Korean J Radiol.  2003 Sep;4(3):170-178. 10.3348/kjr.2003.4.3.170.

MR Evaluation of Radiation Synovectomy of the Knee by Means of Intra-articular Injection of Holmium-166-Chitosan Complex in Patients with Rheumatoid Arthritis: Results at 4-month Follow-up

• Lee SH
• Suh JS
• Kim HS
• Lee JD
• Song J
• Lee SK

• KMID: 754021
• DOI: http://doi.org/10.3348/kjr.2003.4.3.170

Abstract

OBJECTIVE
To determine whether MRI is able to demonstrate the effect of radiation synovectomy after the intra-articular injection of holmium-166-chitosan complex for the treatment of rheumatoid arthritis of the knee. MATERIALS AND METHODS: Fourteen patients aged 36-59 years were treated with 10-20 mCi of holmium-166-chitosan complex. A criterion for inclusion in this study was the absence of observable improvement after 3- or more months of treatment of the knee with disease-modifying anti-rheumatic drugs. MR images were acquired both prior to and 4-months after treatment. Clinical evaluation included the use of visual analog scales to assess pain, and the circumference of the knee and its range of motion were also determined. MR evaluation included measurement of the volume of synovial enhancement and wall thickness, the amount of joint effusion, and quantifiable scoring of bone erosion, bone edema and lymph nodes. RESULTS: Visual analog scale readings decreased significantly after radiation synovectomy (p < 0.05). MRI showed that joint effusion decreased significantly (p < 0.05), and that the volume of synovial enhancement tended to decrease, but to an insignificant extent (p = 0.107). CONCLUSION: The decreased joint effusion noted at 4-month follow-up resulted from radiation synovectomy of the rheumatoid knee by means of intra-articular injection of holmium-166-chitosan complex.

Keyword

Knee, MR, Rheumatoid arthritis, Radiation synovectomy

Figure

• 

  Fig. 1 MR images of a 50-year-old woman with rheumatoid arthritis of the knee. A. Postcontrast fat-suppressed, three-dimensional spoiled gradient-echo sagittal image (TR/TE=21.1/2.2, flip angle=15°) shows a highly enhanced pannus (arrowheads). Joint effusion (arrow) is seen, with low signal intensity at the suprapatellar recess before treatment involving the intra-articular injection of 166Ho-chitosan complex. B. MR image obtained four months after treatment shows that the size of the pannus and joint effusion have decreased.

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  Fig. 2 MR images of a 37-year-old woman with rheumatoid arthritis of the knee. A. Postcontrast, fat-suppressed, three-dimensional spoiled gradient-echo sagittal image (TR/TE = 21.1/2.2, flip angle=15°) obtained before the intra-articular injection of 166Ho-chitosan complex depicts extensive bone marrow edema in the lateral condyle of the femur and tibia (arrows). Enhanced synovial tissue is seen in the infrapatellar region and posterior joint space (arrowheads), and in the suprapatellar pouch, joint effusion is apparent (double arrow). B. MR image obtained four months after treatment shows that bone marrow edema has almost disappeared. Bony erosion still remains, however, and is clearly demarcated in the subchondral bone of the lateral tibia (arrow). Joint effusion and the size of the pannus have both decreased.

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  Fig. 3 MR images of a 54-year-old woman with rheumatoid arthritis of the knee. A. Postcontrast, fat-suppressed, three-dimensional spoiled gradient-echo sagittal image (TR/TE = 21.1/2.2, flip angle=15°) obtained before the intra-articular injection of 166Ho-chitosan complex depicts lymph nodes in the popliteal region (arrows). B. MR image obtained 4-months after treatment shows that the size and number of the lymph nodes are unchanged (arrows).

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