^99m Technetium scintiphotography in arthritis. II. its nonspecificity and clinical and roentgenographic correlations in rheumatoid arthritis

Abstract

Technetium-99m scintiphotography of the hands, wrists and knee joints of 24 patients with rheumatoid arthritis (RA) showed abnormal localization of isotope in one or more synovial structures in 96% of hands, in 94% of wrists and in 74% of knees. The results of scintiphotography correlated well with clinical assessment of synovial thickening and tenderness in the proximal interphalangeal and metacarpophalangeal joints of 9 consecutive RA patients. Scintiphotography proved more sensitive than clinical examination only in knee joints; in 2 patients clinical involvement was antedated by positive scintiphotos. Joint visualization after intravenous pertechnetate was nonspecific, and positive scintigrams were obtained in other diseases associated with increased articular or periarticular vascularity. The technic is definitely useful in the serial evaluation of the results of local medical and surgical treatment of arthritis and as an aid in the diagnosis of psychogenic rheumatism.A technic for visualization of inflamed joints using DDmTechnetiurn as the pertechnetate (NaTcO,) and an Anger (scintillation) camera is described in an accompanyFrom the Section of Arthritis and Metabolism.

Articular scanning and external counting in experimental synovitis in the guinea-pig.

“…They found a good correlation with their clinical assessment of the activity of the joint disease. Whaley, Pack, Boyle, Dick, Downie, Buchanan, and Gillespie (1968), Green andHays (1969), andMcCarty, Polcyn, andCollins (1970a) applied scanning and scintiphotographic techniques over normal and diseased joints after intravenous injections of radio-technetium (M99 TcO4). All these methods measure primarily the vascularity of the synovial tissue, although the radioactivity may be increased slightly by accumulation of the tagged material in joint effusions (Weiss and others, 1965;McCarty, Polcyn, Collins, and Gottschalk, 1970b) and by synovial tissue binding in the case of radiotechnetium (Green and Hays, 1969;McCarty and others, 1970b).…”

The Agreement Between Blood Pool - Delayed Bone Scintigraphy and Tc-99m Human Immunoglobulin G (HIG) Scintigraphy in the Determination of the Presence and Severity of Inflammatory Arthritis

“…These joints were as follows: shoulders (2), elbows (2), wrists (2), metacarpophalangeal (10), proximal interphalangeal (10), distal interphalangeal (8), hips (2), knees (2), ankles (2), metatarsophalangeal (2) and forefeet (2). Since sacroiliac joint is not a commonly involved joint, it was not evaluated in RA.…”

“…In inflammatory joint disease, the uptake of diphosphonates in bone is either secondary to increased blood flow to periarticular bone, or is related to new bone formation with diphosphonate absorbed on the surface of hydroxyapatite crystals or is a combination of both factors (1). Bone scintigraphy appeared to be a sensitive method for detecting inflammatory joint disease, however the disadvantage of bone scintigraphy is its’ low specificity (1,7,8,9). Other radiopharmaceuticals such as Ga-67 (10,11), radiolabelled leucocytes (12), In-111 chloride (13), 99m Tc labelled liposomes (14) were demonstrated to accumulate in inflammed area in arthritis, however these agents have not been used in routine clinical practice (15).…”

Technetium counting in rheumatoid arthritis evaluation in the small joints of the hand

“…of the apparatus was such that it could easily be used in a side room of an outpatient clinic. In the initial studies, sodium perchlorate was administered to each patient to block uptake of technetium by the thyroid but this did not have any effect on the uptake over joints when omitted, an observation made by McCarty et al (5). The possible effect of displacement of technetium from its binding sites by highly protein bound drugs was considered in this study but no changes attributable to this phenomenon could be detected.…”