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FDG-PET/CT can visualise the extent of inflammationin rheumatoid arthritis of the tarsusWouter V. Vogel1, Piet L. C. M. van Riel2, Wim J. G. Oyen1
1 Department of Nuclear Medicine (565), Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands2 Department of Rheumatology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
Received: 14 July 2006 / Accepted: 21 August 2006 / Published online: 18 October 2006© Springer-Verlag 2006
Eur J Nucl Med Mol Imaging (2007) 34:439DOI 10.1007/s00259-006-0246-8
A 59-year-old man presented with therapy-resistant rheu-matoid factor-negative oligoarthritis, with persistent painafter surgical synovectomy of the ankle joint andpharmacological treatment. Physical examination andconventional radiography could not discriminate whichjoints in the tarsus were causing the complaints. Thepatient was referred for FDG-PET/CT. The radiopharma-ceutical 18F-fluorodeoxyglucose (FDG) accumulates inactivated macrophages and granulocytes, and thus pro-vides a tool for visualisation of joint inflammation [1, 2].Shown are sagittal slices through the lateral (left) andmedial (right) sides of the foot, obtained with A FDG-PET, B fused PET and CT, and C CT. D Anatomicalreference (Ti tibia, Ta talus, Ca calcaneus, N os naviculare,Cu cuboid, Cm os cuneiforme mediale, Ci os cuneiformeintermediale, Mt os metatarsale). The images demonstrateintense inflammation in the talo-navicular and calcaneo-talar joints. Inflammation of lower intensity is visualisedin the talo-calcaneal, navicular-cuneiform and metatarso-phalangeal joints. The ankle joint does not show activeinflammation, indicating successful previous synovecto-my. In this patient, the most severe inflammation waslocalised in the lower talar joints, and many other jointsof the tarsus were affected to some extent. Because of thelarge involved area, triple arthrodesis of the tarsus wasperformed, with successful pain reduction.
References
1. Polisson RP, Schoenberg OI, Fischman A, Rubin R, Simon LS,Rosenthal D, et al. Use of magnetic resonance imaging andpositron emission tomography in the assessment of synovialvolume and glucose metabolism in patients with rheumatoidarthritis. Arthritis Rheum 1995;38:819–25.
2. Beckers C, Ribbens C, Andre B, Marcelis S, Kaye O, Mathy L,et al. Assessment of disease activity in rheumatoid arthritiswith 18F-FDG PET. J Nucl Med 2004;45:956–64.
Wouter V. Vogel ())Department of Nuclear Medicine (565),Radboud University Nijmegen Medical Center,P.O. Box 9101, 6500 HB Nijmegen, The Netherlandse-mail: [email protected].: +31-24-3614048, Fax: +31-24-3618942
European Journal of Nuclear Medicine and Molecular Imaging Vol. 34, No. 3, March 2007
