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. 2016 Dec;6(1):45.
doi: 10.1186/s13550-016-0201-z. Epub 2016 May 31.

Correlation of clinical outcomes with bremsstrahlung and Y-90 PET/CT imaging findings following Y-90 radiosynoviorthesis: a prospective study

Thomas W Barber  1   2 , Martin H Cherk  3   4 , Anne Powell  4   5 , Kenneth S K Yap  3 , Baki Billah  6 , Victor Kalff  3   4
Affiliations

Correlation of clinical outcomes with bremsstrahlung and Y-90 PET/CT imaging findings following Y-90 radiosynoviorthesis: a prospective study

Thomas W Barber et al. EJNMMI Res. 2016 Dec.

Abstract

Background: It is unclear how to predict which patients will respond to Y-90 radiosynoviorthesis. The aim of this study is to correlate clinical outcomes following Y-90 radiosynoviorthesis with bremsstrahlung and Y-90 PET/CT imaging findings.

Methods: Fifty-one joints underwent bremsstrahlung planar and Y-90 PET/CT imaging following Y-90 radiosynoviorthesis. The Y-90 distribution pattern on bremsstrahlung planar imaging was classified as diffuse or non-diffuse and compared with the intra or extra-articular location of activity on Y-90 PET/CT. Treatment response was assessed by patients and clinicians at 6 months. In patients who underwent bremsstrahlung SPECT, side-by-side comparison with PET was performed with image quality/resolution scored using a five-point-scale.

Findings: Bremsstrahlung planar images were classified as diffuse in 33/51 (65 %) and non-diffuse in 18/51 (35 %) scans. There was no association between treatment response and the bremsstrahlung planar imaging pattern. PET/CT confirmed an intra-articular location in all 33/33 (100 %) diffuse scans and an extra-articular location in 3/18 (17 %) non-diffuse scans. Of the three joints with extra-articular activity, none had any treatment response. Excluding these three joints, there remained no association between the bremsstrahlung planar imaging pattern and treatment response. Of the 42 joints imaged with SPECT, PET image quality/resolution was classified as superior in 40 (95 %). In one patient with extra-articular activity on PET/CT, SPECT/CT was unable to definitively localise the activity to the intra or extra-articular space.

Conclusions: The distribution pattern on bremsstrahlung planar imaging did not correlate with clinical outcome following Y-90 radiosynoviorthesis in our study population. However, in patients with non-diffuse planar imaging patterns, Y-90 PET/CT should be considered to exclude extra-articular activity with PET providing superior image quality compared to SPECT.

Keywords: Bremsstrahlung; PET/CT; Radiation synovectomy; Radiosynoviorthesis; SPECT/CT; Yttrium.

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Figures

Fig. 1
Fig. 1
Anterior bremsstrahlung planar (a), axial fused PET/CT (b) and co-registered CT (c) images of the left knee demonstrating a diffuse planar imaging Y-90 pattern confirmed to be located intra-articularly on fused PET/CT
Fig. 2
Fig. 2
Anterior bremsstrahlung planar (a), axial fused PET/CT (b) and co-registered CT (c) images of the right knee demonstrating a predominantly diffuse but also focal (non-diffuse) planar imaging Y-90 pattern located intra-articularly on fused PET/CT
Fig. 3
Fig. 3
Anterior bremsstrahlung planar (a), axial fused SPECT/CT (b), axial fused PET/CT (c) and co-registered CT (d) images of the right knee demonstrating a predominantly diffuse but also focal (non-diffuse) planar imaging Y-90 pattern with the focal component of the Y-90 activity located extra-articularly on fused PET/CT (superficial to the deepest capsular layer but deep to the medial patellar retinaculum). SPECT/CT was unable to definitively localise the focal component to the intra- or extra-articular space
Fig. 4
Fig. 4
Anterior bremsstrahlung planar (a), axial fused PET/CT (b) and co-registered CT (c) images of the left knee demonstrating a focal (non-diffuse) planar imaging Y-90 pattern located extra-articularly on fused PET/CT (superficial to the deepest capsular layer but deep to the medial patellar retinaculum)
See this image and copyright information in PMC

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