Scintigraphy of rheumatoid peripheral joints. Reliability of visual assessment vs. computerized methods

Area of Science:

• Nuclear medicine
• Rheumatology
• Medical imaging analysis

Background:

• 99mTc-MDP scintigraphy is utilized for evaluating peripheral joint activity.
• Assessing scintigraphy results requires robust analytical methods for clinical application.

Purpose of the Study:

• To compare the efficacy of visual assessment and computerized region-of-interest (ROI) methods for analyzing 99mTc-MDP peripheral joint scintigraphy.
• To determine the most suitable method for clinical evaluation of joint inflammation in rheumatoid arthritis.

Main Methods:

• Visual Assessment (VA) of scintigrams.
• Computerized region-of-interest (ROI) method without a reference region.
• Corrected ROI method utilizing a reference region.
• Comparison of scintigraphy results with clinical joint activity assessed by palpation in 16 rheumatoid patients (477 joints).

Main Results:

• The ROI method without a reference was insensitive and unsuitable for clinical use.
• Both Visual Assessment and the Corrected ROI method showed good correlation with clinical joint activity.
• Sensitivity for detecting inflamed finger joints: ROI (6%), Corrected ROI (71%), Visual Assessment (75%).
• Sensitivity for detecting inflamed peripheral foot joints: ROI (28%), Corrected ROI (41%), Visual Assessment (58%).

Conclusions:

• Visual Assessment of 99mTc-MDP scintigraphy is adequate and the preferred method for clinical use.
• The Corrected ROI method also demonstrates clinical utility, correlating well with clinical assessment.
• The standard ROI method without a reference region is not recommended for clinical practice.