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. 2022 Jan;49(2):681-708.
doi: 10.1007/s00259-021-05541-7. Epub 2021 Oct 20.

The EANM guideline for radiosynoviorthesis

W U Kampen  1 , B Boddenberg-Pätzold  2 , M Fischer  3 , M Gabriel  4 , R Klett  5 , M Konijnenberg  6 , E Kresnik  7 , H Lellouche  8   9 , F Paycha  10 , L Terslev  11 , C Turkmen  12 , F van der Zant  13 , L Antunovic  14 , E Panagiotidis  15 , G Gnanasegaran  16 , T Kuwert  17 , T Van den Wyngaert  18   19 ; EANM Bone & Joint Committee, the Dosimetry Committee, the Oncology & Theranostics Committee
Affiliations

The EANM guideline for radiosynoviorthesis

W U Kampen et al. Eur J Nucl Med Mol Imaging. 2022 Jan.

Abstract

Purpose: Radiosynoviorthesis (RSO) using the intraarticular application of beta-particle emitting radiocolloids has for decades been used for the local treatment of inflammatory joint diseases. The injected radiopharmaceuticals are phagocytized by the superficial macrophages of the synovial membrane, resulting in sclerosis and fibrosis of the formerly inflamed tissue, finally leading to reduced joint effusion and alleviation of joint pain.

Methods: The European Association of Nuclear Medicine (EANM) has written and approved these guidelines in tight collaboration with an international team of clinical experts, including rheumatologists. Besides clinical and procedural aspects, different national legislative issues, dosimetric considerations, possible complications, and side effects are addressed.

Conclusion: These guidelines will assist nuclear medicine physicians in performing radiosynoviorthesis. Since there are differences regarding the radiopharmaceuticals approved for RSO and the official indications between several European countries, this guideline can only give a framework that must be adopted individually.

Keywords: Arthritis; Radiosynoviorthesis; Synovitis.

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Conflict of interest statement

Author W.U. Kampen has received travel grants and speakers fee from Curium Germany in the past, lastly in 2016.

Author M. Fischer is an external medical advisor regarding pharmacovigilance of Curium Germany GmbH, which does not mean any potential conflict of interest regarding this publication.

Author L. Terslev has received speakers fee from AbbVie, Janssen, Roche, Novartis, Pfizer, MSD, BMS, and GE.

Authors W. U. Kampen, F. Paycha, L. Antunovic, M. Panagiotidis, G. Gnanasegaran, T. Kuwert, and T. v.d. Wyngaert are or were members of the EANM Bone & Joint committee, M. Konijnenberg is a member of the EANM Dosimetry Committee, and G. Gnanasegaran is now a member of the Oncology & Theranostics committee.

Authors B. Boddenberg-Pätzold, M. Gabriel, R. Klett, M. Konijnenberg, E. Kresnik, H. Lellouche, F. Paycha, C. Turkmen, F. van der Zant, L. Antunovic, M. Panagiotidis, G. Gnanasegaran, T. Kuwert, and T. v.d. Wyngaert declare that they have no conflict of interest (except those being members of the abovementioned committees).

Figures

Fig. 1
Fig. 1
Ultrasound of (A) the puncture of a large Baker’s cyst and (B) the puncture of a knee joint from lateral into the suprapatellar recess with the whole needle in view (arrows), here penetrating a thick synovial fold (arrowheads) (images courtesy of Dr. B. Boddenberg-Pätzold, Cologne/Germany)
Fig. 2
Fig. 2
Set of instruments for the puncture of a knee joint, (A) large syringe (20 ml) with applicator for aspiration of joint effusion, (B) a ring made of acrylic plastic to reduce the local radiation dose at the base of the needle significantly, and (C) a syringe shielding made of acrylic plastic to reduce radiation load from yttrium-90 and rhenium-186 during RSO
Fig. 3
Fig. 3
A small flexible tube (volume 350 µl) may be used for difficult injections to avoid displacement of the needle inside the joint when the syringes with a contrast agent, radiocolloid, and glucocorticosteroid are exchanged
Fig. 4
Fig. 4
Dorsal recess of a finger joint on a macroscopic anatomy specimen (arrow). Inlay (A) shows the histology of the dorsal recess in a proximal interphalangeal joint (arrow heads) (image by courtesy of Prof. Dr. Bernhard Tillmann, Kiel, Germany) and inlay (B) illustrates the intraarticular distribution of the injected contrast media
Fig. 5
Fig. 5
Distribution scan by SPECT/CT 30 min after intraarticular injection of 74 MBq [186Re]rhenium sulfide in an ankle joint of a patient with rheumatoid arthritis
Fig. 6
Fig. 6
Dose rate at the surface of a plexiglass shielding of a syringe filled with 185 MBq yttrium-90 in different distances from the neck of the hollow needle. Values in parentheses show the dose rates without shielding. (reproduced with permission of the Bundesamt f. Strahlenschutz BfS)
See this image and copyright information in PMC

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