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Early detection of bony alterations in rheumatoid and erosive arthritis of finger joints with high-resolution single photon emission computed tomography, and differentiation between them
Skeletal Radiology, 08/11/09
Ostendorf B et al. – Study reports that multi-pinhole single photon emission computed tomography (MPH-SPECT) is sensitive to early changes in early rheumatoid arthritis (ERA) and early osteoarthritis (EOA) and permits them to be distinguished by their patterns of uptake.
Methods- An evaluation of high-resolution MPH-SPECT for the detection of bony alterations in ERA, EOA of the fingers and healthy controls
- Clinically dominant hands of 27 pts (13 ERA, 9 EOA, 5 healthy controls) were examined by MPH-SPECT and bone scintigraphy
- Additionally, MRI was performed in the ERA pts
- Number of affected joints, localisation, pattern of tracer distribution and joint involvement were scored
- Quantitative analysis was achieved by measurement of the region of interest (ROI) in all pts
- MPH-SPECT and MR images were fused in ERA group
- Bone scintigraphy detected fewer joints (26 joints,13/22 pts) with increased tracer uptake than did MPH-SPECT (80 joints, 21/22 pts)
- Bone scintigraphy did not show recognisable uptake patterns in any group of pts
- With MPH-SPECT central tracer distribution was typical in ERA (10/13 pts, EOA 2/9)
- In contrast, an eccentric pattern was found predominantly in EOA
- Normalised counts were 4.5 in unaffected joints and up to 222.7 in affected joints
- Mean uptake values in affected joints were moderately higher in the EOA pts
- Mean tracer uptake in affected joints was ~x3 higher vs unaffected joints in both groups
- Correlation with MR images revealed that bone marrow oedema and erosions matched pathological tracer accumulation of MPH-SPECT in 11/13
- MPH-SPECT demonstrated increased activity in 2/13 pts with normal bone marrow signal intensity and synovitis seen on MR images
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