvis was obtained to calculate SI/S ratio 3 hr after injection of 740 MBq 99mTc-methylenediphosphonate. Our data showed that: (a) the change in SI/S ratios related to age was significant in both females and males; (b) the SI/S ratios were higher in males younger than 30 yr and higher in men in the 41-50-yr age group and in females in other groups; (c) the SI/S ratios declined steadily with increasing age in females, whereas there were two plateaus in men aged 21-40 yr and 41-70 yr; (d) there were significant differences of SI/S ratios between the genders in certain age groups; and (e) no differences were found between left SI/S ratios and right SI/S ratios.. The influence of age and gender on SI/S ratios are substantial, and it is essential for each department to establish its own values for SI/S ratios based on gender and age (in 10-yr intervals).

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Aging; Arthritis; Child; Female; Humans; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Reference Values; Sacroiliac Joint; Sacrum; Sex Factors; Technetium Tc 99m Medronate

Uptake of technetium-99m methylene diphosphonate by the rectus abdominis muscle was unexpectedly found in a 29 year old man who had started to perform 30 to 40 sit ups a day for five days before the bone scan. After a week of rest, serum creatine kinase activity was still abnormal but muscle uptake of technetium-99m methylene diphosphonate had ceased. This specific muscle injury after short term sit ups as well as the resolution of the phenomenon within a week are of interest.

Topics: Adult; Arthritis; Bone and Bones; Creatine Kinase; Exercise; Humans; L-Lactate Dehydrogenase; Male; Muscle Contraction; Radiopharmaceuticals; Rectus Abdominis; Rest; Rhabdomyolysis; Sacroiliac Joint; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Inflammatory joint disease is mainly diagnosed on grounds of clinical investigation, laboratory testing (acute phase reactants), and radiography. Radionuclide imaging has recently been added to the armamentarium of clinician. This case report points out the role of three-phase bone scan and HIG (human immunoglobulin) scan in the discovery of the inflammatory nature of polyarthralgia in a young woman with equivocal clinical and laboratory results. In the aim of diagnosing arthritis early in its course scintigraphy proved to be superior to conventional radiography. It also allows more discriminating selection of subsequent X-ray examination to limit radiation exposure.

Topics: Acute-Phase Proteins; Adult; Arthritis; Bone and Bones; Diagnosis, Differential; Female; Gamma Cameras; Humans; Inflammation; Radiography; Radionuclide Imaging; Regional Blood Flow; Serologic Tests; Technetium Tc 99m Medronate

Indium-111-labeled human nonspecific immunoglobin G (111In-IgG) is one of the newer agents suggested for scintigraphic evaluation of infection and inflammation. In this study, the utility of this agent was studied in routine clinical practice.. A dose of 75 MBq 111In labeled to 2 mg IgG (MacroScint) was administered intravenously in 226 patients with 232 possible foci of infection or inflammation. Imaging was performed 4, 24 and 48 hr postinjection. The results were verified by culture, obtained either surgically (42%) or via puncture (19%) and long-term clinical and roentgenological follow-up (39%). Follow-up data were used in patients of whom the vast majority had a negative work-up, including negative 111In-IgG scintigraphy.. All infected total hip (THA) and total knee arthroplasties, focal osteomyelitis, diabetic foot infections, septic arthritis and soft-tissue infections were detected (61 foci). Only one patient with early, low-grade spondylodiscitis was false negative with 111In-IgG. Since 111In-IgG scintigraphy does not discriminate between infectious and sterile inflammation, careful interpretation is necessary in cementless THA up to 1 yr after insertion, uptake only around the neck of the femoral component of a THA, recent fractures and pseudarthrosis, in which uptake may be caused by sterile inflammation and not by infection (specificity for inflammation 100%, specificity for infection of 77%).. Indium-111-IgG scintigraphy is a very sensitive tool for detection of infectious bone and joint disease. Moreover, when uptake patterns of 111In-IgG, which are characteristic for sterile inflammation, are excluded, infection can be ruled out with a high degree of certainty.

Topics: Arthritis; Arthritis, Infectious; Diabetic Foot; Discitis; Female; Hip Prosthesis; Humans; Immunoglobulin G; Indium Radioisotopes; Knee Prosthesis; Male; Middle Aged; Osteomyelitis; Predictive Value of Tests; Prosthesis-Related Infections; Pseudarthrosis; Radionuclide Imaging; Sensitivity and Specificity; Soft Tissue Infections; Technetium Tc 99m Medronate

Bone scintigraphy is an extremely sensitive method for the detection of focal bone disease. In many hospitals, quantitative sacroiliac joint scintigraphy is still a routine procedure in detecting sacroiliitis. In previous studies, both 99Tcm-methylenediphosphonate (99Tcm-MDP) and 99Tcm-pyrophosphate have been used for bone imaging. 99Tcm-pyrophosphate is eliminated more slowly than 99Tcm-MDP from the circulation and gives a higher background activity. We wished to discover the sacroiliac/sacral ratio (SI/S ratio) changes when using different bone agents. The aim of this study was to evaluate differences in SI/S ratios between the two bone agents. Forty-six control subjects, aged 31-50 years, with no history of back pain, scoliosis, kyphosis, joint pain, arthritis, lesions within the pelvis, chemotherapy or systemic diseases such as diabetes or systemic lupus erythematosis, were included in the study. A posterior planar image of the pelvis was performed to calculate the SI/S ratio 3 h after the injection of 740 MBq 99Tcm-MDP or 99Tcm-pyrophosphate. Twenty-five subjects were studied with 99Tcm-MDP and 21 with 99Tcm-pyrophosphate. We found the SI/S ratios using 99Tcm-MDP to be slightly higher than those using 99Tcm-pyrophosphate, especially on the left side, but this difference was not statistically significant (P-values > 0.1 on both sides using Student's t-tests for unpaired data).

Topics: Adult; Arthritis; Evaluation Studies as Topic; Humans; Male; Middle Aged; Radionuclide Imaging; Reference Values; Sacroiliac Joint; Sensitivity and Specificity; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

No data are available on the presence and frequency of peripheral or central joint disease, routinely determined by bone scintigraphy with 740 MBq of [99mTc]MDP, in adult celiac disease. Bone scintigraphy was carried out to detect early acute inflammatory lesions in 22 adult celiac patients (15 females and seven males; mean age 36.72 years, range 17-63). Bone scintigraphy was positive for sacroiliitis in 14 cases (63.6%). Except in the case of one patient suffering from rheumatoid arthritis, laboratory data were normal. Our data suggest that as in other chronic intestinal diseases, celiac disease in adults, is frequently associated with central joint disease. This high incidence of sacroiliitis, the joint disease most frequently found in our patients, has not been previously reported in other series. We believe, therefore, this difference could be explained by the different methodology used for the screening of joint disease.

Topics: Adult; Arthritis; Celiac Disease; Female; Humans; Incidence; Male; Radionuclide Imaging; Sacroiliac Joint; Technetium Tc 99m Medronate

The accumulation of 99mTc-methylene diphosphonate (99mTc-MDP) and 99mTc-dicarboxypropane diphosphonate (99mTc-DPD) in sacroiliac (si) joints was evaluated as a function of imaging time in 22 control patients and 5 patients with sacroiliitis. The controls were injected with either 99mTc-DPD or 99mTc-MDP (12 and 10 patients, respectively) and the patients with sacroiliitis with both agents within 5 days. Both the anterior and posterior views of the si joints were taken. The sacroiliac joint-to-sacrum (SI/S) ratio was calculated with the region of interest method. No statistically significant differences between these bone-seeking agents were found in the SI/S ratios of the control or the diseased patients. A clear overlap of indices (mean +/- SD) was found between the control patients and the patients with sacroiliitis. When the inflamed si joint was divided into three small adjacent areas and the SI/S ratios calculated for these areas, a statistically significant (P less than 0.001) increase in the SI/S ratio was noticed when compared with the SI/S ratio of the whole joint. Comparison of control patients and patients with sacroiliitis showed the most significant differences in the anterior views as well as in the P value: P less than 0.001 in all patients injected with 99mTc-DPD and in most patients injected with 99mTc-MDP. In the posterior views, the significance was less marked. In every case, the inflamed part of the si joint was visible in the anterior views. The background subtraction had the greatest effect on the SI/S ratio of anterior images, but in the posterior views no significance was found.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Arthritis; Back Pain; Diphosphonates; Humans; Organotechnetium Compounds; Radionuclide Imaging; Sacroiliac Joint; Technetium Tc 99m Medronate; Time Factors

An acute arthritis in a patient with mixed connective tissue disease (MCTD) was found to be associated with intra-articular deposition of carbonated hydroxyapatite crystals. A technetium hydroxymethylene diphosphonate bone scan showed intense uptake in the delayed phase scan of the affected joints. Synovial fluid analysis demonstrated uptake of the radiopharmaceutical drug directly onto the crystals.

Topics: Adult; Arthritis; Calcinosis; Crystallography; Female; Hand; Humans; Hydroxyapatites; Mixed Connective Tissue Disease; Radionuclide Imaging; Synovial Fluid; Technetium Tc 99m Medronate

Quantitative scintigraphy of the sacroiliac joints was performed in a group of normal subjects and a group of subjects with unilateral and bilateral sacroiliitis. The aim of the study was to determine whether the time intervals of imaging had any effect on the values of the sacroiliac index. Imaging was performed every 30 min up to 300 min and the indices were calculated at the time intervals mentioned. We found that the values of the sacroiliac index increased in the group of normal subjects until 150 min after the application of the radiopharmaceutical, and that in the group of subjects who had sacroiliitis they increased until 210 min. The results show that the time interval optimal to quantitative sacroiliac joint imaging is at least 3 1/2 h after administration of the radiopharmaceutical.

Topics: Adolescent; Adult; Aged; Arthritis; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sacroiliac Joint; Technetium Tc 99m Medronate; Time Factors

We reviewed the medical records and technetium bone/joint scans of 160 children presenting to the inpatient Pediatric Rheumatology service over a 3-year period. When the scan result (normal versus abnormal) was considered for each patient as a whole, scan sensitivity and specificity were both approximately 75%. However, when each joint was considered individually, sensitivity decreased to 37%, while specificity rose to more than 95% when compared to clinical examination. Reasons for these variations and their clinical correlation are discussed. Overall, radionuclide bone/joint scanning was found to be very useful in the evaluation of monoarticular and nonrheumatic disorders, but it did not alter therapy in children with known connective tissue disorders or other polyarticular diseases.

Topics: Adolescent; Arthritis; Arthritis, Juvenile; Bone and Bones; Child; Child, Preschool; Female; Humans; Infant; Joint Diseases; Joints; Male; Radionuclide Imaging; Rheumatic Diseases; Spinal Diseases; 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

Early detection of inflammatory arthropathy is notoriously difficult with standard radiographic techniques. We therefore assessed bone turnover with technetium Tc 99m medronate in 16 patients with persistent polyarthralgias who had no clinical synovitis, normal radiographs, and nondiagnostic results from laboratory evaluations. Abnormal scans were found in 11 of 16; five were unremarkable. Scan abnormality corresponded with symptomatic joints (11 of 11 patients). These 11 patients had normal test results for rheumatoid factor, antinuclear antibody, and HLA-B27. Patients with abnormal scans were treated with nonsteroidal antiinflammatory drugs or analgesics (11 of 11), hydroxychloroquine sulfate (four), or gold salts (one), with improvement (nine of 11); patients with normal scans (five of five) were treated successfully with nonsteroidal antiinflammatory drugs or analgesics and reassurance. One patient with a normal scan developed sarcoidosis; one, hypermobility syndrome; and one, a viral syndrome. Two patients had no diagnosis. Abnormal technetium Tc 99m medronate scans in patients with previously undiagnosed polyarthralgias suggested inflammatory arthropathy and influenced management decisions with favorable therapeutic outcomes.

Topics: Adult; Arthritis; Arthrography; Female; Humans; Joints; Male; Pain; Radionuclide Imaging; Technetium Tc 99m Medronate

Bone scintigraphy using 99mTc-EHDP was carried out in 147 psoriatics of both sexes and in 35 nonpsoriatic patients. The psoriatics were subdivided into four groups according to clinical aspects: psoriasis vulgaris (Pv, n = 55), psoriasis inversa (Pinv, n = 32), psoriasis pustulosa of the Königsbeck-Barber type (PpK-B, n = 28), and pustulosis palmaris et plantaris (Ppp, n = 32). The following frequencies of joint involvement were found in the different groups: Pv = 18.3%; Pinv = 22.6%, PpK-B = 11.1%; Ppp = 12.5%; control group 2.3%. In patients suffering from psoriasis vulgaris and psoriasis inversa a pathologic preferential radionuclide uptake was demonstrated in the small peripheral joints of the hands and fingers. The characteristic psoriatic pattern with axial and transverse joint involvement was found in all groups of psoriatic patients. No correlation could be proved between age and pathologic accumulation of the radionuclide or between duration of psoriasis and joint involvement. The so-called anterior chest wall syndrome was found in all patients, but predominantly in those with psoriasis palmaris et plantaris. Finally the indications for bone scintigraphy are discussed.

Topics: Arthritis; Female; Humans; Joints; Keratoderma, Palmoplantar; Male; Middle Aged; Psoriasis; Radionuclide Imaging; Technetium Tc 99m Medronate

Modern imaging techniques can be a valuable aid to the rheumatologist. Isotope scans, particularly technetium diphosphonate, can give very early localisation of inflammatory activity. Infra-red thermography can also provide early data, and is completely non-invasive. In drug assessment, thermography is particularly useful, quantifying the anti-inflammatory effects, which may be more rapid in the small joints and slower in joints such as the knee. Given that many anti-inflammatory drugs are analgesic at a low dose yet may improve subjective function e.g. grip test, there is a definite role for objective measurement of true anti-inflammatory effects. The methodology is now well proven and easily used in clinical practice.

Topics: Arthritis; Humans; Radionuclide Imaging; Technetium Tc 99m Medronate; Thermography

Clinical, radiographic and scintigraphic abnormalities in primary oxalosis of a 52 years old female are demonstrated. Severe oxalosis-nephropathy and oxalosis-arthropathy/enthesiopathy are shown. For the first time an intense myocardial uptake of 99 m Tc-HDP and 99 m Tc-MDP is described in connection with oxalosis. It is suggested that in the appropriate clinical setting this pattern may be suggestive of oxalosis-cardiomyopathy. Review of literature.

Topics: Arthritis; Bone Diseases; Cardiomyopathies; Diphosphonates; Female; Humans; Hyperoxaluria; Kidney Calculi; Middle Aged; Oxalates; Technetium; Technetium Tc 99m Medronate

A clinical and x-ray review of 118 GSB-Knee-Protheses without resurfacing the patella--mean time of follow-up 4 years--was performed. In 50 knees of these an additional quantifying bone-scan with 99mTc-MDP ("ROI-method") indicated new aspects of the pathomechanics of the patella after knee replacement. Comparing 42 healthy knee joints and 82 knees with osteoarthrosis principles for early diagnosis of patellar changes could be set up. According to these findings the quantifying scans show the development of dystrophic patellar changes after knee replacement.

Topics: Aged; Arthritis; Diphosphonates; Female; Femur; Follow-Up Studies; Humans; Knee Joint; Knee Prosthesis; Male; Patella; Radiography; Radionuclide Imaging; Sacrum; Technetium; Technetium Tc 99m Medronate; Tibia; Time Factors

Thirteen patients with isolated pain and swelling of a sterno-clavicular clavicular joint have been reviewed. Three groups were identified. Group 1 comprised four patients, all of whom had a short history of less than six weeks and suffered a pyarthrosis or malignant disease; group 2, four patients who were shown to have features of condensing osteitis of the clavicle (Cone et al, 1983); and group 3, five patients, had degenerative arthritis of a sterno-clavicular joint. The only difference between groups 2 and 3 were that patients in group 3 had a rather longer history, both articular surfaces were involved and showed a possible increase in the incidence of degenerative joint disease elsewhere. It is suggested that condensing osteitis is but a part of a spectrum of degenerative disease of the sterno-clavicular joints, akin to discogenic vertebral body sclerosis (McCarthy & Dorfman, 1982).

Topics: Adult; Aged; Arthritis; Female; Gallium Radioisotopes; Humans; Male; Middle Aged; Osteitis; Pain; Radiography; Radionuclide Imaging; Sclerosis; Sternoclavicular Joint; Technetium Tc 99m Medronate

Topics: Adolescent; Adult; Arthritis; Diphosphonates; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sacroiliac Joint; Technetium; Technetium Tc 99m Medronate; Thermography

Studies with gallium-67 and three-phase bone imaging (TPBS), though very sensitive, are not very specific in evaluating suspected osteomyelitis (OM) that is superimposed upon other diseases causing increased bone turnover. A total of 57 patients with suspected OM were studied; this included 48 with increased bone turnover. All of the patients were studied with granulocytes labeled with In-111 acetylacetone (In-111 GRAN), TPBS and 29 of these patients had Ga-67 studies as well. In-111 GRAN had a sensitivity of 100% in acute OM and 60% in chronic OM, with a specificity of 96%. Gallium-67 was excellent in ruling out OM when the study was normal, or in ruling in OM when the relative uptake of Ga-67 exceeded the uptake of Tc-99m MDP, or when the Ga-67 in bone had a different distribution from the TPBS. Unfortunately, these criteria were met in only 28% of our subjects. We conclude that when added to TPBS, the In-111 GRAN study plays an important role in detecting complicating OM.

Topics: Acute Disease; Adolescent; Adult; Aged; Arthritis; Bone and Bones; Chronic Disease; Diphosphonates; Female; Fractures, Bone; Gallium Radioisotopes; Granulocytes; Humans; Indium; Male; Middle Aged; Osteomyelitis; Prostheses and Implants; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Three-phase radionuclide scintigraphy of the hand was performed on 116 patients. Normal and abnormal patterns for radionuclide angiography, immediate post-injection blood-pool images, and delayed scans (3-4 hr.) were established. Of 80 patients with normal circulation, 61 (76%) had equal radial and ulnar artery flow bilaterally, while in 19 (24%) either the radial or ulnar artery was dominant. Abnormal studies were grouped into three categories: suspected vascular lesions (Group I), pain of uncertain etiology (Group II), and patients evaluated before and after reconstructive surgery (Group III). The diagnosis was correct in 89% of the patients in Group I (34/38), 89% of those in Group II (57/64), and all of those in Group III (14/14). Three-phase scintigraphy of the hand yields significant information about perfusion and bone metabolism.

Topics: Adolescent; Adult; Aged; Arteriovenous Malformations; Arthritis; Bone Neoplasms; Child; Child, Preschool; Diphosphonates; Female; Hand; Hand Injuries; Hemangioma; Humans; Male; Middle Aged; Radionuclide Imaging; Raynaud Disease; Reference Values; Regional Blood Flow; Technetium; Technetium Tc 99m Medronate; Thrombosis

Increased participation in sports by the general public has led to an increase in sports-induced injuries, including stress fractures, shin splints, arthritis, and a host of musculotendinous maladies. Bone scintigraphy with Tc-99m MDP has been used with increasing frequency in detecting stress fractures, but this study can miss certain important conditions and detect other lesions of lesser clinical significance. This paper demonstrates the spectrum of findings on bone scanning in nonacute sports trauma and offers suggestions for the optimal use of Tc-99m MDP for detecting the causes of lower extremity pain in athletes.

Topics: Adolescent; Adult; Arthritis; Athletic Injuries; Bone and Bones; Diphosphonates; Female; Fractures, Bone; Humans; Leg; Male; Muscles; Pain; Radionuclide Imaging; Sports Medicine; Technetium; Technetium Tc 99m Medronate

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

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

Besides the known joint involvement as seen in the whole-body scan which uses 99m technetium-phosphate-complexes, skeletal scintigraphic investigations in 17 patients with psoriasis have demonstrated circumscribed or diffuse accumulative pathological concentrations of the radionuclide within the skeleton of the skull, the thyroid cartilage, the bony thorax and osseous long bones. These pathological accumulations of radionuclides of TcP-complexes which are distant from joint regions, point to proliferative phenomena in the bone in case of psoriasis especially in alterations of the collagenous metabolism.

Topics: Adult; Aged; Arthritis; Bone Diseases; Diphosphonates; Female; Humans; Male; Middle Aged; Psoriasis; Radionuclide Imaging; Technetium; Technetium Compounds; Technetium Tc 99m Medronate

The association between acute iridocyclitis (a.i.) and sacroiliitis/ankylosing spondylitis is well known. Since bone scintigraphy is a sensitive method of detecting sacroiliitis before radiologic evidence of this condition appears, we examined the role of scintiscanning in the investigation of sacroiliitis in patients with a.i. The sacroiliac-joint/sacrum ratio was determined in 30 control subjects and in 21 patients with a.i., who showed no radiologic signs of sacroiliitis. No discrimination between patients with a.i. and control subjects was obtained by scintigraphy, neither did we find any difference in the mean sacroiliac-joint/sacrum ratios between HLA-B-27-positive and HLA-B-27-negative individuals with a.i. This study does not support the claim that patients with a.i. often suffer from clinically and radiologically silent sacroiliitis which would be detected only by scintigraphy. According to our results, regular scintigraphic examinations of the sacroiliac joint in all patients with a.i. are not indicated.

Topics: Adult; Aged; Arthritis; Diphosphonates; Female; HLA Antigens; HLA-B27 Antigen; Humans; Male; Middle Aged; Radionuclide Imaging; Sacroiliac Joint; Technetium; Technetium Tc 99m Medronate; Uveitis, Anterior