Yttrium-90 distribution following radiosynoviorthesis of the knee joint in rheumatoid arthritis patients: a SPECT/CT stu
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Yttrium-90 distribution following radiosynoviorthesis of the knee joint in rheumatoid arthritis patients: a SPECT/CT study A. Bielin´ska • M. Korkosz • J. Ga˛sowski • M. Tomaszuk • A. Staszczak-Sowa • B. Kwas´ny-Krochin • M. Buziak-Bereza A. Hubalewska-Dydejczyk • T. Grodzicki
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Received: 7 October 2013 / Accepted: 19 February 2014 Ó The Author(s) 2014. This article is published with open access at Springerlink.com
Abstract Objective To examine yttrium-90 distribution 1 and 72 h following its injection into a knee joint in patients with rheumatoid arthritis (RA). Methods In 14 RA patients we injected yttrium-90 into the affected knee joint using lateral approach. To assess the radioisotope distribution in the joint, the superimposed sequential SPECT and CT imaging was performed 1 and 72 h after the injection. We analyzed the percentage of radioisotope distribution in three predefined compartments of the knee joint (lower, upper medial, upper lateral). Results After 1 and 72 h, the mean percentage distributions were, respectively, 7.14 and 23.07 % in lower; 21.42 and 15.38 % in upper medial, and 71.42 and 61.53 % in upper lateral compartment. The percentage of isotope
deposition did not change significantly with time in any of the compartments (all p [ 0.26). The deposition of isotope, both at 1 and 72 h, was significantly greater in upper lateral compartment, where the injection was performed, than in all other compartments (all p \ 0.05). Conclusions Using the SPECT/CT hybrid method, we proved that the majority of isotope is located at the compartment adjacent to the injection. Two injections targeting different compartments might improve the clinical efficacy of the procedure. Keywords Rheumatoid arthritis Radiosynoviorthesis Yttrium-90 isotope SPECT/CT
Introduction A. Bielin´ska (&) B. Kwas´ny-Krochin Department of Rheumatology and Balneology, Jagiellonian University Medical College, Sniadeckich 10, 31-501 Krako´w, Poland e-mail: [email protected] M. Korkosz Division of Rheumatology, Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krako´w, Poland J. Ga˛sowski T. Grodzicki Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krako´w, Poland M. Tomaszuk Nuclear Medicine Unit, Department of Endocrinology, University Hospital in Krakow, Krako´w, Poland A. Staszczak-Sowa M. Buziak-Bereza A. Hubalewska-Dydejczyk Nuclear Medicine Unit, Department of Endocrinology, Jagiellonian University Medical College, Krako´w, Poland
Radiosynoviorthesis (RSO) is a safe and effective therapeutic modality for synovitis in inflammatory arthritis [1– 3]. It was developed as an alternative to or preceding the surgical synovectomy [4]. The main indication is a chronic synovitis of affected knee in rheumatoid arthritis (RA). Yttrium-90 (90Y), a radionuclide with an intense b-emission, is most widely used for the treatment of knee joint. Efficacy of the RSO is estimated at 60–80 % [3]. However, the accurate predict
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