Tc-99m Human Immunoglobulin Research Articles

Tc-99m HIG Scintigraphy in Detection of Active Inflammation in Ankylosing Spondylitis

Objective: The diagnosis of active inflammation in ankylosing spondylitis (AS) is crucial for treatment to delay possible persistent deformities. There are no specific laboratory tests and imaging methods to clarify the active disease. We evaluated the value of Tc-99m human immunoglobulin (HIG) scintigraphy in detection of active inflammation. Material and Methods: Twenty-nine patients were included. Tc-99m methylenediphosphonate bone (MDP) and HIG scintigraphies were performed within 2-5 day intervals. Two control groups were constituted both for MDP and HIG scintigraphies. Active inflammation was determined clinically and by serologic tests. Both scintigraphies were evaluated visually. Sacroiliac joint index values (SII) were calculated. Results: Active inflammation was considered in five (sacroiliitis in 2, sacroiliitis-spinal inflammation in 1, achilles tendinitis in 1, arthritis of coxafemoral joints in 1) patients. HIG scintigraphy demonstrated active disease in all 3 patients with active sacroiliitis. But, it was negative in the rest. The other 2 active cases were HIG negative. Right and left SII obtained from HIG scintigraphy was higher (p<0.05) in clinically active patients than inactive patients. There was not any significant difference between patients with inactive sacroiliitis and normal controls. Right and left SII obtained from bone scintigraphy was higher (p<0.05) in patient group than in control group. Conclusion: Clinically inactive AS patients, behave no differently than normal controls with quantitative sacroiliac joint evaluation on HIG scintigraphy. HIG scintigraphy may be valuable for evaluation of sacroiliac joints in patients with uncResults:ertain laboratory and clinical findings.Conflict of interest:None declared.

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

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.

Tc-99m polyclonal human immunoglobulin scintigraphy in brucellosis

The aim of this study was to evaluate the accuracy of Tc-99m polyclonal human immunoglobulin (HIG) scintigraphy for the diagnosis of brucellosis, and to compare its effectiveness in the diagnosis of osteoarticular involvement in comparison with bone scanning. Of 30 patients with brucellosis, Tc-99m HIG detected osteoarticular involvement in 18 (60%) patients, in whom the sacroiliac joints were affected most commonly (n = 13; 72.2%), with statistically predominant bilateral involvement (p < 0.05). By bone scanning, the rate of osteoarticular involvement was 70% (21 of 30 patients), and the joints affected most commonly were sacroiliac (15 of 21 patients; 71.4%). Although bilateral involvement was observed mostly by bone scanning, there was no significant difference between the rate of bilateral and unilateral involvement. The anatomical distribution of osteoarticular complications, as detected by Tc-99m HIG and bone scintigraphy, did not differ significantly. With Tc-99m HIG, orchitis was detected in two patients and paravertebral abscess in one patient. Since bone scanning did not detect these soft tissue complications, Tc-99m HIG scintigraphy might be useful for the detection of both osteoarticular and soft tissue complications resulting from brucellosis.

Absence of Increased Tc-99m Polyclonal Human Immunoglobulin (HIG) Joint Uptake in a Patient With Systemic Lupus Erythematosus Presenting With Polyarticular Joint Complaints

Several studies have shown that Tc-99m HIG (polyclonal human immunoglobulin) scintigraphy allows for identification of inflamed joints. However, no data are available in patients with systemic lupus erythematosus (SLE). Apatient with a definite diagnosis of SLE presented with symmetric polyarticular complaints and was injected with 550 MBq (14.8 mCi) of Tc-99m labeled HIG. Whole-body images as well as detailed images of the hands and feet were acquired 4 hours after injection and showed no significant tracer uptake in any joint.

Uptake of Tc-99m human immunoglobulin in malignant abdominal lymphoma.

Hodgkin's and non-Hodgkin's lymphomas are malignant lymphoreticular tumors. The usual imaging procedures used for diagnosis and prognosis include radiography, CT, and Ga-67 citrate scintigraphy. Tc-99m human immunoglobulin is an inflammatory imaging agent that has been reported to show uptake in some malignant tumors and was used for imaging non-Hodgkin's lymphoma before and after therapy.

Evaluation of gastrointestinal involvement of Behçet's disease by nuclear medical techniques.

To evaluate the value of nuclear medicine procedures in the diagnosis of gastrointestinal involvement of Behcet's disease in asymptomatic patients, Tc-99m human immunoglobulin (HIG) and Tc-99m leucocyte (LC) whole body scintigraphies were performed on 30 patients with major symptoms of the disease. Comparison of the results with other diagnostic techniques showed that Tc-99m HIG whole body scanning can be a useful diagnostic aid before the disease becomes clinically active in the gastrointestinal system.

Tc-99m dextran and Tc-99m HIG findings in patients with ulcerative colitis.

Various radionuclide methods have been studied for the evaluation of the disease activity and extent of ulcerative colitis and other protein-losing enteropathies. Recently, Tc-99m dextran and Tc-99m human immunoglobulin (HIG) have been used to detect inflammation and protein loss into the intestine, but only a few studies have been reported with these agents. In this study, Tc-99m dextran and Tc-99m HIG were used to evaluate disease activity and extent in patients with ulcerative colitis. These agents were used in 12 patients with active disease and in five patients in remission, and five healthy control participants also were included. Large bowel activity was detected in 11 of the 12 patients with active ulcerative colitis using Tc-99m dextran and in 10 patients using Tc-99m HIG. Fifty-eight bowel segments were found to be active with endoscopy, 39 with Tc-99m dextran, and 31 with Tc-99m HIG. No intestinal activity was detected in the control participants. Grade 1 activity localization in the large bowel was detected in three patients with ulcerative colitis in remission using Tc-99m dextran and in one patient using Tc-99m HIG. Tc-99m dextran is more sensitive for detecting disease activity and extent than is Tc-99m HIG.

Accumulation of Tc-99m HIG in Brucellosis

A 22-year-old man who was complaining of fever, anorexia, weight loss, and back and knee pains was diagnosed as having brucellosis. Tc-99m MDP whole body scanning was performed in the second week after beginning therapy. Although x-ray imaging showed only narrowing of the left sacroiliac joint, Tc-99m human immunoglobulin (HIG) whole body scanning and Tc-99m MDP whole body scanning showed bone and joint involvement. Tc-99m HIG whole body scanning at the end of therapy showed reduced uptake in involved areas.