Feasibility of dual-phase 99m Tc-MDP SPECT/CT imaging in rheumatoid arthritis evaluation

Quantitative Imaging in Medicine and Surgery

article

Yasser G. Abdelhafez¹  Felipe Godinez¹  Kanika Sood⁴  Rosalie J. Hagge¹  Robert D. Boutin¹  Siba P. Raychaudhuri⁴  Ramsey D. Badawi¹  Abhijit J. Chaudhari¹ 

[1] Department of Radiology, University of California Davis;Nuclear Medicine Unit, South Egypt Cancer Institute, Assiut University;School of Biomedical Engineering and Imaging Science, King’s College;Rheumatology Section, Sacramento Veterans Affairs Medical Center;Department of Radiology, Stanford University;Department of Internal Medicine, University of California Davis

关键词: Bone scan;    rheumatoid arthritis;    SPECT/CT;    soft tissue vascularity;    osteoblastic response;   

DOI  :  10.21037/qims-20-996

学科分类：外科医学

来源: AME Publications

【 摘 要 】

Background: To prospectively demonstrate the feasibility of performing dual-phase SPECT/CT for the assessment of the small joints of the hands of rheumatoid arthritis (RA) patients, and to evaluate the reliability of the quantitative and qualitative measures derived from the resulting images. Methods: A SPECT/CT imaging protocol was developed in this pilot study to scan both hands simultaneously in participants with RA, in two phases of 99mTc-MDP radiotracer uptake, namely the softtissue blood pool phase (within 15 minutes after radiotracer injection) and osseous phase (after 3 hours). Joints were evaluated qualitatively (normal vs. abnormal uptake) and quantitatively [by measuring a newly developed metric, maximum corrected count ratio (MCCR)]. Qualitative and quantitative evaluations were repeated to assess reliability. Results: Four participants completed seven studies (all four were imaged at baseline, and three of them at follow-up after 1-month of arthritis therapy). A total of 280 joints (20 per hand) were evaluated. The MCCR from soft-tissue phase scans was significantly higher for clinically abnormal joints compared to clinically normal ones; P<0.001, however the MCCR from the osseous phase scans were not different between the two joint groups. Intraclass Correlation Coefficient (ICC) for MCCR was excellent [0.9789, 95% confidence interval (CI): 0.9734–0.9833]. Intra-observer agreement for qualitative SPECT findings was substantial for both the soft-tissue phase (kappa =0.78, 95% CI: 0.72–0.83) and osseous-phase (kappa =0.70, 95% CI: 0.64– 0.76) scans. Conclusions: Extracting reliable quantitative and qualitative measures from dual-phase 99mTc-MDP SPECT/CT hand scans is feasible in RA patients. SPECT/CT may provide a unique means for assessing both synovitis and osseous involvement in RA joints using the same radiotracer injection.

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