Scintigraphy in rheumatic diseases

Nuclear Medicine in Musculoskeletal Disorders: Clinical Approach

“…Scintigraphy imaging (Fig. 4) shows increased perfusion during the angiographic and vascular pool phases and widespread increases in radiophosphonate bone uptake in the late stage (Colamussi et al, 2004). The highest diagnostic accuracy is provided by the combination of three signs: Increase activity ratio in the blood pool phase performed at 5-15 min, diffuse uptake in the carpus o tarsus and periarticular uptake in all the small joints .…”

“…In this regard, a published review (Schneider, 2006;Song et al, 2008) realized with the aim to assess the diagnostic value of scintigraphy for detecting sacroilitis in patients with established and/or probable ankylosing spondylitis, has proven limited value of scintigraphy both in the early detection of sacroilitis and in patients with established ankylosing spondylitis. In patients with SpA and gastrointestinal symptoms but negative endoscopic or radiological test results, abdominal scintigraphy with labelled leukocytes can be used to assess the abdominal involvement (Colamussi et al, 2004;as cited in Elkayam et al, 2002).…”

“…In recent years, the use of labelled immunoglobulins (Igs) that head for areas of inflammation and where they stay accumulated (aspecific polyclonal IgG-type antibodies labelled in most cases with Tc-99m), has been developed ( Table 3). The immunoscintigraphy has proven to be more sensitive than clinical examination for identifying synovitis and have a high positive predictive value for the onset of RA in patients with nonspecific arthropathy, and its usefulness for monitoring and assessing treatment response (Colamussi et al, 2004;as cited in De Bois et al, 1995a, 1995b. It can also be used to detect infection, although the preferred technique in these cases is labelled leukocyte scintigraphy, in which two tracers are often used: 99mTc-HMPAO or 111In-oxine (De Gersem & Jamar, 2010).…”

“…It is also a useful technique when an additional pathology (eg, osteonecrosis, stress fractures or metastatis) is suspected. Furthermore, in patients with nonspecific polyarthralgia, normal bone scan excludes the presence of active arthritis (Colamussi et al, 2004;as cited in Shearman et al, 1982). It is a sensitive tool but not highly specific, and may be altered in other diseases such as osteoarthritis.…”

“…Nuclear medicine techniques, such as imaging with nanocolloids, PET or three-phase bone scintigraphy may also be useful in this field. Three-phase bone scintigraphy is still used in clinical practice in patients with RA because it allows the detection of changes (hyperemia, increased permeability, altered bone metabolism) before the structural lesions appear, and may display the pattern of joint involvement and even predict the development of erosions (Colamussi et al, 2004; as cited in Mottonen et al,…”