Radionuclide joint imaging in the diagnosis of synovial disease

Bilateral pulmonary artery aneurysms in a patient with Behcet syndrome: evaluation with radionuclide angiography and V/Q lung scanning

The case of a 14-year-old girl with Behcet syndrome is described. Besides painful and recurrent oral ulcerations, the patient had a cough and intermittent hemoptysis. The initial chest roentgenogram revealed bilateral parahilar opacities. CT and MRI scans of the thorax showed bilateral thrombosing aneurysms of the pulmonary arteries. Pulmonary blood flow imaging was performed after technegas ventilation lung scanning and Tc-99m MAA injection using a first-pass radionuclide angiography procedure. Altered blood flow in the left pulmonary artery was shown. Bilateral and well-defined ventilation/perfusion mismatched areas suggested a high probability of pulmonary embolism. Little additional information was obtained on subsequent contrast pulmonary angiography. The high incidence of pulmonary artery hypertension and associated vascular injury risk makes pulmonary angiography an unsafe procedure in patients with pulmonary Behcet syndrome. The need for pulmonary angiography could be obviated in such cases with the use of high-precision MRI and ventilation/perfusion lung scanning, including radionuclide pulmonary angiography.

Scintimetric assessment of synovitis activity during treatment with disease modifying antirheumatic drugs

In a double blind trial of 36 patients with rheumatoid arthritis a new scintimetric method was applied to three comparable patient groups before and after eight months' treatment with levamisole, penicillamine, or azathioprine. Technetium-99m pyrophosphate scintigraphy of both hands was performed on a gammacamera with a computer attached, immediately after the administration of the tracer. The uptake ratio of each proximal interphalangeal (PIP) joint and the mid-half of the adjacent proximal phalanx was calculated from the activity counted for one minute. A scintimetric index was expressed as the sum of eight uptake ratios. This index was higher for each of the three patient groups before start of treatment than that for 10 age matched controls. After eight months of treatment the index, the number of PIP joints with clinical signs of synovitis, and the total circumference of the PIP joints decreased in the penicillamine and azathioprine groups. The scintimetric method reliably reflected local synovitis activity and its changes but, like grip strength and PIP circumference, was not a representative measure of the overall activity of the disease.

Bacterial arthritis in an English health district: a 10 year review

Bacterial arthritis continues to present a difficult clinical and therapeutic problem, necessitating prompt diagnosis and intensive therapy. This study comprises a 10 year review of the condition in an English health district, with particular reference to aetiology, presentation, treatment, and outcome. Although the causative organisms remain qualitatively unchanged, increasing numbers of patients are elderly, immunosuppressed, or have underlying arthropathy. Factors which influence outcome include age, causative organism, joint involved, and delay in diagnosis. Attention is drawn to the notably poor outcome of hip infections in the elderly.

Sequential joint scintigraphy in rheumatoid arthritis

In this sequential study joint scintigraphy was compared with clinical and röntgenological evaluation in 19 patients with rheumatoid arthritis. Scintigraphy sometimes preceded clinical and radiological abnormalities and scan results were independent of radiological findings showing no differences when large and small joints were compared. Scan findings in 2 patients with arthralgias only were negative, suggesting that arthritis was unlikely.

Predictive value of radionuclide joint scintigrams

Twenty-two patients with normal or "noninflammatory" 99mtechnetium-labeled polyphosphate (TPP) peripheral joint scintigrams taken between 1974 and 1976 were reevaluated clinically. Retrospective chart review revealed that all initially had persistent polyarthralgia of more than 3 months duration. At followup, a mean of 3.6 years later, none had evidence of inflammatory joint disease, although 1 patient had systemic lupus erythematosus and 2 had polymyalgia rheumatica. A noninflammatory joint scintigram as part of a thorough rheumatologic evaluation may be a useful procedure in excluding inflammatory joint disease in selected patients with chronic persistent polyarthralgia.

Stress fractures of the femoral neck: a scintigraphic sign for early diagnosis

Two patients with hip pain are presented; both patients were on steroid therapy. The diagnosis of a stress fracture was initially missed because the patients were not exceedingly active and the plain roentgenograms were essentially normal. The bone scan demonstrated a discretely localized area of increased radionuclide uptake in the femoral neck, which alerted us to the correct diagnosis. This scintigraphic sign is helpful in arriving at an early diagnosis and preventing prolonged disability.

Prospective evaluation of sacroiliac scintigraphy in chronic inflammatory back pain

To assess the usefulness in screening for sacroiliitis of a wide band profile cut which included the entire sacroiliac (SI) joint, 34 patients with chronic inflammatory back pain (IBP) underwent sacroiliac joint scintigraphy with 99mTc-methylene diphosphonate while receiving no antiinflammatory therapy. The sacroiliac joint to sacrum (SIJ/S) ratios in those with back pain differed significantly from the ratios of an age-matched control group. However, 12 of the 34 patients with inflammatory back pain had normal or equivocal sacroiliac radiographs and 4 of 12 had normal SIJ/S ratios. All 4 were HLA-B27 positive, had diminished lumbar movement, and required antiinflammatory medication; 2 had diminished chest expansion; 1 has developed iritis. We conclude that this technique is not a reliable screening procedure. Therapy with antiinflammatory drugs was associated with a significant decrease in the SIJ/S ratios in 19 of the 34 who were reimaged.