Radiosynovectomy in pigmented villonodular synovitis

Area of Science:

• Orthopedics
• Nuclear Medicine
• Radiology

Background:

• Pigmented villonodular synovitis (PVS) is a rare benign synovial proliferation with high relapse rates after surgical synovectomy.
• Current treatment relies on surgical or arthroscopic synovectomy, but recurrence remains a significant challenge.

Purpose of the Study:

• To evaluate the efficacy of combined radiosynovectomy (RS) and surgical synovectomy for treating pigmented villonodular synovitis.
• To assess the impact of this combined therapy on clinical symptoms and bone scintigraphy findings.

Main Methods:

• Eleven patients with PVS underwent thirteen radiosynovectomies using Y-90 citrate or Re-186 sulfide, following surgical synovectomy.
• Clinical response was evaluated using a composite score for hydrops, rubor, motility, and pain.
• Bone scintigraphy, including blood pool (BUR) and delayed (DUR) uptake of Tc-99m-diphosphonate, was quantified.

Main Results:

• The overall clinical score significantly decreased from 5.45 to 1.18 one year post-treatment (p < 0.005).
• Blood pool uptake (BUR) showed a significant reduction from 0.51 to 0.08 (p < 0.005).
• Delayed image uptake (DUR) did not demonstrate significant changes (p = 0.3).

Conclusions:

• Combined surgical synovectomy and radiosynovectomy is highly effective for managing clinical symptoms of PVS.
• This combined approach improves bone scintigraphic signs of inflammation.
• Radiosynovectomy does not appear to influence late diphosphonate uptake in PVS patients.