J Korean Med Sci.  2016 Apr;31(4):502-509. 10.3346/jkms.2016.31.4.502.

Bone Scintigraphy in the Diagnosis of Rheumatoid Arthritis: Is There Additional Value of Bone Scintigraphy with Blood Pool Phase over Conventional Bone Scintigraphy?

• Kim JY
• Choi YY
• Kim CW
• Sung YK
• Yoo DH

• KMID: 2363687
• DOI: http://doi.org/10.3346/jkms.2016.31.4.502

Abstract

We aimed to investigate the value of bone scintigraphy with additional blood pool phase (BSBP), compared with conventional bone scintigraphy (CBS), in the assessment of rheumatoid arthritis (RA). A total of 242 patients (43 males, 199 females; 14-78 years) with arthralgia, and underwent BSBP were retrospectively analyzed. On the first physical examination, active arthritis was found in 128 of the 242 patients. Clinical diagnosis was made by a rheumatologist on the basis of the 1987 American College of Rheumatology (ACR) criteria, which are considered to be the gold standard. The diagnostic performances and prognostic value of BSBP and CBS were analyzed in the total patients with arthralgia and in the patients with arthritis. The sensitivity of BSBP (84.2%, 80/95) were significantly higher than that of CBS (74.8%, 72/95) in the patients with arthralgia (P = 0.039). When BSBP was interpreted with the results of elevated/positive anti-CCP antibody, its accuracy over CBS also became significantly higher (86.0%, 208/242 vs. 83.1%, 201/242 respectively, P = 0.021). The diagnostic odds ratio of BSBP positivity was higher than CBS positivity in the patients with arthralgia (26.0, 12.9-52.4 vs. 21.1, 10.8-41.3) and with arthritis (12.0, 4.9-29.4 vs. 10.0, 4.2-23.4). Both BSBP and CBS appear to provide acceptable accuracy and comparable diagnostic performance for diagnosis of RA. However, in the patients with arthralgia, BSBP was found to be more sensitive than CBS and more accurate when interpreted with the result of anti-CCP antibody. This could help physicians diagnose RA in daily clinical practice.

Keyword

Rheumatoid Arthritis; Whole Body Bone Scan; Additional Blood Pool Phase; Diagnostic Performance

MeSH Terms

Adolescent
Adult
Aged
Arthralgia/complications
Arthritis, Rheumatoid/complications/*diagnosis
Autoantibodies/blood
Bone and Bones/diagnostic imaging
Female
*Gated Blood-Pool Imaging
Humans
Male
Middle Aged
Odds Ratio
Peptides, Cyclic/immunology
Positron-Emission Tomography
Prognosis
Retrospective Studies
Sensitivity and Specificity
Technetium/chemistry
*Tomography, X-Ray Computed
Young Adult
Autoantibodies
Peptides, Cyclic
Technetium

Figure

• 

  Fig. 1 Findings are not compatible with rheumatoid arthritis (RA) on additional blood pool phase and bone phase of a patient with arthralgia. No significant increased blood pool activity (A) or periarticular bone uptake (B) in hands and wrists, elbows, feet, ankles and knees.

• 

  Fig. 2 Findings are compatible with rheumatoid arthritis (RA) on additional blood pool phase and bone phase of patients with RA. Increased blood pool activity (A) and periarticular bone uptake (B) are shown in right 2nd, 3rd, 5th, left 3rd, 5th PIP joints and left 1st IP joint of both hands, in both wrists, in right elbow, in right 4th, left 2nd, 3rd, and 5th MTP joints of both feet, in right ankle, and in right knee.

• 

  Fig. 3 Flowchart of the study design and number of patients enrolled. RA, rheumatoid arthritis; OA, osteoarthritis; PR, palindromic rheumatism; FMS, fibromyalgia syndrome; SpA, seronegative spondyloarthritis; AOSD, adult onset Still’s disease; Others, others not specified.

• 

  Fig. 4 Hand radiography and 99mTc-HDP bone scintigraphy findings in rheumatoid arthritis (RA) patients with positive RF and anti-CCP antibodies. (A) A 51-year old female patient with right wrist and bilateral hands pain for 10 years. Hand radiography (left column) shows uniform joint space narrowing with periarticular bony erosion in the right wrist and 1st, 2nd, and 3rd MCP joints of left hand which are suggestive of advanced rheumatoid arthritis. CBS (middle column) and blood pool image of BSBP (right column) show increased periarticular bone uptakes as well as fusiform increased blood pool activity in corresponding area of structural changes on radiography, finally interpreted as “compatible RA” on both CBS and BSBP. (B) A 45-year old female patient with left wrist, both hands and left ankle pain for 3 years. Hand radiography shows (left column) negative finding. However, CBS (middle column) and blood pool image of BSBP (right column) show increased periarticular bone uptakes as well as fusiform increased blood pool activity in right 1st IP, left 2nd MCP joins of both hands and left wrist, finally interpreted as “compatible RA” on both CBS and BSBP. (C) A 47 years old female patient with both hands and both feet pain for 1 month which might represent very early RA patient. Hand radiography (left column) and CBS (middle column) show negative finding. However, blood pool image of BSBP (right column) shows fusiform increased blood pool activity in 2nd PIP joint of left hand, finally interpreted as “compatible RA” only on BSBP.

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