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

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.     

99m Technetium-pyrophosphate scintiphotography in bone sarcoidosis.

Comparative studies between routine roentgenograms and scintiphotographs using 99mTc-pyrophosphate, of the hands and feet are documented in three cases of bone sarcoidosis. All the abnormal roentgenographic findings were also detected by 99mTc-pyrophosphate bone imaging. However, several areas of increased radiopharmaceutical uptake were found in areas with normal roentgenographic studies. These results suggest that the 99mTc-pyrophosphate bone scintiphotographs might be more sensitive than radiographs in the localization of the bone involvement in sarcoidosis.     

External counting and scintiphotography in rabbits with arthritis

Bedsonia arthritis in rabbits was studied by Anger camera Scintiphotography and external counting, using pertechnetate 99m as the label. This method of evaluating the intensity of the arthritis and the changes in the disease proved more sensitive and more accurate than did clinical and roentgenographic examinations.     

99mTechnetium pyrophosphate scintigraphy in the detection of skeletal muscle disease

We aimed to assess the specificity and sensitivity of ^99mtechnetium pyrophosphate muscle scintigraphy in the diagnostic workup of patients with suspected myopathy. We reviewed the charts of 166 patients; 52% of the subjects had myalgias, 36% had muscle weakness, 45% had an elevated serum creatine kinase (CK), and 49% had an increased C reactive protein (CRP). Scintigraphy was positive in 34 patients (20%). The test was more sensitive in the presence of muscle weakness, elevated CK, or increased CRP. The presence of myalgias did not influence the odds. Sensitivity was 60% in patients with the final diagnosis of polymyositis, dermatomyositis, or inclusion body myositis, and 70% in noninflammatory myopathies. Eight percent had false positive scintigrams. In individuals with biopsy-proven myopathy (51 subjects), the diagnostic sensitivity was 43%, and its specificity was 60%. Low positive and high negative likelihood ratios (5.0 and 0.65, respectively) document an only limited diagnostic efficiency of ^99mTc-PYP scintigraphy in the evaluation of inflammatory and noninflammatory myopathies and suggest that the test is not helpful in the routine diagnostic workup of muscle complaints, even after a priori selection of patients for CK plus CRP abnormalities.     

99mTechnetium pyridoxylidene glutamate imaging in visceral heterotaxy (Ivemark's syndrome).

A two and one-half year old boy with complex congenital heart disease had Howell-Jolly bodies in his blood raising the possibility of the asplenia syndrome. A 99mTc-sulfur colloid liver-spleen scan was reported normal, but the right lobe of the abnormally reversed liver was mistaken for the spleen. The diagnosis of visceral heterotaxy (Ivemark's syndrome) was established after scanning the patient with a new radiopharmaceutical, 99mTechnetium pyridoxylidene glutamate. The agent clearly demonstrated a left-sided gall bladder, and on comparison with the sulfur colloid scan it was established that asplenia was present. Radionuclide imaging with the new generation of hepatobiliary agents is a reliable method to document asplenia and is useful in studying patients with visceral heterotaxy.     

Status of arthrosonography in rheumatologic diagnosis: examination technic, findings and their interpretation. I. The elbow joint

Between July 1984 and October 1985 the elbow joints of 135 patients were examined by arthrosonography. Of these 97 patients suffered from rheumatoid arthritis, 4 from psoriatic arthritis, 2 from suspected ankylosing spondylitis, 1 from gout, and 27 patients were found to be normal. The equipment used was a Kretz sector scanner Combison 320 and a Siemens Sonoline SL linear scanner. The examination was divided into three parts: longitudinal and transversal scans of the fossa olecrani, the fossa coronoidea and fossa radii. We found, that inflammation of the elbow joint has to be evaluated separately for each part of the joint. The more intense the inflammation, the more certain diagnosis becomes. Bursitis and rheumatoid nodules could be separated sonographically. Also synovialitic complications such as of the bone and the development of synovial cysts could easily be recognized. These arthrosonographical findings are a valuable help in the diagnostics of rheumatic diseases. Their interpretation, however, requires the input of all clinical data.     

Reliability and reproducibility of interpretation of 99mtechnetium pyrophosphate myocardial scintigrams.

The interpretations of 156 99mtechnetium pyrophosphate myocardial scintigrams by four observers were analyzed in order to determine the reliability and reproducibility of the subjective process of reading scintigrams. The scintigrams were scored on an integral scale from 0 to 4, depending upon the degree of myocardial radionuclide accumulation, and the site and nature of uptake were specified. Exact agreement upon score was generally poor but approximate concurrence of interpretation was good (90.4 and 92.5% inter- and intra-observer agreement, respectively). There was somewhat less agreement on scintigrams with the higher scores of 3 and 4 (83.3 and 78.0%, respectively). A high level of concurrence upon the differentiation between diffuse and localized uptake, and upon the site of uptake, was found. We conclude that only approximate rather than exact agreement of individual readers' interpretations can be expected in this subjective technique, that scintigrams with higher degrees of radionuclide accumulation produce slightly greater observer disagreement, and that variability of interpretation could account for some of the diagnostic inaccuracy of 99mtechnetium pyrophosphate myocardial scintigraphy.     

Rheumatoid arthritis in Kenya. I. Clinical observations.

76 Kenyan Africans with classical or definite rheumatoid arthritis are described. Their age, sex ratio, and pattern of joint involvement closely resembled that seen in Europe and the USA and differed from that described in West Africa and rural South Africa. However, they showed a marked lack of systemic nonarticular complications, with relatively little functional incapacity. Radiological grading was carried out on 58 cases, and the changes were found to resemble more closely those seen in an English series than in a Nigerian series.     

Scintigraphy using a technetium 99m-labelled anti-E-selectin Fab fragment in rheumatoid arthritis.

OBJECTIVE: We previously described a novel radiolabelled monoclonal antibody (1.2B6), which reacts with porcine E-selectin, for targeting activated endothelium as a means of imaging inflammatory disorders, and presented initial clinical work based on (111)In-labelled antibody. The aim of the present study was to evaluate a Fab fragment of 1.2B6 labelled with (99m)Tc in patients with rheumatoid arthritis (RA) by comparison with (i) (111)In-labelled 1.2B6 F(ab')(2) and (ii) conventional bone scanning. METHODS: (99m)Tc-1.2B6-Fab ( approximately 440 MBq) and (111)In-1.2B6-F(ab')(2) ( approximately 27 MBq) were compared in 10 patients using a double-isotope protocol. Images were obtained 4 and 20-24 h after injection. Two normal volunteers were also imaged. In a separate group of 16 patients, (99m)Tc-1.2B6-Fab and (99m)Tc-oxidronate ((99m)Tc-HDP) ( approximately 740 MBq) were compared on the basis of visual and semi-quantitative analysis of joint uptake (joint/soft tissue ratios) 4 h after injection. The respective biodistributions and blood clearances of the two 1.2B6 fragments were also compared. RESULTS: Image contrast was slightly better with (99m)Tc-Fab at 4 h but equal for the two tracers at 24 h. Diagnostic accuracy, taking joint tenderness or swelling as the clinical endpoint, was 76% for both fragments at 24 h. Plasma clearance of (99m)Tc-Fab was faster than that of (111)In-F(ab')(2) (t(1/2) 142 vs 421 min; P<0.0001). (99m)Tc-Fab appeared somewhat unstable in vivo, as shown by activity in the thyroid gland and bowel. The diagnostic accuracy of (99m)Tc-Fab was 88%, higher than that of (99m)Tc-HDP (57%) as a result of the low specificity of the latter in RA. Receiver operating characteristic (ROC) curve analysis using joint/soft tissue ratios as a variable cut-off showed that (99m)Tc-Fab discriminates better than (99m)Tc-HDP between actively inflamed and silent joints (Z=4.72; P<0.0001). No uptake of (99m)Tc-Fab was observed by inactive or normal joints, whereas (99m)Tc-HDP was taken up by all joints to a variable degree, making the decision as to whether a particular joint is actively involved or chronically damaged very difficult. CONCLUSION: (99m)Tc-anti-E-selectin-Fab scintigraphy can be used successfully to image synovitis with better specificity than (99m)Tc-HDP bone scanning. The advantages over (111)In-1.2B6-F(ab')(2) are easier availability of the radionuclide, improved physical properties and optimal imaging 4 h after injection.