technetium-tc-99m-medronate and Osteoarthritis

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

Topics: Adult; Animals; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Biopsy; Bone Diseases; Humans; Knee Joint; Menisci, Tibial; Middle Aged; Osteoarthritis; Patella; Radionuclide Imaging; Reproducibility of Results; Technetium Tc 99m Medronate; Tibial Meniscus Injuries

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

Both osteoarthritis and impingement syndrome are the disorders commonly observed in sports medicine. However, failure in pain alleviation by surgical intervention introduces challenges in the diagnosis and decision-making for orthopedists. Hybrid single photon emission computed tomography/computed tomography (SPECT/CT) provides both functional and structural information of ankle pathology. The purpose of this retrospective study was to evaluate whether bone tracer uptake by ankle SPECT/CT is related to the lesion type and visual analog scale (VAS) pain score for patients with osteoarthritis and bony impingement. Fifty individuals with chronic ankle pain who underwent pretreatment ankle SPECT/CT were included in the current study. The median follow-up period was 2.5 (range 1.8 to 3.2) years. The lesion types were categorized by the positions of anatomical changes and bone tracer uptake. The VAS pain score was recorded 2 weeks before and 1.5 year after surgical intervention. Twenty-nine (58%) of 50 patients had osseous impingement. Among them, 16 (55.2%), 4 (13.8%), and 9 (31%) patients had anterior, posterior, and both types of ankle impingement, respectively. The uptake grade of bone tracer was significantly related to the lesion type of ankle impingement (p < .001). The VAS pain score was significantly correlated with bone tracer uptake before treatment (p < .001). Bone tracer uptake was related to the lesion type of impingement detected by SPECT/CT and was confirmed by surgical findings. The VAS pain score was significantly correlated with the bone tracer uptake. Preoperative ankle SPECT/CT may be helpful to clinically correlate the VAS pain score in the pre- and postsurgical periods for patients with osteoarthritis and bony impingement syndrome.

Topics: Adult; Aged; Aged, 80 and over; Ankle Joint; Arthralgia; Female; Fluorodeoxyglucose F18; Humans; Joint Diseases; Male; Middle Aged; Osteoarthritis; Radiopharmaceuticals; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate; Visual Analog Scale; Young Adult

The study aims to evaluate whether bone scintigraphy is effective in diagnosing temporomandibular joint (TMJ) osteoarthritis (OA) in juvenile patients. A retrospective study was conducted with 356 consecutive patients with TMJ-OA who were clinically assessed according to the Research Diagnostic Criteria for Temporomandibular Disorders. Patients were assigned to three groups based on their ages: Group 1: aged 12-16 years; Group 2: aged 17-19 years; and Group 3: aged 20 years. Additionally, we performed qualitative and quantitative analyses of bone scintigraphy images for the TMJ uptake ratio of the involved joint. The diagnostic rate of TMJ-OA (

Topics: Adolescent; Arthralgia; Child; Cone-Beam Computed Tomography; Female; Humans; Male; Osteoarthritis; Pain Measurement; Radiography, Panoramic; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate; Temporomandibular Joint Disorders; Young Adult

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

Bone and joint infections are common diseases in pediatrics. They still are a public health problem in Tunisia. The diagnosis is based on clinical, biological, radiological and skeletal scintigraphy arguments. The purpose of this study is to determine the contribution of triple phase bone scan in the exploration of musculoskeletal pain febrile child.. This was a descriptive and retrospective study. It was conducted over a period of 5 years. It has interested all children explored in nuclear medicine department with suspected acute osteomyelitis (OMA) , osteoarthritis (OA) or septic arthritis (SA) referred from Orthopaedic Infantile service. All these patients had, alongside the conventional radiologic exams, a triple phase bone scan HMDP-Tc99m.. We collected 62 patients. Among the selected diagnoses, there were: 22 OMA, 4 OA, 4 SA. The mean age of the patients was 5.58 years with a male predominance. The main reason for consultation was pain. Fever was ≥ 38° C in 80 % of cases. The preferential localization was the lower limb (93.5 %). The quantitative and qualitative bone scan abnormalities objectified led to a correct diagnosis of: 18 OMA, 3 OA and 2 SA with a respectively estimated sensitivity and specificity of 76.6% and 90.6% in the all population.. Bone scan demonstrates early abnormalities allowing osteoaricular infection diagnosis. It highlights the infection site, and draws a map of the lesions. Currently, imaging modalities differ in their availability, their cost, their input and diagnostic accuracy but they are complementary.

Topics: Acute Disease; Adolescent; Arthritis, Infectious; Child; Child, Preschool; Female; Fever; Hospitalization; Humans; Infant; Male; Osteoarthritis; Osteomyelitis; Pain; Pain Management; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Tunisia

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

The purpose of this study was to compare the clinical utility of fluoride-18 positron emission tomography (¹⁸F-PET)/CT with that of conventional (99m)Tc-methylene diphosphonate (MDP) bone scan in temporomandibular disorder (TMD) with osteoarthritis.. 24 patients with TMD who underwent both ¹⁸F-PET/CT and (99m)Tc-MDP bone scans for diagnostic work-up were enrolled. The temporomandibular joint (TMJ)-to-skull uptake ratio, TMJ-to-muscle uptake ratio and TMJ-to-spine uptake ratio on ¹⁸F-PET/CT and the TMJ uptake ratio on bone scan were measured.. Of the 48 TMJs in 24 patients, 35 TMJs were diagnosed as TMD with osteoarthritis, 8 TMJs as TMD with anterior disc displacement (ADD), and the remaining 5 TMJs showed no evidence of TMD (NED). All three uptake ratios on ¹⁸F-PET/CT and the TMJ uptake ratio on the bone scan tended to be higher in TMD with osteoarthritis than in TMD with ADD or NED. Receiver operating characteristic (ROC) curve analysis for detecting TMD with osteoarthritis indicated that the TMJ-to-skull uptake ratio, TMJ-to-muscle uptake ratio and TMJ-to-spine uptake ratio on PET/CT (0.819, 0.771 and 0.813, respectively) showed higher area under the ROC curve value than the TMJ ratio on bone scan (0.714). The TMJ-to-skull uptake ratio on PET/CT showed the highest sensitivity (89%) and accuracy (81%) of all uptake ratios.. ¹⁸F-PET/CT can help diagnose TMD with osteoarthritis with superior diagnostic ability and is a suitable alternative modality to a conventional (99m)Tc-MDP bone scan.

Topics: Adult; Area Under Curve; Cervical Vertebrae; Female; Fluorodeoxyglucose F18; Humans; Joint Dislocations; Male; Muscle, Skeletal; Osteoarthritis; Parietal Bone; Positron-Emission Tomography; Radiopharmaceuticals; ROC Curve; Sensitivity and Specificity; Technetium Tc 99m Medronate; Temporal Bone; Temporomandibular Joint; Temporomandibular Joint Disc; Temporomandibular Joint Disorders

The objective of this study was to evaluate the usefulness of bone scan procedures for the diagnosis of temporomandibular joint (TMJ) osteoarthritis.. From February 2009 to June 2009, 22 patients (4 males and 18 females) from Seoul National University Bundang Hospital, Republic of Korea, were diagnosed with TMJ disorder. They were examined by clinical examination, plain radiograph and bone scan and were categorized into three groups: normal, internal derangement and osteoarthritis. TMJ uptake ratios and asymmetrical indices were calculated.. There were no significant differences in uptake ratios associated with pain and bone change. However, significant results were obtained when comparing uptake ratios between the osteoarthritis and non-osteoarthritis groups.. It was concluded from this study that bone scans may help to diagnose osteoarthritis when increased uptake ratios are observed.

Topics: Adolescent; Adult; Aged; Arthralgia; Facial Pain; Female; Humans; Image Processing, Computer-Assisted; Joint Dislocations; Male; Middle Aged; Osteoarthritis; Parietal Bone; Physical Examination; Radiography, Panoramic; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Temporomandibular Joint Disorders; Young Adult

The spine is a common site of various pathologic changes. On bone scans, differential diagnosis between metastasis and benign changes is not always easy. We describe a characteristic bone scan appearance of facet osteoarthritis most often seen at the fifth lumbar level. The lesion typically appears oval/elongated in shape, located along the lateral margin of the spine; its superior end is usually outside (lateral to) or just at the margin of the spine, and the inferior end is just at or inside (medial to) the margin, yielding a pattern of slightly oblique activity.. Bone scans performed in 448 patients with known malignancy and interpreted as having some sort of spinal abnormalities were reviewed. Of these, the scans in 36 patients were judged to show the facet osteoarthritis sign (FOS). Follow-up was available in 28 of the 36 patients. The presence or absence of metastasis at the site of the FOS was determined by a minimum of 6-month follow-up by chart review and correlation with plain radiographs, computed tomography (CT), magnetic resonance imaging, and/or serial bone scans.. None of the 28 patients had metastasis at the site of the FOS. CT and/or plain radiographs performed in 13 patients invariably showed facet disease.. When planar bone scan images show the FOS, further evaluation of this region with SPECT imaging or other imaging, ie, plain radiography, CT, or magnetic resonance imaging, would be unnecessary because this sign has an extremely high negative predictive value for metastasis (100% in this series).

Topics: Adult; Aged; Aged, 80 and over; False Negative Reactions; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteoarthritis; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Risk Assessment; Risk Factors; Sensitivity and Specificity; Spinal Neoplasms; Technetium Tc 99m Medronate; Zygapophyseal Joint

Topics: Aged; Bone and Bones; Humans; Knee Joint; Male; Osteoarthritis; Radionuclide Imaging; Radiopharmaceuticals; Synovial Fluid; Technetium Tc 99m Medronate

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

The aim of this study is to determine the sacroiliac index (SII) of healthy subjects and to compare these values with patients having sacroiliitis (SI). Quantitative sacroiliac scintigraphy (QSS) was performed with Tc-99m hydroxy methylene diphosphonate (HMDP) and whole sacroiliac joint-to-sacrum ratio was calculated as a SII by the region of interest (ROI) method. Forty-seven nonarthritic healthy subjects and 13 patients with SI were studied. Effects of aging, gender and laterality on SII were evaluated in 47 healthy subjects. The sacroiliac index was higher in men than women (p < 0.05). SII did not change significantly in aged men, but it decreased significantly in aged women (p < 0.05). Eleven of 13 patients with SI had a higher SII than healthy subjects (> mean + 2SD). In the other two cases by using small ROIs, SIIs were found to be higher than the normal range. Our results suggest that QSS is a sensitive method for the diagnosis of early stage SI and every institution should establish its own normal SII.

Topics: Adolescent; Adult; Age Factors; Female; Humans; Inflammation; Male; Middle Aged; Osteoarthritis; Radionuclide Imaging; Radiopharmaceuticals; Reference Values; Reproducibility of Results; Sacroiliac Joint; Sensitivity and Specificity; Sex Characteristics; Technetium Tc 99m Medronate

A retrospective study was made to evaluate the usefulness of bone SPECT of the dorsolumbar spine in identifying benign and malignant lesions. A study was made of oncological patients who presented active images in the spinal column visible on planar radionuclide scans who also underwent SPECT. The average follow-up period was 25+/-13 months.. In 43 neoplastic patients 55 visible lesions on SPECT were evaluated, of which 29 were benign and 26 metastatic. The criteria for benign lesions were the absence of change or involution without treatment in the follow-up period. The criteria for classifying metastases were: 1. Positive biopsy. 2. Neurological complications derived from the lesion. 3. Increased extension and tracer uptake by the lesion, and the appearance of other bone metastases.. Twelve of 15 lesions located in the vertebral body or pedicle and 11/16 located in the body with extension toward the pedicles were metastases. Twenty-one of 24 lesions located on the anterior face of the vertebral body, articular processes, lamina, or intervertebral disk were benign.. Bone SPECT was useful for locating the vertebral lesion, which in many cases allows differentiation of benign and metastatic lesions.

Topics: Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Evaluation Studies as Topic; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Neoplasms; Osteoarthritis; Retrospective Studies; Spinal Diseases; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, Emission-Computed, Single-Photon

Osteoarthritis (OA) is a multifactorial process affecting cartilage and subchondral bone. Traditionally, plain radiographs and eventually bone scintigraphy are used to establish the diagnosis, whereas MR imaging, as a sensitive instrument for early diagnosis, is less commonly used. Therefore, these methods have been compared in the format of a prospective study of knee OA.. Individuals aged 35-54 years with chronic knee pain have been identified. The prevalence of chronic knee pain was 15% (279/2,000). Within this group, both knees in 61 randomly chosen persons were examined with plain weight-bearing radiographs of the tibiofemoral joint (TFJ), standing axial radiographs of the patellofemoral joint (PFJ), and with bone scintigraphy. One knee (the most painful at inclusion in the study) in each person was examined with MR imaging on a 1.0 T imager.. Assessment of the minimal joint space (MJS) width in the p.a. view of the TFJ in weight-bearing examinations should be performed with equal weight on both legs and in semiflexion. The p.a. view of the TFJ and the axial view of the PFJ, as well as the MJS measurements in these views, were reproducible. MJS of 3 mm in the TFJ and MJS of 5 mm in the PFJ are limits in diagnosing joint-space narrowing (JSN) in the TFJ and the PFJ, respectively. There was a high prevalence of meniscal abnormalities within the narrowed compartments of the TFJ when compared with those that were not narrowed. With the presence of marginal osteophytes in the TFJ, there was a high prevalence of MR-detected cartilage defects in the same joints whether JSN (MJS < 3 mm) was present or not. No such relationship, independent of MJS, was found between marginal osteophytes and cartilage defects in the PFJ. The agreement between increased bone uptake and MR-detected subchondral lesion (increased signal in the STIR sequence) was good. The agreement between increased bone uptake and MR-detected osteophytes or cartilage defects was in general poor. Conventional radiography is inexpensive and readily available. With the increased knowledge about interpreting weight-bearing p.a. radiographs of the TFJ and standing axial radiographs of the PFJ, these examinations will, even in the future, be a valuable and competitive technique compared with a more expensive and sophisticated method such as MR imaging, when evaluating knee pain. Further studies have to be performed to evaluate whether MR imaging has the same ability as bone scintigraphy to predict the progression of the OA process in the knee joint.

Topics: Adult; Female; Follow-Up Studies; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Middle Aged; Osteoarthritis; Prospective Studies; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Sampling Studies; Sweden; Technetium Tc 99m Medronate; Time Factors

In order to evaluate the diagnostic efficiency of arthroscintigraphy in suspected rotator cuff ruptures this new imaging procedure was performed 20 times in 17 patients with clinical signs of a rotator cuff lesion. The scintigraphic results were compared with sonography (n = 20), contrast arthrography (n = 20) and arthroscopy (n = 10) of the shoulder joint.. After performing a standard bone scintigraphy with intravenous application of 300 MBq 99m-Tc-methylene diphosphonate (MDP) for landmarking of the shoulder region arthroscintigraphy was performed after an intraarticular injection of 99m-Tc microcolloid (ALBU-RES 400 MicroCi/5 ml). The application was performed either in direct combination with contrast arthrography (n = 10) or ultrasound conducted mixed with a local anesthetic (n = 10). Findings at arthroscopical surgery (n = 10) were used as the gold standard.. In case of complete rotator cuff rupture (n = 5), arthroscintigraphy and radiographic arthrography were identical in 5/5. In one patient with advanced degenerative alterations of the shoulder joint radiographic arthrography incorrectly showed a complete rupture which was not seen by arthroscintigraphy and endoscopy. In 3 patients with incomplete rupture, 2/3 results were consistent. A difference was seen in one patient with a rotator cuff, that has been already revised in the past and that suffered of capsulitis and calcification.. Arthroscintigraphy is a sensitive technique for detection of rotator cuff ruptures. Because of the lower viscosity of the active compound, small ruptures can be easily detected, offering additional value over radiographic arthrography and ultrasound, especially for evaluation of incomplete cuff ruptures.

Topics: Adult; Aged; Diagnosis, Differential; Female; Humans; Humerus; Male; Middle Aged; Osteoarthritis; Radionuclide Imaging; Radiopharmaceuticals; Rotator Cuff; Rotator Cuff Injuries; Rupture; Shoulder Impingement Syndrome; Shoulder Injuries; Shoulder Joint; Technetium Tc 99m Medronate; Ultrasonography

To examine the effects on 99mTc medronate (MDP) bone scintigraphy of unilateral anterior cruciate ligament (ACL) transection in the unstable and contralateral knee of dogs.. Bone scintigraphy was performed in 5 dogs at baseline and 6 and 12 weeks after ligament transection, with images of both knees obtained 3-4 h after intravenous injection of the radionuclide. An image of the T4-T5 vertebral region was also acquired as an internal standard. In 3 additional dogs, scintigraphy was performed at baseline and 5 1/2 weeks after sham ACL transection.. A marked increase in uptake of 99mTc MDP was seen in the unstable knee. In contrast, in all but one case uptake in the contralateral knee did not increase significantly. Sham ligament transection had no effect on uptake of the radionuclide.. Changes occur in subchondral bone as well as in articular cartilage in the unstable knee in this model. The bony changes, which could be either primary or secondary to early changes in the biomechanical properties of the cartilage, may contribute to the pathogenesis of cartilage damage. No appreciable effects on bone turnover in the contralateral knee could be proved in this study.

Topics: Animals; Anterior Cruciate Ligament; Bone and Bones; Cartilage, Articular; Dogs; Knee Joint; Male; Osteoarthritis; Radionuclide Imaging; Technetium Tc 99m Medronate; Uronic Acids

We studied the pattern of 99mTc-methylene diphosphonate uptake around uncemented femoral components in 44 asymptomatic hip arthroplasties, performing isotope scans at intervals from 4 to 48 months after operation. We used phase-II images obtained with a high-resolution gamma camera and measured the activity in various zones using a specially designed computer program. The components studied at 4, 6, 9 and 12 months were coated with hydroxyapatite (HA) and those studied at 18, 24, 36 and 48 months were not coated. We found a statistically significant fall in activity between four and six months around HA-coated prostheses in all five femoral periprosthetic zones. After six months activity was relatively uniform, but remained higher than that in normal femoral bone at 48 months in non-coated prostheses. We discuss the application of these patterns in the evaluation of painful cementless hip arthroplasties.

Topics: Adult; Female; Femur; Hip Prosthesis; Humans; Male; Middle Aged; Osteoarthritis; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Medronate

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

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

A case of reflex sympathetic dystrophy (RSD) after total hip replacement (THR) is reported. It is a very unusual cause of pain after any arthroplasty procedure. Three-phase bone imaging diagnosed the condition and sympathetic blockade was used for confirming and treating the condition. The role of the bone scan in differentiating RSD from other causes of pain after THR is highlighted.

Topics: Ankle Joint; Diagnosis, Differential; Femur; Femur Head Necrosis; Hip Joint; Hip Prosthesis; Humans; Knee Joint; Leg; Male; Middle Aged; Nerve Block; Osteoarthritis; Pain, Postoperative; Radionuclide Imaging; Radiopharmaceuticals; Reflex Sympathetic Dystrophy; Regional Blood Flow; Sympathetic Nervous System; Technetium Tc 99m Medronate

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

Quantitative bone scanning of the hip was carried out in 50 patients, 45 with unilateral disorders, and 5 with no symptoms and normal radiographs. The uptake ratio of the involved femoral head was calculated in the perfusion and static phases. In the patients with no symptoms the difference in the uptake ratio between the right and left hips averaged less than 0.02 in both phases. In 5 patients with a unilateral endoprosthesis the average was 0.52 in the perfusion and 0.34 in the static phase. In 10 patients with intertrochanteric fractures, 9 with undisplaced femoral neck fractures and 7 with osteoarthritis, each uptake ratio averaged more than 1.1 in both phases. In 9 patients with displaced femoral neck fractures, the mean ratio was 0.76 in the perfusion and 0.92 in the static phase. In 5 patients with avascular necrosis the ratio was 0.82 in the perfusion and 1.57 in the static phase. Quantification of uptake in both phases provides objective data reflecting bone blood flow and metabolism in various disorders of the hip.

Topics: Adult; Aged; Aged, 80 and over; Female; Femoral Neck Fractures; Femur Head; Hip Fractures; Humans; Male; Middle Aged; Osteoarthritis; Osteonecrosis; Radionuclide Imaging; Regional Blood Flow; Technetium Tc 99m Medronate

A prospective study was designed to compare two methods of quantifying technetium-99m methylene diphosphonate uptake in the mandibular condyle. The standard technique expresses condylar activity as a ratio of condylar uptake to a reference (often the fourth lumbar vertebra) with planar scans (lateral images of the mandible). The experimental technique quantifies condylar activity as a ratio of condyle to clivus uptake with single-photon emission computed tomography (SPECT). The results of this study indicated that the uptake ratio of condyle/clivus by SPECT scintigram was positively correlated (p = 0.039) with the planar scan technique. The SPECT technique, similar to an axial computed tomography scan, was easier to perform with better reproducibility than the standard planar technique. In addition, activity in the clivus showed less variation than activity in the fourth lumbar vertebrae. With the development of normal uptake standards in the clivus, the SPECT technique may replace the planar image technique in nongrowing patients.

Topics: Adolescent; Adult; Bone Resorption; Cohort Studies; Cranial Fossa, Posterior; Female; Humans; Hyperplasia; Linear Models; Lumbar Vertebrae; Male; Mandibular Condyle; Mandibular Diseases; Middle Aged; Osteoarthritis; Prospective Studies; Radionuclide Imaging; Reference Standards; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Determining the etiology of a focal lesion seen on bone scan in patients with primary tumors usually requires the use of other imaging procedures or biopsy. Single positron emission computed tomography (SPECT) with high resolution multidetector systems can localize the specific site of a vertebral lesion and in this way potentially differentiate between benign and metastatic disease. SPECT images of the lower thoracic and lumbar spine were reviewed for lesion location and intensity by two experienced interpreters. Follow-up data were adequate to ascertain the cause of 71 lesions seen on SPECT in 29 patients. Twenty-six of these lesions were not seen on planar images. Of the 71 lesions, 44 were benign and 27 metastatic. Of the 15 lesions where the pedicle was involved, 11 were found to metastatic. There were a total of 14 facet lesions, 9 of which were present in vertebra with no lesions at sites other than the facets. All 9 of these isolated facet lesions turned out to be benign. Lesion intensity did not distinguish benign from malignant disease. We conclude that SPECT imaging is useful in determining the etiology of focal lesions seen on bone scan in patients with a known primary tumor referred for evaluation of metastatic disease.

Topics: Colonic Neoplasms; Diagnosis, Differential; Diagnostic Imaging; Follow-Up Studies; Humans; Image Enhancement; Lumbar Vertebrae; Lung Neoplasms; Male; Osteoarthritis; Prostatic Neoplasms; Sensitivity and Specificity; Spinal Diseases; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, Emission-Computed, Single-Photon

Hand radiographs and scintigraphy were obtained initially and at the 4-year follow-up in 15 patients with symptomatic osteoarthritis (OA) of distal and/or proximal interphalangeal joints. For each joint, a 0-15 score was obtained for the OA radiographic lesions read blind by the same observer. An abnormal isotope retention over a bone reference area was assessed and quantified. The predictive value of scintigraphy for the OA radiographic progression was confirmed and shown to be improved by a second investigation. During the study period, the percentage of radiographic OA joints increased from 66.3 to 76.6%, but joints showing an abnormal scan decreased from 40 to 22.5%. Progression of the OA radiographic score was closely related to scintigraphic changes. The mean difference between the final and initial OA score was -0.08 in joints with two normal scans (N = 115), +0.73 in joints showing a first abnormal and a second normal scan (N = 94) and +1.8 in joints with two abnormal scans (N = 14) or a scan becoming abnormal (N = 47). An abnormal scan appears to represent a transient event, and this event is associated with a period of progression of digital OA. Potentially, anti-OA therapies that suppress joint isotope retention might slow down OA progression. The magnitude of joint isotope retention was positively correlated with the OA radiographic score established at the same time (R = 0.61 and P < 0.001), but showed no predictive value for progression of the latter.

Topics: Adult; Aged; Female; Finger Joint; Follow-Up Studies; Humans; Male; Middle Aged; Osteoarthritis; Radionuclide Imaging; Range of Motion, Articular; Reproducibility of Results; Technetium Tc 99m Medronate

Palmoplantar pustulosis (PPP) is often associated with osteoarthritis. The relation between osteoarthritis in PPP and other types of seronegative arthritis remains unclear.. The purpose of this study was to investigate the distribution and the frequency of osteoarthritis in patients with PPP and to compare HLA antigen frequencies in osteoarthritis in PPP, psoriatic arthritis, and ankylosing spondylitis.. Clinical findings were identified and HLA-A, -B, -C, and -DR were determined in 84 Japanese patients with PPP. Bone scintigraphic studies were conducted for forty-one patients.. In addition to the anterior aspect of the chest wall, the knee, spine, and ankle were frequently involved. HLA-DR9 frequency was the highest in patients with PPP who had osteoarthritis.. Involvement of the knees, spine, ankles, and the anterior aspect of the chest wall was noted in patients with osteoarthritis and PPP. Osteoarthritis in PPP seems to be a distinct entity from a genetic point of view.

Topics: Adult; Aged; Arthritis, Psoriatic; Female; HLA-A Antigens; HLA-B Antigens; HLA-C Antigens; HLA-DR Antigens; Humans; Japan; Knee Joint; Male; Middle Aged; Osteoarthritis; Psoriasis; Radionuclide Imaging; Spine; Spondylitis, Ankylosing; Sternoclavicular Joint; Technetium Tc 99m Medronate

Radiolabeled granulocyte scintigraphy is a recently introduced technique for detecting osteoarticular infections. Technetium-99m-labeled hexamethylpropylamineoxime (HMPAO), in use since 1986, provides excellent resolution with less radiation exposure than indium-111. Elimination of lymphocytes provides further improvements in image quality and safety, making the technique suitable for use in children. The authors prospectively studied 30 scintigraphies performed with isolated autologous 99mTc-HMPAO-labeled granulocytes to evaluate suspected osteoarticular infection. Image quality was outstanding. In peripheral sites, infection manifested as a focus of increased uptake visible in all three phases (30 min, 3 hours and 18 hours after the injection). Performance was excellent, with 11 true-positive scans, 14 true negative scans, 4 false-positive scans (including two ascribable to recent surgery), and one false-negative scan. Among the 28 evaluable cases, positive predictive value was 85%, negative predictive value was 90%, and sensitivity, specificity, and accuracy were 92%, 88%, and 89%, respectively. The only limitation to routine use of this technique is the need for in vitro granulocyte separation which is time-consuming and requires special precautions to preserve granulocyte function. Nevertheless, these data demonstrate that 99mTc-HMPAO-labeled granulocyte scintigraphy is of value for the detection of osteoarticular infections in patients without chronic inflammatory joint disease.

Topics: Acute Disease; Adolescent; Adult; Aged; Bacterial Infections; Child; Chronic Disease; Extremities; Female; Granulocytes; Humans; Male; Middle Aged; Osteoarthritis; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate

We studied the results of bone scans in 50 consecutive patients with symptomatic, unilateral, chronic anterior cruciate ligament (ACL) tears. All patients had failed conservative therapy and underwent radionuclide imaging of the knee prior to arthroscopic ACL reconstruction. The scintigraphic activity in each of the three knee compartments was quantitatively scaled from 1 (normal scintigraphic activity) to 4 (marked activity). Quantitative activity in each of the three compartments was correlated with plain radiographic, arthroscopic, and clinical findings. All but four of the scans (92%) showed abnormal scintigraphic activity. The quantitative activity was highest overall in the medial compartment (2.9), followed by the lateral (2.4) and patellofemoral compartments (1.9). In the subgroup of patients with normal menisci (10 patients), most of the abnormal activity was in the lateral compartment (2.9), implying that when the medial meniscus remains competent in the presence of a torn ACL, there is increased stress on the lateral compartment. There was little correlation with scintigraphy and roentgenographic changes, except in the presence of moderate or severe radiographic degenerative arthritis. Similarly, there was little correlation between increased scintigraphic activity and chondromalacia. These results provide a baseline for future studies that use scintigraphic imaging in monitoring restoration of bone homeostasis following ACL reconstruction.

Topics: Adolescent; Adult; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Arthroscopy; Cartilage Diseases; Chronic Disease; Evaluation Studies as Topic; Female; Humans; Injury Severity Score; Male; Osteoarthritis; Preoperative Care; Radiography; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate; Wounds and Injuries

Thirty-five patients with OA of the hands had an early and late phase isotope bone scan performed at entry and 1 yr later. Simultaneous assessment of symptoms was made by a visual analogue pain score (VAS) and a tender joint articular index (AI) and comparisons were made between the clinical and scintigraphic findings. Sixty-five percent of joints were classed as positive in the late phase compared to 17% in the early phase scan. Thirteen per cent of joints were positive only in the early phase and 49% only in the late phase. There was no significant overall change in either phase of the scan in 1 yr. The pattern of positive joints showed considerable symmetry and wrist involvement. There was a high degree of correlation between AI and the late phase scan but none with the early phase scan. VAS showed no correlation with the late phase scan but did correlate significantly with the early phase scan at 1 yr.

Topics: Aged; Female; Hand; Humans; Male; Middle Aged; Osteoarthritis; Pain Measurement; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

Topics: Adult; Female; Humans; Male; Osteoarthritis; Radionuclide Imaging; Technetium Tc 99m Medronate; Temporomandibular Joint; Temporomandibular Joint Disorders

The possible contribution of an inflammatory component in osteoarthritis was investigated. There was no correlation between the percentage uptakes of 99Tcm-hexamethylpropyleneamine oxime (HMPAO)-labelled white blood cells and 99Tcm-methylene diphosphonate (MDP) and between the former and pain scores. A significant correlation was found between the percentage uptake of 99Tcm-MDP and pain scores (0.002 > P > 0.01). In osteoarthritis, 99Tcm-HMPAO-labelled white cell imaging may or may not show a positive localization in the synovial membrane. Positive white cell localization appears to be limited to the area that corresponds to the radiological evidence of the condition and the positive uptake of the skeletal imaging agent.

Topics: Adult; Aged; Cell Movement; Female; Humans; Inflammation; Knee Joint; Leukocytes; Male; Middle Aged; Neutrophils; Organotechnetium Compounds; Osteoarthritis; Oximes; Pain; Radionuclide Imaging; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

In patients with chronic low back pain, bone scintigraphy with single photon emission computed tomography (SPECT) of the lumbar spine allows identification of lesions not seen with planar imaging. In this study, findings from radiography, computed tomography (CT), and bone scintigraphy with SPECT in 34 patients with chronic back pain were examined to determine the nature and clinical relevance of the lesions. Twenty-seven patients had lesions at SPECT, of whom 24 (89%) had abnormalities at CT and 18 (67%) had abnormalities at radiography. SPECT allowed identification of 54 lesions, of which only 20 (37%) were detected with planar imaging. Forty-three (80%) SPECT lesions were located at the site of an abnormality also seen at CT and 20 (37%) at the site of an abnormality also seen at radiography. It was concluded that bone SPECT provides diagnostic information in chronic low back pain that is not available with radiography or planar imaging. The majority of lesions seen at SPECT corresponded to identifiable disease at CT.

Topics: Adult; Back Pain; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Osteoarthritis; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

A case of Kashin-Beck's disease is presented. It is an acquired, disabling, polyarthritic, degenerative condition of early onset, sometimes leading to a variable degree of dwarfism. It occurs endemically in certain Asian areas. Treatment is, if possible, preventive. In the established disease the therapy is that of any other form of secondary osteoarthritis. Reconstructive surgery and removal of loose bodies may be needed in severe cases (11). Early detection, facilitated by careful family history taking, is a prime requisite, especially in non-endemic areas (7).

Topics: Ankle; Hip Joint; Humans; Male; Medical History Taking; Middle Aged; Osteoarthritis; Radiography; Shoulder Joint; Syndrome; Technetium Tc 99m Medronate

Simultaneous clinical, scintigraphic, and macroradiographic assessments were carried out on 32 patients with hand osteoarthritis and the results at entry and one year reported. The presence and growth of osteophyte correlated with symptoms and a positive scan. The scan did not detect the radiographic features of juxta-articular radiolucencies, subchondral sclerosis, or cartilage thinning. Osteophytes, particularly when fast growing, produce pain, a 'hot' scan, and may predict disintegration of joint architecture.

Topics: Arthrography; Bone and Bones; Female; Hand; Humans; Joints; Male; Middle Aged; Osteoarthritis; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

In this prospective study, the radiological features characteristic of osteoarthritis of the hand were compared with the radionuclide bone scan images. A total of 32 patients was assessed at 6-monthly intervals for 18 months. Microfocal radiographs were taken at each visit. The high magnification and resolution of this technique permitted direct measurement of joint space width, subchondral sclerosis, osteophyte number and area and juxta-articular radiolucency area for each joint in the hand. Four-hour technetium 99m methylene diphosphonate bone scans were taken at 0 and 12 months and the activity of tracer uptake at each joint scored. The latter was compared with each X-radiographic feature at every visit and the changes between visits analysed. The scan scores did not correlate with any of the X-radiographic features other than osteophyte size. During the study the size of growing and remodelling osteophytes increased significantly at joints with raised or increased isotope uptake.

Topics: Female; Finger Joint; Hand; Humans; Male; Middle Aged; Osteoarthritis; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors; Wrist Joint

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

Twenty-eight patients with chronic abnormalities of the knee were examined by 3-phase scintigraphy and ECT. The unobscured images produced by ECT provide additional information for evaluating the localisation, extent and activity of the lesions. The diagnosis of meniscus abnormalities in particular revealed pathognomonic patterns. The indications and value of ECT was compared with other diagnostic measures and particularly with invasive techniques (arthroscopy and arthrotomy).

Topics: Humans; Joint Diseases; Joint Instability; Knee Joint; Menisci, Tibial; Osteoarthritis; Patella; Synovitis; Technetium Tc 99m Medronate; Tomography, Emission-Computed

The pattern of joint involvement on conventional radiographs and the four hour gammacamera image of 99Tc HMDP bone scans were studied in 33 patients with generalised nodal osteoarthritis. Both techniques showed the predominant involvement of the distal interphalangeal, scaphotrapezial, and first carpometacarpal joints. Some joints were abnormal just on one investigation: either x ray or scan alone. Others showed a marked dissimilarity in the severity of involvement on x ray compared with scan. This discrepancy between x ray and scan suggests that the scan is imaging a different process than the radiograph and offers a different way of assessing change in osteoarthritis.

Topics: Female; Hand; Humans; Male; Osteoarthritis; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

In 14 patients with generalised nodal osteoarthritis a four hour bone scan image was found to predict the changes that occur on the radiograph at follow up between three and five years later. The scan abnormality appeared to precede the development of radiographic signs, and joints abnormal on scintigraphy showed most progression. Normal joints and joints abnormal on x ray alone showed little progression, and those that did subsequently alter became abnormal on scan. Scanning may provide a sensitive technique for monitoring osteoarthritis, it may enable a greater understanding of the underlying disease process, and allow evaluation of modifying therapeutic procedures.

Topics: Female; Hand; Humans; Male; Osteoarthritis; Prospective Studies; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

The uptake of [99mTc]MDP in metastatic lesions of the vertebrae was compared with the uptake in normal vertebrae. The ratio of these lesion-to-nonlesion uptakes at 4 and 24 hr was called the 24-hr/4-hr ratio (TF ratio). A similar ratio was measured for lesions in the spine due to degenerative bone disease. Lesions in vertebrae with degenerative bone disease and treated metastases had a significantly lower TF ratio than lesions in vertebrae with untreated bone metastases. These findings suggest that the TF ratio might be a reliable method for separating metastatic lesions from degenerative changes in the vertebral column, and could be especially useful in cancer patients whose bone scans demonstrate a single lesion in the spine.

Topics: Adult; Aged; Diphosphonates; Female; Humans; Male; Middle Aged; Osteoarthritis; Radionuclide Imaging; Spinal Diseases; Spinal Neoplasms; Spinal Osteophytosis; Technetium; Technetium Tc 99m Medronate; Time Factors

The present study was undertaken to investigate the sites at which the 99mTc phosphorous compounds bind to skeletal tissue in general, and their localization at different stages of osteoarthritis in particular, in order thereby to arrive at a better morphological basis for interpreting the scintigrams. It was endeavoured also to relate the uptake of bone-seeking agents to abnormal changes in cartilage, synovium, and subchondral bone to obtain better insight into the pathogenesis of osteoarthritis. The bone remodelling activities in subchondral bone in osteoarthritic human femoral heads were elucidated by the alkaline phosphatase activity of osteoblasts and the acid phosphatase activity of osteoclasts. The enzyme activity was measured semiquantitatively by the initial time for the histochemical reaction. The distribution of the activity of the two enzymes in different areas proved parallel, and considerable variation in enzyme activity was seen between different areas within the same femoral head. Increased osteoarthritic cartilaginous changes were associated with increased subchondral enzyme activity, highest in denuded weightbearing areas and in the osteophytes and lowest in non-weightbearing subchondral bone and centrally in the femoral head. Studies on different histochemical staining of glycosaminoglycans in the matrix of human osteoarthritic cartilage and of normal cartilage revealed a heterogeneous distribution of the different glycosaminoglycans through the cartilage. Except for superficial loss of glycosaminoglycans, no difference was found in the distribution of keratan sulphate between osteoarthritic cartilage and control cartilage. In osteoarthritis, however, a relative increase in stainability for chondroitin sulphate was found in the territorial area, especially around the cell clusters, and only chondroitin sulphate was present in the cartilage of osteophytes. These findings were interpreted as an increased GAG metabolism, its mode of production being like that of very young cartilage. In the experimental rabbit model used in studying the uptake of bone-seeking agents this GAG regeneration was able to refill demasked collagen network with glycosaminoglycans in certain areas of the joint. The height of the depleted superficial area was estimated on patellar cartilage stained for sulphated GAG with toluidine blue-0 at pH 3, visually and by optical densitometry using the wavelength corresponding to the gamma-band of toluidine blue. The time rel

Topics: Alkaline Phosphatase; Animals; Autoradiography; Bone and Bones; Cartilage; Collagen; Diphosphonates; Disease Models, Animal; Dogs; Femur Head; Glycosaminoglycans; Humans; Knee; Knee Joint; Osteoarthritis; Proteoglycans; Rabbits; Radionuclide Imaging; Rats; Synovial Fluid; Synovial Membrane; Technetium; Technetium Tc 99m Medronate

Bone scintigraphy (99mTc-MDP) was used to study the development of experimental osteoarthritis produced by extension immobilization in rabbit knees. The purpose of the study was to determine a repeatable and noninvasive method for following the joint reaction leading to osteoarthritis. In comparison with the contralateral joints activity uptake in immobilized joints was already detectable in bone scintigraphy at 24 h, at the same time as the earliest changes in the biochemical reactions of joint tissues can be detected.

Topics: Animals; Bone and Bones; Diphosphonates; Female; Immobilization; Male; Osteoarthritis; Rabbits; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors

Topics: Arthritis, Infectious; Diphosphonates; Gallium Radioisotopes; Humans; Osteoarthritis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

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

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

In order to elucidate the uptake and localization of bone-seeking agents in early and advanced osteoarthritis, bone scintigraphy and contact autoradiography were employed in experimental rabbit osteoarthritis, induced by joint instability of the knee. 42 adult rabbits were examined after administration of 99mTc-methylene diphosphonate given intravenously 1, 2, 4, 6, 12, 26 weeks and 1 1/2-2 years postoperatively, 6 animals at each interval. The scintimetric ratio between uptake in the unstable joint vs. control joint had P6creased as early as one week postoperatively and was highest within the first 3 months. The autoradiograms revealed two localizations of increased 99mTc-MDP uptake during different stages in osteoarthritic development: early uptake in growing osteophytes and late uptake in subchondral bone. The uptake in the osteophytes was localized to the provisional calcifications of enchondral ossification and could be observed as early as one week postoperatively, before there was any radiographic sign of osteophytes. The osteophytic uptake was responsible for the highest scintimetric ratios registered, but in the advanced state most osteophytes had lost their earlier increased uptake. The late subchondral uptake was seen mostly in the medial compartment of the joint under denuded or eburnated articular surfaces. The results provide a better understanding of the topography of bone scintigraphic uptake in osteoarthritis and indicate that early osteophytic growth is the cause of increased bone scintigraphic uptake in joints free from radiographic signs of osteoarthritis.

Topics: Animals; Autoradiography; Bone Development; Diphosphonates; Knee Joint; Osteoarthritis; Rabbits; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors

Increased patellar uptake on bone scans is seen quite commonly but the possible or probable etiologies of this finding have not been previously well described. A review of 100 consecutive bone scans showed that the incidence of bilateral "hot" patellae is 15%. Identified etiologies include osteoarthritic degenerative disease (35%), fracture, possible metastatic disease, bursitis, Paget's disease, and osteomyelitis. The value of careful history, physical examination, and radiographs is stressed.

Topics: Adult; Arthritis, Infectious; Bone and Bones; Bursitis; Diphosphonates; Female; Humans; Male; Middle Aged; Osteitis Deformans; Osteoarthritis; Osteomyelitis; Patella; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adolescent; Adult; Age Factors; Aged; Cartilage Diseases; Cartilage, Articular; Child; Child, Preschool; Diphosphonates; Female; Humans; Knee Joint; Male; Middle Aged; Osteoarthritis; Patella; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate