Sahin M, Bernay I, Basoglu T, Canturk F
Department of Nuclear Medicine, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.
Ann Nucl Med. 1999 Dec;13(6):389-95. doi: 10.1007/BF03164932.
Tc-99m polyclonal immunoglobulin-G has been shown to be a successful agent in the depiction of active inflammation in rheumatoid arthritis (RA). The objective of this study was to compare the uptake behaviors of Tc-99m HIG and Tc-99m MDP in RA and variants of rheumatoid arthritis (VRA). Seventeen patients with RA and 8 patients with VRA presenting with active inflammation were included in this study. Ten subjects with well-diagnosed degenerative joint disease constituted the control group. All joints in patients were also imaged with Tc-99m HSA to evaluate the vascularization status of the joints. Tc-99m HIG and HSA scans were obtained at 2, 4 and 24 hours after the injection of 555 MBq Tc-99m HIG and 296 MBq Tc-99m HSA. Conventional bone scans were performed 4 hours after the injection of 740 MBq Tc-99m MDP. Target-to-background (T/B) ratios were obtained exclusively over the joint regions. Tc-99m HIG T/B ratios of the active joints in RA were significantly higher than those of the non-active joints and the control group (p < 0.05). Tc-99m HIG T/B ratios in active joints showed a progressive increase between 2 and 24 hour images (p < 0.05). In contrast, Tc-99m HSA T/B ratios decreased in all active joints significantly (p < 0.05) except the ankle joint region (p > 0.05). The T/B ratios in Tc-99m MDP bone scans were higher in all active joints than in non-active RA joints and joints of controls but significantly differences were only detected in wrist and elbow joints. All clinically active joints in VRA patients accumulated Tc-99m HIG and HSA, and showed increased Tc-99m MDP uptake. These joints had a very similar Tc-99m HIG retention pattern to the RA joints. The detection rate of active joint inflammation with Tc-99m HIG was much higher than that with Tc-99m MDP. The increasing Tc-99m HIG uptake ratio between 2 and 24 hours in contrast to Tc-99m HSA indicates the presence of other binding mechanisms besides increased vascularity in RA.
锝-99m多克隆免疫球蛋白G已被证明是一种成功的药物，可用于描绘类风湿关节炎（RA）中的活动性炎症。本研究的目的是比较锝-99m人免疫球蛋白G（HIG）和锝-99m亚甲基二膦酸盐（MDP）在RA及类风湿关节炎变异型（VRA）中的摄取行为。本研究纳入了17例患有活动性炎症的RA患者和8例VRA患者。10例诊断明确的退行性关节病患者组成对照组。对患者的所有关节也进行了锝-99m人血清白蛋白（HSA）显像，以评估关节的血管化状态。在注射555 MBq锝-99m HIG和296 MBq锝-99m HSA后2、4和24小时进行锝-99m HIG和HSA扫描。在注射740 MBq锝-99m MDP后4小时进行常规骨扫描。仅在关节区域获得靶本底（T/B）比值。RA中活动关节的锝-99m HIG T/B比值显著高于非活动关节和对照组（p<0.05）。活动关节的锝-99m HIG T/B比值在2至24小时图像之间呈逐渐升高趋势（p<0.05）。相比之下，除踝关节区域外（p>0.05），所有活动关节的锝-99m HSA T/B比值均显著下降（p<0.05）。锝-99m MDP骨扫描中所有活动关节的T/B比值均高于非活动RA关节和对照组关节，但仅在腕关节和肘关节检测到显著差异。VRA患者所有临床活动关节均摄取锝-99m HIG和HSA，并显示锝-99m MDP摄取增加。这些关节的锝-99m HIG保留模式与RA关节非常相似。锝-99m HIG对活动关节炎症的检测率远高于锝-99m MDP。与锝-99m HSA相比，2至24小时内锝-99m HIG摄取率的增加表明，除血管增多外，RA中还存在其他结合机制。
