Comparison of Tc-99m HIG and three-phase Tc-99m MDP bone scintigraphy for evaluating the efficacy of Yttrium-90 silicate radionuclide synovectomy.
OBJECTIVE
The aim of this study was to compare Tc-99m human immunoglobulin (HIG) and three-phase Tc-99m MDP bone scintigraphy for the assessment of the efficacy of Y-90 silicate therapy in rheumatoid knee synovitis.


METHODS
Fifteen patients with rheumatoid arthritis and chronic persistent synovitis in 23 knee joints had radionuclide synovectomy with Y-90 silicate. The patients underwent imaging before and 3, 6, 9, and 12 months after therapy using clinical evaluation, Tc-99m HIG scintigraphy, and three-phase Tc-99m MDP bone scintigraphy.


RESULTS
In the 13 of 23 knee joints that showed successful clinical results with Y-90 therapy, the Tc-99m HIG index values obtained 3 months after radionuclide synovectomy were significantly lower than the pretreatment index values (P < 0.001). In the same 13 joints, the Tc-99m MDP index values (in the blood-pool and delayed phases) before and 3 months after therapy were statistically similar. Six months after injection, these values were significantly lower in both the blood-pool (P < 0.001) and late (P < 0.05) phases in all 13 joints. In the other 10 of 23 knee joints that did not respond to treatment, the Tc-99m MDP and Tc-99m HIG index values were statistically similar before and after Y-90 therapy.


CONCLUSIONS
Based on these findings, Tc-99m HIG scintigraphy appears to be a valuable method that complements clinical assessment of the efficacy of Y-90 silicate therapy in rheumatoid knee synovitis, starting in the early post-treatment period. However, three-phase Tc-99m MDP bone scintigraphy may be valuable in the late postsynovectomy period.
Arzu Gencoglu
Esra
E
Department of Nuclear Medicine, Ankara University Medical Faculty, Turkey. arzugencoglu@hotmail.com
Aras
Gulseren
G
Kucuk
Ozlem
O
Atay
Gulay
G
Tutak
Ibrahim
I
Ataman
Sebnem
S
Soylu
Ayfer
A
Ibis
Erkan
E
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000000981:diagnostic imaging / Q000532:radiotherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007136:Immunoglobulins; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000528:radiation effects; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017640:Silicates / Q000627:therapeutic use*; D013583:Synovial Membrane / Q000000981:diagnostic imaging / Q000528:radiation effects; D013585:Synovitis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000532:radiotherapy*; D013667:Technetium; D013669:Technetium Tc 99m Medronate; D016896:Treatment Outcome; D015019:Yttrium / Q000627:therapeutic use*
D007136:Immunoglobulins; D019275:Radiopharmaceuticals; D017640:Silicates; C065376:technetium Tc 99m immunoglobulin; C028301:yttrium silicate; D015019:Yttrium; D013667:Technetium; D013669:Technetium Tc 99m Medronate