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Radiosynovectomy in Rheumatology, Orthopedics, and Hemophilia

Peter Schneider, Prof.Dr.med.1, Jamshid Farahati, PD, Dr.med.2 and Christoph Reiners, Prof.Dr.med.1

1 Clinic for Nuclear Medicine, University of Würzburg, Würzburg, Germany
2 Department for Nuclear Medicine, Bethesda Clinics, Essen, Germany



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  		FIGURE 1. Synovitis in arthritis (left) and activated osteoarthrosis (right).

 


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  		FIGURE 2. (A) ß-Emitting colloidal particles (yellow stars) phagocytized by inflamed hypertrophic synovial lining with proliferating synoviocytes (pink). Top cartilage layer remains unaffected. (B) Subsequent cell damage and sclerosis of synovial membrane.

 


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  		FIGURE 3. Two-phase bone scintigraphy using 600 MBq of 99mTc-methylene diphosphonate in a 34-y-old women with RA shows multiple inflamed joints. Right elbow was treated with 85 MBq of 186Re-sulfide; both proximal interphalangeal joints of the digitus secundus manus were treated later with 20 MBq of 169Er-citrate.

 


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  		FIGURE 4. Injection of 169Er-citrate into proximal interphalangeal joint.

 


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  		FIGURE 5. Radiography of interphalangeal joint documents intraarticular location of needle and good distribution of small amount of contrast medium.

 


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  		FIGURE 6. Bremsstrahlung scintigraphy shows good intraarticular 90Y-silicate distribution 30 min after injection into knee joint. No activity is found extraarticularly or in puncture channel.

 


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  		FIGURE 7. Pain intensity in 4 patients documented by visual analog scale (range, 0–100) over 3 mo, beginning 10 d before RSV: immediate long lasting success (A); protracted remission (B); unsuccessful treatment (C); and temporary success, mostly due to placebo effect (D). Green = morning; red = noon; blue = evening.

 




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