Yttrium-90 distribution following radiosynoviorthesis of the knee joint in rheumatoid arthritis patients: a SPECT/CT study

A Bielińska,B Kwaśny-Krochin,M Buziak-Bereza,A Hubalewska-Dydejczyk,M Tomaszuk,T Grodzicki,J Gąsowski,A Staszczak-Sowa,M Korkosz

doi:10.1007/s12149-014-0827-8

Abstract

ObjectiveTo examine yttrium-90 distribution 1 and 72 h following its injection into a knee joint in patients with rheumatoid arthritis (RA).MethodsIn 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).ResultsAfter 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).ConclusionsUsing 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.

Highlights

Radiosynoviorthesis (RSO) is a safe and effective therapeutic modality for synovitis in inflammatory arthritis [1,2,3]
Using the SPECT/CT hybrid method, we proved that the majority of isotope is located at the compartment adjacent to the injection
45,041.6 21.9 24,868.4 32.2 58,956.9 28.7 21,640.9 28.0 101,222.8 49.3 30,667.1 39.7 found significant differences of uptake between compartments, with the greatest percentage of isotope deposition at the upper lateral compartment which was adjacent to the injection site, (Table 1)

Summary

Introduction

Radiosynoviorthesis (RSO) is a safe and effective therapeutic modality for synovitis in inflammatory arthritis [1,2,3]. Yttrium-90 (90Y), a radionuclide with an intense b-emission, is most widely used for the treatment of knee joint. The efficacy of RSO largely depends on the radionuclide distribution within the joint. Ann Nucl Med (2014) 28:688–692 creates computer-generated images of radionuclide distribution, while CT enables 3D anatomical images of joint. The majority of published studies assessed the distribution of radionuclide using gamma camera/SPECT imaging yielding imprecise information which does not reflect the uptake of radionuclide into the anatomic compartments of the knee. There are no guidelines for follow-up time needed to assess RSO efficacy. The aim of this study was to assess, using SPECT/CT, the yttrium-90 radionuclide distribution 1 and 72 h following its injection into RA affected knee joint

Methods

Procedures

Results

Discussion