Diagnosis of Joint Disorders

Although scintigraphy has a limited role in the diagnosis of rheumatic diseases, it can provide important complementary information, and familiarity with the scintigraphic patterns of different disease conditions of the joints and periarticular structures is important. Scintigraphy, however, could be more useful in evaluating the activity of the disease processes. The scintigraphic pattern of different arthropathies varies depending on the type and phase of the condition. Some conditions affect mainly small or large joints, while others affect both in either symmetrical or asymmetrical fashion. Primary osteoarthritis and rheumatoid arthritis show a classically symmetrical uptake. When large joints such as the shoulders, hips, or knees are only involved, it indicates certain conditions such as osteoarthritis, ankylosing spondylitis, calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, or joint infection. Other radionuclides used in the diagnosis and follow-up of these conditions include 111In- and 99mTc-labeled poly- and monoclonal antibodies such as Tc-99 m-labeled human polyclonal immunoglobulin-G, Tc-99 m-anti-E-selectin-Fab, respectively, Tc-99 m hexamethylpropylene amine oxime (Tc-99 m HMPAO), Tc-99 m SC, Tc-99 m nanocolloid, F-18 sodium fluoride, and F-18 fluoro-2-deoxy-D-glucose (FDG). The use of SPECT and pinhole techniques should be remembered since they add diagnostic value to the scintigraphic methods. F-18 FDG positron emission tomography has the potential to quantitatively assess the degree of arthritis activity. Although scintigraphy has a limited role in the diagnosis of rheumatic diseases, it can provide important complementary information, and familiarity with the scintigraphic patterns of different disease conditions of the joints and periarticular structures is important. Scintigraphy, however, could be more useful in evaluating the activity of the disease processes. The scintigraphic pattern of different arthropathies varies depending on the type and phase of the condition. Some conditions affect mainly small or large joints, while others affect both in either symmetrical or asymmetrical fashion. Primary osteoarthritis and rheumatoid arthritis show a classically symmetrical uptake. When large joints such as the shoulders, hips, or knees are only involved, it indicates certain conditions such as osteoarthritis, ankylosing spondylitis, calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, or joint infection. In addition to Tc99m diphosphonates, other radionuclides are used in the diagnosis and follow-up of these conditions. These include 111In- and 99mTc-labeled poly- and monoclonal antibodies such as Tc-99 m-labeled human polyclonal immunoglobulin-G, Tc-99 m-anti-E-selectin-Fab, respectively, Tc-99 m hexamethylpropylene amine oxime (Tc-99 m HMPAO), Tc-99 m SC, Tc-99 m nanocolloid, F-18 sodium fluoride, and F-18 fluoro-2-deoxy-D-glucose (FDG). The use of SPECT, SPECT/CT, and pinhole techniques should be remembered since they add diagnostic value to the scintigraphic methods. F-18 FDG PET/CT has the ability to quantitatively assess the degree of arthritis activity.