The Agreement Between Blood Pool - Delayed Bone Scintigraphy and Tc-99m Human Immunoglobulin G (HIG) Scintigraphy in the Determination of the Presence and Severity of Inflammatory Arthritis

Gulizar Kacar,Cahit Kacar,Firat Gungor

doi:10.4274/mirt.24

Abstract

Objective: In this study, it was aimed to investigate the agreement between early phase of bone scintigraphy – human immunoglobulin scintigraphy (EPBS-HIG) and late phase bone scintigraphy – HIG (LPBS-HIG) in the determination of the presence and also the severity of inflammatory arthritis. Material and Methods: Twenty-eight patients (23 female, 5 male; between 19 to 80 years of age) with inflammatory arthritis were included in the study. Tc-99m HIG and blood pool/late phase bone scintigraphies were performed in all patients. In scintigraphic examinations, the joints were scored with the degree of accumulation of the radiopharmaceutical by the semiquantitative analysis (0=Background activity, 1=Faint uptake, 2=Moderate uptake, 3=Marked uptake) which is called as visually active joint score as severity index of the disease. To estimate the agreement between EPBS – HIG and LPBS - HIG in the determination of the presence and severity of inflammatory arthritis, 2x2 kappa coefficients were calculated. Results: Our results showed good agreement between EPBS - HIG for the presence of inflammation (kappa: 0.72) but not for the severity of the disease (kappa: 0.29), poor agreement between LPBS - HIG for both the presence (kappa: 0.51) and severity (kappa: 0.01) of inflammatory arthritis. Conclusion: The blood pool scintigraphy could be used in the investigation of the presence of inflammatory arthritis because the good agreement with HIG and the lower cost but not for the severity of the diseaseConflict of interest:None declared.

Highlights

Radiopharmaceuticals have been used for detection of inflammation and to evaluate the activity of the arthritis in several arthritic conditions [1,2,3,4,5]
Our results showed good agreement between EPBS - HIG for the presence of inflammation but not for the severity of the disease, poor agreement between late phase bone scintigraphy (LPBS) - HIG for both the presence and severity of inflammatory arthritis
The blood pool scintigraphy could be used in the investigation of the presence of inflammatory arthritis because the good agreement with HIG and the lower cost but not for the severity of the disease. (MIRT 2011;20:45-51)

Summary

Introduction

Radiopharmaceuticals have been used for detection of inflammation and to evaluate the activity of the arthritis in several arthritic conditions [1,2,3,4,5]. Some radiopharmaceuticals accumulate nonspecifically in arthritic joints because of the increased vascular permeability at the site of inflammation or particular physicochemical properties [6]. Bone scintigraphy appeared to be a sensitive method for detecting inflammatory joint disease, the disadvantage of bone scintigraphy is its’ low specificity [1,7,8,9]. Some radiopharmaceuticals were considered as specific targeting agents for inflammation in especially rheumatoid arthritis (RA)

Methods

Discussion

Conclusion