Synovitis and bone inflammation in early rheumatoid arthritis: high-resolution multi-pinhole SPECT versus MRI

PURPOSE We aimed to assess the relationship between bone inflammation in multi-pinhole single-photon emission computed tomography (MPH-SPEC) and synovitis detected by magnetic resonance imaging (MRI) in early rheumatoid arthritis patients. MATERIALS AND METHODS MPH-SPECT with technetium dicarboxypropanedisphosphonate (Tc-99mDPD) and 3 Tesla MRI were performed in 10 early rheumatoid arthritis patients. Eight finder joint sites were assessed for increased osteoblastic activity using visual and region-of-interest (ROI) analysis Presence of joint inflaimmation in MRI was investigated using the subscores of the rheumatoid arthritis MRI score. RESULTS Tc-99mDPD uptake was increased in 38 (47.5%) and 22 (27.5%) joint sites as determined by visual and ROI analysis, respectively. A total of 32 (84.2%) sites with increased bone metabolism showed a normal MRI bone signal. The MPH-SPECT uptake ratio was elevated only in the subgroup with severe synovitis (P < 0.001). CONCLUSION In early rheumatoid arthritis, molecular imaging with MPH-SPECT detects higher rates of inflammatory bone involvement compared to MRI. Our preliminary data-suggest that osteitis is related to severe synovitis.