[Radiosinoviektomija z itrijem 90 pri bolnikih z različnimi revmatskimi boleznimi: ugotavljanje trajanja terapevtskega učinka]

The aim of the retrospective study was to evaluate the efficacy of radiosynovectomy (with yttrium 90) mainly in patients with rheumatoid arthritis, less with some other rheumatic diseases. The evaluation period varied from half to nine years. The procedure was performed in 273 patients (225 females, 48 males) or in 463 joints (402 knees, 61 shoulders and ankles).The effects was evaluated by change in degree of morning stiffiness, pain and swelling (score from 0 to 9). Very good results were obtained in 69 (15%), good in 142 (30.5%), moderate in 197 (42.5%) and no effect in 55 (12%) joints. Six months after the procedure 38 joints (8%), half to two years after221 joint (48%) were in good remission, after 3 to 4 years 95 joints (20%), after 5 to 6 years 57 joints (12%) were well, 7 to 9 years later 52 joints (11%) showed no signs of arthritis. Joint pain and swelling were the most frequent procedure complications (5.6%). In two patients with additional immunomodulating therapy chronic myeloid and lymphocityc leukaemia were diagnosed. Radiosynovectomy is considered to be an effective and safe treatment for synovitis indifferent rheumatic diseases.Cilj retrospektivne študije je bil oceniti učinek izotopske sinovektomije z itrijem 90 predvsem pri bolnikih z revmatoidnim artritisom inmanj z nekaterimirevmatičnimi boleznimi. Bolnike smo opazovali v obdobju od pol do devet let. Poseg je bil napravljen pri 273 bolnikih (225 žensk, 48 moških) oziroma na 463 sklepih (402 na kolenih, 61 na ramenih in gležnjih). Učinek smoocenjevali s spremembo stopnje jutranje okorelnosti , bolečine in otekline sklepa (od 0 do 9). Zelo dobre rezulate smo dosegli na 69 (15%), dobre na 142 (30,5%), srednje dobre na 197 sklepih (42,5%), na 55 sklepih ni bilo učinka (12%). Pol leta po posegu je bilo 38 sklepov (8%) v remisiji, pol do dve leti 221 (48%), po 3 do 4 letih 95 (20%), po 5 do 6 letih je bilo 57 sklepov brez znakov vnetja (12%), po 7 do 9 letih pa še 52 (11%). Najpogostejši zapleti po sinovektomiji so bile bolečine in otekline sklepov (5,6%). Pri dveh bolnicah, ki sta dobivali tudi imunomodulirajoča zdravila, smo odkrili kronično mieloično oziroma limfatično levkemijo. Izotopska sinovektomija je torej učinkovito in varno zdravljenje sinovitisa pri različnih boleznih

The value of spect when added to planar scintigraphy in patients with metastases and benign disease of the spine

Namjera rada bila je utvrditi da li je SPECT scintigrafijom moguća sigurnija diferencijacija među benignim i malignim lezijama u kralježnici i da li postoji razlika u senzitivitetu između tih metoda. Planirana i SPECT scintigrafija su bile obavljene kod 37 bolesnika s bolovima u kralježnici bez poznate maligne bolesti i kod 38 bolesnika s poznatim malignomom. Lokalizacija, tip i jakost akumulacije radioindikatora su bili uspoređeni na planarnoj i SPECT scintigrafiji. Malignitet ili benigno značenje lezija je bilo dokazano radiološkim metodama, histologijom i 6-mjesečnim praćenjem bolesnika uz ponavljanje relevantnih pretraga. Više metastaza je bilo otkriveno pomoću SPECT-a (58/64 - 90,6%) u odnosu na planarnu scintigrafiju (42/64 - 65,6%, p<0,01). U 3/7 bolesnika s poznatim malignomom, kod kojih je Ljublplanirani sken bio normalan, SPECT je pokazao metastaze. Lezije su bile kontrastnije na SPECT-u. Promjene koje su bile na rubovima kralježaka, u fasetnim zglobovima ili u spinozusima gotovo uvijek su bile benigne, a u pediklima, korpusima s ekstenzijom u pedikle, unutar korpusa ili u cijelim kralješcima često su bile maligne. Većina benignih i malignih lezija bila je na planiranim scintigramima i SPECT-u vruća. SPECT je više metastaza pokazao u obliku hladnih lezija (12/58) u usporedbi s planarnom scintigrafijom (2/42) p<0,01. SPECT (single photon emission computed tomography) omogućava veći broj pravilnih ocjena bolesti ako se doda planarnoj scintigrafiji kralježnice kod bolesnika s poznatim malignomom i kliničkom sumnjom na metastaze u skeletu, osobito kod bolesnika s graničnom značajnošću promjena na planarnom scintigramu i kod bolesnika sa solitarnom lezijom u kralježnici.Aim: The purpose of this study was to establish whether SPECT was more accurate than planar scintigraphy at differentiating between malignant and benign lesions and to compare the sensitivity of both methods in detection of metastases in the spine. Methods: Planar scintigraphy and SPECT were performed in 37 patients with back pain without known malignancy and 38 patients with confirmed malignancy. Location, type and intensity of tracer accumulation were compared on planar and SPECT scans. Malignant or benign nature of lesions was proven by radiological methods, histology and during 6-month follow-up. Results: More metastases were detected with SPECT (SPECT 58/64, planar sc. 42/64, p<0.01). In 3 out of 7 patients with known malignancy and normal planar scan only SPECT detected metastases. The lesion to background ratio was higher on SPECT than planar scans. Lesions showing increased radioactivity in lateral edges of the vertebral body, with prominence (n=8) or non-prominent (n=12), in terminal plate (n=3), in the spinous processus (n=29) and in facetal joint (n=29) noticed in patients with known malignancy were always benign. Lesions were more often malignant (3/5) than benign (2/5) when seen in the pedicle, in the body with extension into pedicle (14/22, vs. 8/22) as well as in case of small lesions inside the vertebral body (4/5, vs. 1/5) and increased uptake in the whole vertebra (4/6 vs. 2/6). Conclusions: SPECT can improve accuracy of planar bone scans in patients with known malignancy and clinical suspicion on skeletal metastases, in case of solitary lesions shown on planar scan, or when radioactivity in one or more vertebras is borderline increased