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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, 08/13/09

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

Results

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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