technetium-tc-99m-medronate and Osteoarthritis--Knee

To explore whether the risk of incident tibiofemoral (TF) osteoarthritis (OA) in the radiographically normal contralateral knee of overweight/obese women with unilateral knee OA is mediated by malalignment and/or preceded by increased turnover of subchondral bone.. We used data of post hoc analyses from a randomized controlled trial. Cross-sectional analyses evaluated the baseline association between frontal plane alignment and bone turnover in the medial TF compartment in 78 radiographically normal contralateral knees. Longitudinal analyses ascertained whether incident radiographic OA (TF osteophyte formation within 30 months) was associated with malalignment and/or increased bone turnover at baseline. Alignment subcategories (varus/neutral/valgus) were based on the anatomic axis angle. (99m)Tc-methylene diphosphonate uptake in a late-phase bone scan was quantified in regions of interest in the medial tibia (MT) and medial femur (MF) and adjusted for uptake in a reference segment of the ipsilateral tibial shaft (TS).. MF and MT uptake in varus contralateral knees was 50-55% greater than in the TS. Adjusted MT uptake in varus contralateral knees was significantly greater than that in neutral and valgus contralateral knees (mean 1.55 versus 1.38 and 1.43, respectively; P < 0.05). Among 69 contralateral knees followed longitudinally, 22 (32%) developed TF OA. Varus angulation was associated with a marginally significant increase in the odds of incident OA (adjusted odds ratio 3.98, P = 0.067).. While the small sample size limited our ability to detect statistically significant risk factors, these data suggest that the risk of developing bilateral TF OA in overweight/obese women may be mediated by varus malalignment.

Topics: Bone Malalignment; Bone Remodeling; Female; Humans; Knee Joint; Logistic Models; Middle Aged; Obesity; Odds Ratio; Osteoarthritis, Knee; Osteophyte; Overweight; Predictive Value of Tests; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Risk Assessment; Risk Factors; Technetium Tc 99m Medronate

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

To compare the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a baseline late-phase bone scan and assessments of the radiographic and symptomatic severity of knee osteoarthritis (OA) at baseline as predictors of loss of articular cartilage thickness, as reflected in joint space narrowing (JSN) in the medial tibiofemoral compartment.. Subjects (174 obese women, 45-64 yrs of age, with unilateral knee OA) were a subset of a larger cohort who participated in a placebo controlled trial of a disease modifying OA drug. Uptake of technetium medronate (99mTc-MDP) in anteroposterior (AP) and lateral views of a late-phase bone scan was measured at baseline in a region of interest drawn around the medial tibia, and was adjusted for (i.e., expressed as a ratio to) uptake in a reference segment of the tibial shaft, which served as an internal standard. Each subject underwent a fluoroscopically standardized radiographic examination of the knees (semiflexed AP view) and a pain assessment with the WOMAC OA Index at baseline, 16 months, and 30 months.. Controlling for baseline joint space width and treatment group, multiple linear regression models showed that the adjusted 99mTc-MDP uptake at baseline was a significant predictor of joint space narrowing (JSN) in the index knee at 16 months (b = 0.180, p = 0.015) and 30 months (b = 0.221, p = 0.049). In the contralateral knee, uptake was only a marginally significant predictor of JSN at 30 months (b = 0.246, p = 0.083). Uptake in the upper and middle tertiles of the distribution predicted subjects who would exhibit JSN >/= 0.50 mm within 16 months with 65% sensitivity (PPV 23%) and 36% specificity (NPV 77%). In contrast, a prediction rule based solely on the presence of Kellgren-Lawrence grade 3 OA severity and greater than median WOMAC Pain score identified progressors with 65% sensitivity (PPV 48%) and 79% specificity (NPV 88%).. Although the level of adjusted 99mTc-MDP uptake was significantly associated with JSN in knees with established radiographic OA, baseline bone scintigraphy is inferior to the radiographic severity of OA and knee pain (alone or in combination) as a predictor of loss of articular cartilage in subjects with knee OA.

Topics: Aged; Antirheumatic Agents; Disease Progression; Doxycycline; Female; Femur; Humans; Knee Joint; Middle Aged; Obesity; Osteoarthritis, Knee; Pain Measurement; Predictive Value of Tests; Radionuclide Imaging; Sensitivity and Specificity; Severity of Illness Index; Technetium Tc 99m Medronate; Tibia

To determine the predictive value of bone scintigraphy with respect to joint space narrowing (JSN) in patients with knee osteoarthritis (OA), based on quantitative estimates of uptake of a bone-seeking radiopharmaceutical and fluoroscopically standardized knee radiography.. Our study group included 86 obese women, 45-64 years of age, with unilateral knee OA. Uptake of technetium medronate (99mTc-MDP) in late-phase bone scans was measured at baseline in 5 regions of interest (ROI: lateral femur, lateral tibia, medial femur, medial tibia, and patellofemoral joint) and was adjusted for uptake (i.e., expressed as a ratio to uptake) in a ROI in the shaft of the tibia, which served as an internal standard. Each subject underwent a fluoroscopically standardized radiograph of the knees (semiflexed anteroposterior view) at baseline, 16, and 30 months. Magnification-corrected minimum joint space width in the medial tibiofemoral compartment was measured by digital image analysis.. Followup was available for 79 patients (92%) at 16 months and from 73 patients (85%) at 30 months. On average, 99mTc-MDP uptake in each ROI and in the whole knee (average of 4 tibiofemoral ROI) was 170-240% of that in the tibial shaft. Uptake in the medial tibia and in the whole knee was significantly correlated with JSN at 16 and 30 months (r = 0.22-0.30, p < 0.05). However, after controlling for age, body mass index, and radiographic severity of OA, the associations between adjusted uptake and JSN were not significant. The rate of JSN in knees of patients with OA who were in the lower tertile with respect to adjusted 99mTc-MDP uptake in the medial tibia was significantly less rapid than in patients in whom uptake was in the middle and upper tertiles (0.04 mm/yr vs 0.18 mm/yr; p < 0.05). However, after controlling for overall radiographic severity at baseline, the difference in 30-month JSN in knees of patients with OA in the lower versus middle/upper tertiles was not significant.. The predictive utility of bone scintigraphy is confirmed by these data. However, its practical value is considerably diminished, insofar as similarly predictive information may be obtained by routine radiographic examination, without the radiation exposure and cost of scintigraphy.

Topics: Cartilage, Articular; Female; Follow-Up Studies; Humans; Knee Joint; Middle Aged; Obesity; Osteoarthritis, Knee; Predictive Value of Tests; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

To compare increased bone uptake of 99Tcm-MDP and magnetic resonance (MR) detected subchondral lesions, osteophytes, and cartilage defects in the knee in middle aged people with long-standing knee pain.. Fifty eight people (aged 41-58 years, mean 50) with chronic knee pain, with or without radiographic knee osteoarthritis, were examined with bone scintigraphy. The pattern and the grade of increased bone uptake was assessed. On the same day, a MR examination on a 1.0 T imager was performed. The presence and the grade of subchondral lesions, osteophytes, and cartilage defects were registered.. The kappa values describing the correlation between increased bone uptake and MR detected subchondral lesions varied between 0.79 and 0.49, and between increased bone uptake and MR detected osteophytes or cartilage defects the values were < 0.54. The kappa values describing the correlation between the grade of bone uptake and the grade of the different MR findings was < 0.57.. Good agreement was found between increased bone uptake and MR detected subchondral lesion. The agreement between increased bone uptake and osteophytes or cartilage defects was in general poor as well as the agreement between the grade of bone uptake and the grade of the MR findings.

Topics: Adult; Cartilage, Articular; Female; Femur; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Osteoarthritis, Knee; Patella; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia

To assess the relationship of subchondral bone tracer uptake (BTU) on SPECT/CT and meniscal pathologies on MRI in patients with painful knees.. Twenty-five patients who had MRI and SPECT/CT within 3 months without knee surgery or grade ≥3 cartilage lesions were prospectively included. Maximum values of each subchondral femorotibial area were quantified and a ratio was calculated in relation to a femoral shaft reference region, which represented the BTU background activity. Meniscal lesions were graded (intact/degeneration/tear) and meniscal extrusion (no/yes) was assessed using MRI by two musculoskeletal radiologists blinded to the SPECT/CT findings. One-tailed Spearman correlations served for statistics (p < 0.05).. Knees with meniscal degeneration or tear showed a significantly higher BTU in the medial femorotibial compartment (p = 0.045) when compared to intact menisci. Meniscal degeneration was associated with an increased BTU in the lateral femorotibial compartment; however, this was not statistically significant (p = 0.143). Patients with an extruded meniscus showed significantly higher BTU compared to a non-extruded meniscus (p < 0.020).. Medial femorotibial BTU in SPECT/CT was associated with meniscal pathologies. Highest BTU was found in patients with meniscal tears. SPECT/CT appears to be a useful imaging modality to identify patients with overloading or early osteoarthritis.. • Meniscal degeneration and tears correlate significantly with increased BTU using SPECT/CT. • Medial meniscus extrusion is associated with an increased BTU in SPECT/CT. • SPECT/CT allows detection of overloading and early osteoarthritis.

Topics: Adult; Aged; Arthralgia; Female; Follow-Up Studies; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Menisci, Tibial; Meniscus; Middle Aged; Osteoarthritis, Knee; Positron Emission Tomography Computed Tomography; Prospective Studies; Radiopharmaceuticals; ROC Curve; Technetium Tc 99m Medronate; Young Adult

To evaluate the correlation between the maximum standardised uptake value (SUVmax) from bone single-photon-emission computed tomography/computed tomography (SPECT/CT) and other imaging parameters for medial compartment osteoarthritis (OA) of the knee.. Patients (n=26; male:female=2:24; age, 55.3±5.8 years) underwent quantitative knee SPECT/CT using technetium-99m (Tc-99m) hydroxymethylene diphosphonate (HDP) before surgical operation for medial OA of the knee. SUVmax was calculated using dedicated quantitative software. Visual grades of tracer uptake on bone SPECT/CT and Kellgren-Lawrence (KL) OA scores on plain radiographs were assessed using a five-point scale. Magnetic resonance imaging (MRI) scores (n=22) and patient symptom scores were also assessed.. The operated knees (n=34) had a greater SUVmax than the non-operated knees (n=18) in the medial compartment (14.1±6.1 versus 5.3±4.4, p<0.0001). In the medial compartment, the SUVmax was significantly correlated with SPECT/CT visual grades (rho=0.794, p<0.0001), KL scores (rho=0.703, p<0.0001), and MRI scores (rho=0.714-0.808, p≤0.0002); however, SUVmax and other imaging parameters were not correlated with patient symptom scores (p>0.05).. The SUVmax of quantitative bone SPECT/CT was highly correlated with traditional imaging parameters for medial compartment OA severity of the knee. Quantitative bone SPECT/CT is a promising imaging technique for the objective assessment of knee OA.

Topics: Adult; Arthrography; Bone and Bones; Female; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Middle Aged; Osteoarthritis, Knee; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

The aim of this study was to analyze subchondral bone scan uptake in osteoarthritic knees with reference to subchondral bone microstructure and articular cartilage histology.. This cross-sectional, laboratory study evaluated 123 human distal femoral condyle specimens of 67 patients after joint replacement surgery. All patients were preoperatively examined with bone scan of the knee joint. Specimens were evaluated for cartilage histology and micro-computed tomography analysis of subchondral bone. Data between bone scan, histology and micro-computed tomography were statistically analyzed using either coefficient of correlation, Student's t-test or one-way analysis of variance with Tukey post hoc test.. Bone scan grading and histological articular cartilage degeneration scores showed significant correlation (r = 0.812, P < 0.001). Both bone scan positive and histologically confirmed osteoarthritis samples showed increase in subchondral trabecular bone volume and thickness, reflected in micro-computed tomography. Overall, positive predictive value (%) of bone scan for osteoarthritic cartilage lesions was 91.9%, and the sensitivity and specificity were 88.3% and 60%, respectively. Histology showed that bone scan has both a high positive predictive and a low negative predictive value for detection of osteoarthritic cartilage lesions.. Bone scan uptake correlated with articular cartilage degeneration in osteoarthritic knees. Bone scan may be a useful diagnostic tool that reflects pathologic changes of cartilage in osteoarthritis.

Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee; Biopsy; Cartilage, Articular; Cross-Sectional Studies; Female; Femur; Humans; Knee Joint; Male; Middle Aged; Osteoarthritis, Knee; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; X-Ray Microtomography

The primary purpose of this retrospective study was to evaluate the differences of bone tracer uptake (BTU) in symptomatic and asymptomatic knees after bilateral total knee arthroplasty (TKA) and identify typical BTU patterns with regards to TKA component position and alignment.. A consecutive number of 37 patients after bilateral TKA were retrospectively included. The knees were grouped into symptomatic (group A) and asymptomatic (group B) knees. All patients underwent 99m-Tc-HDP-SPECT/CT. Coronal, rotational, and sagittal TKA component position was analysed in 3D reconstructed CT. BTU was anatomically localised and quantified using a validated standardized localization scheme. Maximum BTU values for each area were recorded and normalized values calculated. Signed log-rank test, chi-square test, paired t-tests, and Pearson correlations were used (p <0.05).. Symptomatic TKAs were significantly more flexed and had a tendency to be more internally rotated when compared to asymptomatic ones (p < 0.05). In all regions, the mean BTU in asymptomatic knees was lower than in symptomatic knees. In both groups the highest mean BTU was found around the tibial stem (symptomatic 7.30; asymptomatic 6.30, p = 0.061) and at the tip of the tibial stem (symptomatic 5.49; asymptomatic 4.74, p = 0.062). Superior patellar regions showed higher BTU than inferior regions. The highest patellar BTU was found in the superior medial patella (symptomatic 4.99; asymptomatic 3.98, p = 0.048). The lowest BTU was found in the posterior femoral regions (flatsp, flatip, fmedsp, fmedip) (Table 3). Tibial and patellar areas showed twice as high mean BTUs than femoral areas (Fig. 3). A significant correlation of TKA component position and BTU was demonstrated.. Distribution and intensity of BTU in SPECT/CT depends on TKA component position and alignment. In addition, typical BTU patterns in symptomatic and asymptomatic knees were identified. A profound knowledge of BTU pattern, TKA component position, and alignment helps to identify pathologies in patients after TKA.. Diagnostic study, level II.

Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee; Asymptomatic Diseases; Female; Humans; Male; Middle Aged; Multimodal Imaging; Osteoarthritis, Knee; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The information content of knee bone scintigraphy was evaluated, including pattern, localisation and intensity of retention relative to radiographic features of knee osteoarthritis, knee alignment and knee symptoms.. A total of 308 knees (159 subjects) with symptomatic and radiographic knee osteoarthritis of at least one knee was assessed by late-phase (99m)Technetium methylene disphosphonate bone scintigraph, fixed-flexion knee radiograph, full limb radiograph for knee alignment and for self-reported knee symptom severity. Generalised linear models were used to control for within-subject correlation of knee data.. The compartmental localisation (medial vs lateral) and intensity of knee bone scan retention were associated with the pattern (varus vs valgus) (p<0.001) and severity (p<0.001) of knee malalignment and localisation and severity of radiographic osteoarthritis (p<0.001). Bone scan agent retention in the tibiofemoral, but not patellofemoral, compartment was associated with severity of knee symptoms (p<0.001) and persisted after adjusting for radiographic osteoarthritis (p<0.001).. To the authors' knowledge, this is the first study describing a relationship between knee malalignment, joint symptom severity and compartment-specific abnormalities by bone scintigraphy. This work demonstrates that bone scintigraphy is a sensitive and quantitative indicator of symptomatic knee osteoarthritis. Used selectively, bone scintigraphy is a dynamic imaging modality that holds great promise as a clinical trial screening tool and outcome measure.

Topics: Aged; Bone Malalignment; Cohort Studies; Female; Humans; Knee Joint; Male; Middle Aged; Osteoarthritis, Knee; Pain Measurement; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Severity of Illness Index; Technetium Tc 99m Medronate

To evaluate that single photon emission computed tomography (SPECT) could reflect the clinical severity of knee osteoarthritis (OA) and to determine the clinical usefulness of SPECT as a sensitive imaging method detecting early OA.. Sixty knees of thirty OA patients were examined with (99m)Tc-methylene diphosphonate (MDP) bone SPECT, the intensity of uptake was graded and the sites of uptake were localized. One hundred millimeter visual analog scale (VAS), Western Ontario McMaster Universities (WOMAC) Osteoarthritis Index scores and physical examination were assessed. Simple radiograph and musculoskeletal ultrasonography (US) were performed, and Kellgren-Lawrence (K-L) grades were determined. The relationships between clinical findings, simple radiographic findings, US findings and the intensity of uptake in SPECT were analyzed.. There were increased uptakes in 91.7% of the knees, and patella and medial tibial condyle were the most common sites of the uptakes. Symptomatic knees had significantly higher intensity of uptake than asymptomatic knees. Uptake intensity of medial compartment in SPECT well correlated with clinical findings, such as VAS, WOMAC scores, and physical examination, as well as US findings. Even in the symptomatic knees without abnormal radiographic findings, the increased uptake was observed in SPECT.. In patients with knee OA, SPECT findings are well correlated with clinical findings, such as pain scores and physical examinations, and SPECT appears to be a sensitive tool for early detection of knee OA. SPECT information could be useful for determining clinical severity of knee OA and for diagnosing early OA more effectively.

Topics: Female; Humans; Knee Joint; Male; Middle Aged; Osteoarthritis, Knee; Pain Measurement; Sensitivity and Specificity; Severity of Illness Index; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

We studied whether a small capsular incision alone, or combined with meniscectomy could induce early osteoarthritic changes in the rabbit knee. Thirty-one rabbits were operated on with a capsular incision in the left knee and meniscectomy in the right knee. Another 12 rabbits were used as controls. The rabbits were killed 3, 6 and 12 weeks after surgery. Osteoarthritic changes in the articular cartilage were evaluated by the modified Mankin score. The subchondral bone was evaluated by scintimetry ((99m)Tc-HDP) and semiquantitative grading of histological changes. Osteogenic protein (OP-1) in its mature and pro-form was examined by immunohistochemistry. Both a capsular incision and meniscectomy induced articular cartilage fibrillation and increased bone metabolic activity during the initial weeks after surgery. Capsular incision led to lesser changes than meniscectomy. Mature OP-1 was elevated, and its pro-form reduced, in meniscectomized knees. A similar pattern was observed in knees with capsular incision. Already 3 weeks after surgery, the articular cartilage and subchondral bone showed typical signs of early osteoarthritis (OA), and a reparative response was suggested by increased intensity of OP-1 staining. As these signs were also found in knees with capsular incision only, it appears that trauma-related factors such as increased bleeding and inflammation are critical for the development of OA.

Topics: Animals; Bone Morphogenetic Protein 7; Bone Morphogenetic Proteins; Bone Remodeling; Cartilage, Articular; Femur; Immunohistochemistry; Joint Capsule; Knee Joint; Menisci, Tibial; Osteoarthritis, Knee; Rabbits; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia; Transforming Growth Factor beta

Plain X-ray is an imprecise tool for monitoring the subchondral bony changes associated with the development of knee osteoarthritis (OA). Our objective was to develop and validate a technique for assessing tibial subchondral bone density (BMD) in knee OA using dual energy X-ray absorptiometry (DXA).. Patients with OA of at least one knee underwent DXA scanning of both knees. Regions of interest (ROI) were placed in the lateral and medial compartments of tibial subchondral bone. Weight-bearing plain X-rays and Te (99m) scintiscans of both knees were obtained and scored.. One hundred and twelve patients (223 knees) underwent DXA and radiography. Intra-observer CV% was 2.4% and 1.0% for the medial and lateral ROI respectively. Definite OA (Kellgren and Lawrence Grade 2, 3 or 4) was correlated with age-related preservation of subchondral BMD compared to radiographically normal knees. Raised BMD was also associated with subchondral sclerosis, and positive scintigraphy.. DXA may provide a safe, rapid and reliable means of assessing knee OA. Cross-sectional age-related subchondral tibial BMD loss is attenuated by knee OA.

Topics: Absorptiometry, Photon; Age Factors; Aged; Bone Density; Cohort Studies; Confidence Intervals; Cross-Sectional Studies; Female; Follow-Up Studies; Humans; Knee Joint; Male; Middle Aged; Observer Variation; Osteoarthritis, Knee; Osteosclerosis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sex Factors; Single-Blind Method; Technetium Tc 99m Medronate; Tibia