A technic for visualization of inflamed joints using intravenously injected technetium-99m as pertechnetate and an Anger (scintillation) camera for detection will be described. Contrast between inflamed and normal tissue was usually greatest in the first few minutes after isotope injection, presumably, at the time of maximal difference in concentration of 99mTc between blood and extravascular tissue. Inflamed joints with moderate to large effusions were often visualized best 1-2 hr after injection. The extensive binding of pertechnetate by plasma and joint fluid proteins found in equilibrium dialysis experiments was evoked as an explanation of this phenomenon.Technetium-99m ("9mTc) scheme for 99M0 is given in Fig 1.4 Many clinical uses of 99mTc have been developed, including joint scans.6-7 A technic for the visualization of diseased joints using 9 s m T~ and a scintillation (Anger) camera is the subject of this report. The data are interpreted in terms of isotope kinetics.
MATERIALS AND METHODSSubjects. T h e optimal time of exposure was determined after scintiphotographs of the hands and wrists of 6 patients without joint disease had demonstrated a nearly uniform distribution of radioactivity (Fig 2). The "normals" were individuals receiving intravenous pertechnetate-99m for other diagnostic studies such as brain tumor localization. The hand, "wrist" and knee joints of patients with classical rheumatoid arthritis (RA) were then examined serially. Serial frontal images (ie, patella to collimator) were obtained of an inflamed knee containing a large effusion in patient E.M.Podtfonlng. Five mc lomTc, as sodium pertechnetate (NaTcO,) , were given intravenously. The