title: Utility of combined high-resolution bone SPECT and MRI for the identification of rheumatoid arthritis patients with high-risk for erosive progression.
abstract: OBJECTIVE
  To evaluate the utility of sequentially acquired, post hoc fused, magnetic resonance imaging (MRI) and multi-pinhole single photon emission computed tomography (MPH-SPECT) with technetium-99m-labeled disphosphonates (Tc99m-DPD) for the identification of finger joints with later erosive progression in early rheumatoid arthritis (ERA) patients.
  
  
  METHODS
  Ten consecutive ERA patients prospectively underwent MPH-SPECT and MRI of metacarpophalangeal (MCP) joints prior to and after 6 months methotrexate therapy. Tc99m-DPD uptake was measured at proximal and distal MCP sites using regional analysis. The course of joint pathologies was scored according to the Rheumatoid Arthritis MRI Score (RAMRIS) criteria.
  
  
  RESULTS
  The frequency of increased Tc99m-DPD uptake, synovitis and bone marrow edemadecreased under MTX therapy; but the number of bone erosions increased. Joints with progressive and new erosions on follow-up had a higher baseline Tc99m-DPD uptake (2.64 ± 1.23 vs. 1.43 ± 0.91) (p=0.02).
  
  
  CONCLUSIONS
  Joints with erosive progression are characterized by an early increased Tc99m-DPD uptake, even in absence of MRI bone pathologies. Tc99m-DPD MPH-SPECT might thus be of additional value to morphological MRI for the identification of RA patients with a high risk for erosive progression.
authors.affiliation: Univ Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Moorenstr. 5, D-40225 Dusseldorf, Germany. christian.buchbender@med.uni-duesseldorf.de
authors.forename: Christian
authors.initials: C
authors.lastname: Buchbender
authors.forename: Philipp
authors.initials: P
authors.lastname: Sewerin
authors.forename: Katalin
authors.initials: K
authors.lastname: Mattes-György
authors.forename: Falk
authors.initials: F
authors.lastname: Miese
authors.forename: Hans-Joerg
authors.initials: HJ
authors.lastname: Wittsack
authors.forename: Christof
authors.initials: C
authors.lastname: Specker
authors.forename: Gerald
authors.initials: G
authors.lastname: Antoch
authors.forename: Hans-Wilhelm
authors.initials: HW
authors.lastname: Müller
authors.forename: Matthias
authors.initials: M
authors.lastname: Schneider
authors.forename: Axel
authors.initials: A
authors.lastname: Scherer
authors.forename: Benedikt
authors.initials: B
authors.lastname: Ostendorf
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000175:diagnosis*; D004164:Diphosphonates; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010014:Osteolysis / Q000150:complications* / Q000175:diagnosis*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D004164:Diphosphonates; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C033905:technetium Tc 99m 1,1-diphosphonopropane-2,3-dicarboxylic acid