Reradiosynoviorthesis of the Knee

Abstract

The aim of this study was to compare the treatment results between radiosynoviorthesis and reradiosynoviorthesis of knees. Before the radiosynoviorthesis, an ultrasonography, X-ray, and three-phase bone scintigraphy were done. The treatment effect can be expected if a synovitis is proved by these examinations. To knees, 200 MBq of the yttrium citrate was injected for the first radiosynoviorthesis or for reradiosynoviorthesis. After an application, it is possible to do the scintigraphic examination, when information about a tracer distribution in joints is obtained. The treatment effect was evaluated by the clinical examination, the ultrasonography, and the three-phase bone scintigraphy with some lapse of time. If the effect of the radiosynoviorthesis was not satisfying, it could be repeated no sooner than 6 months later. Among our patients we had a high percentage of the repeated radiosynoviorthesis. The authors applicated the yttrium citrate to 1243 knees. A rate between single radiosynoviorthesis and reradiosynoviorthesis was 11:8. Repeated radiosynoviorthesis were as effective as the initial ones, and their repeated use does not decrease the expected therapeutic effect.

A new approach for radiosynoviorthesis: A dose-optimized planning method based on Monte Carlo simulation and synovial measurement using 3D slicer and MRI

“…Although synovial thickness is usually used for the evaluation of the RSO outcome, 8 our results demonstrated no significant change in this feature, as observed by other authors that also used MRI. 35,36 The inaccuracy of this measurement can be related to folded or unfolded pannus when joint effusion decreases in the joint cavity.…”

“…In some cases, it is recommendable to repeat RSO in a 3‐month period, always considering the results of a clinical follow‐up. However, repeated RSO did not always show the expected therapeutic effect . Therefore, repeated RSO should be evaluated considering both ST 90 and quantified synovial thickness to avoid unjustified RSO procedures.…”

“…Several clinics around the world still use fixed radionuclide activities, and a drawback in applying this RSO method to hemophilic arthropathy is the prescribed activity based on calculations for adult patients with rheumatoid arthritis . However, due to fast pannus proliferation in hemophilic arthropathy, aggravated by recurrent bleeding cycles, this method is usually more effective in rheumatoid arthritis . Another important aspect is that, differently from rheumatoid arthritis, in hemophilic arthropathy most patients are children and adolescents.…”

“…7 However, due to fast pannus proliferation in hemophilic arthropathy, aggravated by recurrent bleeding cycles, this method is usually more effective in rheumatoid arthritis. 8 Another important aspect is that, differently from rheumatoid arthritis, in hemophilic arthropathy most patients are children and adolescents. To manage these discrepancies, the current protocol adjusts the activity injected in children to 50 or 100% of the activity used in adults, depending on the size of the joint.…”

Radiosynovectomy using yttrium-90, phosphorus-32 or rhenium-188 radiocolloids versus corticoid instillation for rheumatoid arthritis of the knee

“…Several candidates have been proposed to replace commercially available radiocolloid formulations of yttrium-90, rhenium-186 and erbium-169. These formulations include phosphorus-32 colloid [9,10], rhenium-186 sulphide [11], samarium-153 conjugated to particulate hydroxyapatite [12,13], dysprosium-165 ferric hydroxide [14,15], holmium-166 boromacroaggregates [16,17], ytterbium-175 and lutetium-177 hydroxyapatite [18,19]. In this study, the therapeutic efficacy of yttrium-90 citrate was compared to that of phosphorus-32 and rhenium-188 colloids.…”