Non inflammatory joint diseases
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1 Arthritis Inflammatory joint diseases -Diffuse connective tissue diseases -Rheumatoid arthritis (+juvenile rheumatoid arthritis) -Systemic erythematous lupus -Polymyositis/Dermatomyositis -Vasculopathies -Spondylarthropathies -Ankylosing spondylitis -Reactive arthritis (Reiter s syndrome) -Psoriatic arthritis -Crystal-induced arthropathies gout (monosodium urate) -pseudogout, chondrocalcinosis (calcium ppi dihydrate) Non inflammatory joint diseases -Degenerative joint disease (osteoarthritis)
2 Radiopharmaceuticals 99mTc diphosphonates Imaging 2-4 hours Dose: +/- 500 MBq (->740 MBq) 67 Gallium-citrate Imaging hours Dose: 100 MBq (->185 MBq) 99mTcIgG Imaging 4 hours Dose: 300 MBq (->370 MBq) 99mTc nanocolloids Imaging: 45 minutes Dose: 300 MBq (->740 MBq)
3 Mechanism of radiopharmaceuticals uptake in arthritis 99mTc Diphosphonates Acute inflammation: increased vascular pool, chronic: increased bone turnover Adsorption on hydroxyapatite crystals Sensitive, not specific 67 Gallium citrate Acute inflammation:increased vascular pool, increased vascular permeability Binds to transferrin, ferritin, lactoferrin and leucocytes 99mTcIgG Acute inflammation: increased vascular pool, increased vascular permeability 99mTcNanocolloids Acute inflammation: increased vascular pool, increased vascular permeability
4 Patient presenting with severe articular complaints: no significant increased uptake (bone scintigraphy) HIG: faint uptake of proximal phalangeal joint of third left finger
5 Patient with a severe osteoarthritis of the hands
6 Severe osteoarthritis of the hands: Heberdeen nodes of distal phalangeal joints of 3 last fingers of left hand, severe increased uptake of bone scintigraphy, mild uptake of IgG indicating mild inflammation
7 Patient suffering from rheumatoid arthritis: bone scintigraphy with high uptake of the wrist and MCP joints of the right hand and mild uptake of the left hand, IgG scintigraphy shows high uptake of MCP and proximal IP joints of both hand, reflecting actual inflammation
8 Patient with a severe RA, deformation of hands and actual severe inflammation of wrists, mcp joints and IP joints (left: bone scan, right: Human Immunoglobulin)
9 RA: relatively mild uptake of HIG as compared to bone scintigraphy (feet)
10 RA: severe uptake of the wrists and several joints of both hands at bone scintigraphy with relatively mild uptake of IgG
11 Important paravenous injection relatively mild uptake of small joints (bone scintigraphy) and severe uptake of IgG
12 Psoriatic arthropathy: mild increased uptake of several distal phalangeal joints at bone scan Faint uptake of IgG
13 Psoriatic arthropathy: inflammatory process of fifth MCP joint of right hand
14 (a) (b) Patient with a severe crystal-induced arthropathy (gout) and a knee arthritis: comparison of bone scintigraphy (a), antigranulocyte scintigraphy (b) and IgG scintigraphy (c) Note involvement of wrists and feet (c)
15 Patient with gout: comparison of bone scintigraphy and 67 Ga scintigraphy Detail of the hands Note increased uptake of wrists,feet and right knee
16 (a) (b) (c) Patient suffering from a right sacro-iliitis: (a) bone scintigraphy (note increased uptake of calcanea which can be seen in case of ankylosing spondylitis), (b) semi-quantification, (c) 67 Ga confirms increased uptake of right sacro-iliac joint, without another area of abnormal uptake.
17 a: Patient suffering from ankylosing spondylitis: increased uptake of sterno-claviculae, bad individualization of vertebrae and patchy increased uptake, increased activity of right sacro-iliac joint b b: patient with ulcerative colitis and associated spondylitis: note increased uptake of joints between ribs and vertebrae c: same patient increased SI joints activity c a
18 Arthritis of the knees, the wrists (trapezia), fifth lumbar vertebra
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