Nucl Med Mol Imaging.  2024 Apr;58(2):52-61. 10.1007/s13139-023-00823-4.

The Biodistribution and Utility of  ^99mTc‑Ethylenedicysteine‑Deoxyglucose ( ^99mTc‑Glucosamine) in the Identification of Active Disease in Patients with Rheumatoid Arthritis—a Single Center Prospective Study

• Evbuomwan O
• Rensburg B
• Engelbrecht G
• Driver C
• Labuschagne M
• Sempa J
• Je’nine  H

• KMID: 2555454
• DOI: http://doi.org/10.1007/s13139-023-00823-4

Abstract

Purpose
Our objectives were to investigate the utility of ^99mTc-ethylenedicysteine-deoxyglucose (ECDG) in identifying active disease in the joints of patients with rheumatoid arthritis (RA), as well as to evaluate the biodistribution of this radiopharmaceutical.
Methods
A prospective study was conducted at the Department of Nuclear Medicine of the University of the Free State/ Universitas Academic Hospital in Bloemfontein, South Africa. Twenty-two participants from the rheumatology department diagnosed with RA according to the ACR/EULAR classification criteria were enrolled. Participants were injected with 20–25 mCi of ^99mTc-ECDG. Flow, blood pool, whole body, delayed static, and SPECT/CT images were acquired. Known sites of disease were qualitatively assessed for intensity of uptake, and disease severity was graded (Grade 0–3).
Results
Twenty-two participants were studied. The median (interquartile range) age was 59 (49–68) years, and the majority (n = 21; 95.5%) were females. There was abnormal increased uptake of ^99mTc-ECDG noted in majority of the sites of known disease, including unknown sites. SPECT/CT imaging localized radiotracer uptake specifically to the synovial space. Similar biodistribution of radiotracer was noted in all patients, irrespective of disease severity or fasting status.
Conclusion
^99mTc-ECDG can efficiently assess disease activity in the joints of patients with RA. It accumulates in sites of both clinical and subclinical disease and might be a very useful tool for the rheumatologist in the management of patients with RA.

Keyword

^99mTc-ECDG; Glucosamine; Rheumatoid arthritis; SPECT/CT