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Influence of Radiation Synovectomy on Articular Cartilage, Synovial Thickness and Enhancement as Evidenced by MRI in Patients with Chronic Synovitis

Departments of Nuclear Medicine, Orthopedics, Rheumatology, Radiology and Pathology and the MR Institute, University Hospital of Vienna, Vienna
Kurhaus Engelsbad-Melanie, Baden, Austria

Correspondence: For correspondence or reprints contact: Christian Pirich, MD, Department of Nuclear Medicine, University of Vienna, AKH, Währinger Gürtel 18-20, A-1090 Vienna, Austria.

ABSTRACT

Radiation synovectomy is a safe and effective treatment for chronic synovitis that is refractory to the repetitive, intra-articular application of glucocorticosteroids in patients with rheumatoid or seronegative arthritis. Short-term and long-term effects of radiation synovectomy on articular cartilage, synovial enhancement and thickness were assessed in a prospective, clinical trial by MRI. Methods: Thirteen patients (mean age 39 ± 13 y) were treated with a median activity of 8.4 GBq ¹⁶⁵Dy ferric hydroxide, a radionuclide with favorable physical properties and a well documented clinical safety and efficacy profile. MRI was performed on a 1.5-T MR unit using a circular polarized knee coil. Results: After a mean observation period of 13 mo, a marked reduction in synovial enhancement was observed in 10 patients. The mean reduction in baseline synovial thickness (mean 7.6 ± 3.0 mm) was 24% (P = 0.03) at 1 wk and 42% (P = 0.01) about 1 y after treatment, respectively. Clinically, 9 of 13 patients (69%) exhibited persistent response to radiation synovectomy. The local clinical score, as defined by the reduction in pain, pannus, joint effusion and by the increase in the range of motion, improved significantly (P = 0.01), from a median of 7 (range 4–10) to a median of 2 (range 0–9). One year after treatment, changes in the local clinical score were related to the decrease in synovial enhancement in MRI (r = 0.7, P = 0.008, n = 12). There were no persistent adverse effects, nor was there evidence for any severe radiation-induced damage to the articular cartilage. On later follow-up images, the structure of the articular cartilage remained unaltered in all but 3 patients, who had new, superficial erosions most likely attributed to an active disease with persistence of inflammation. Conclusion: This study suggests that radiation synovectomy with ¹⁶⁵Dy-ferric hydroxide is effective in terms of reducing chronic synovitis without causing detectable harm to the articular cartilage, as shown by MRI.

Key Words: radiation synovectomy • cartilage • synovial enhancement • synovial thickness • MRI