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Early and Delayed 99mTc-MDP SPECT/CT Findings in Rheumatoid Arthritis and Osteoarthritis
Yasser G Abdelhafez1, Rosalie J Hagge, Ramsey D Badawi
1From the *Department of Radiology, University of California, Davis, Davis, CA; †Nuclear Medicine Unit, South Egypt Cancer Institute, Assiut University, Assiut, Egypt; and ‡Department of Rheumatology, University of California, Davis, Davis, CA.
Clinical Nuclear Medicine
|September 6, 2017
Summary
Dual-phase Tc-MDP SPECT/CT imaging reveals distinct patterns in rheumatoid arthritis (RA) and osteoarthritis (OA) joints. RA joints show asymmetric delayed enhancement, while OA joints exhibit symmetric, joint-centered uptake, aiding differential diagnosis.
Area of Science:
- Nuclear medicine
- Radiopharmaceuticals
- Medical imaging
Background:
- Rheumatoid arthritis (RA) and osteoarthritis (OA) are common joint diseases with distinct pathologies.
- Differentiating RA and OA can be challenging, especially in cases with overlapping radiographic features.
- Tc-99m methylene diphosphonate (Tc-MDP) SPECT/CT is a functional imaging technique used to assess bone and joint metabolism.
Observation:
- A 74-year-old male patient with seropositive RA and radiographic OA underwent dual-phase high-resolution Tc-MDP SPECT/CT.
- Early-phase imaging showed ring-like radiotracer uptake in RA joints, indicative of active synovitis.
- Minimal early enhancement was observed in the first carpometacarpal joint, despite CT evidence of OA.
Findings:
- Delayed-phase Tc-MDP uptake patterns differed significantly between RA and OA joints.
- RA joints demonstrated asymmetric delayed enhancement.
- The osteoarthritis joint displayed a symmetric, joint-centered delayed enhancement pattern.
Implications:
- Dual-phase Tc-MDP SPECT/CT can help differentiate between rheumatoid arthritis and osteoarthritis based on distinct radiotracer uptake patterns.
- This imaging approach may improve diagnostic accuracy in patients with concurrent or overlapping joint conditions.
- Further studies are warranted to validate these findings in larger patient cohorts.