Annals of Nuclear Medicine

, Volume 20, Issue 3, pp 183–188 | Cite as

Comparison of extraarticular leakage values of radiopharmaceuticals used for radionuclide synovectomy

  • Gonca Kara Gedik
  • Ömer Uğur
  • Bülent Atilla
  • Murat Pekmezci
  • Mustafa Yildirim
  • Bedri Seven
  • Erhan VaroĞlu
Original Article



Radionuclide synovectomy is a reliable therapy in patients with chronic synovitis. However, radiation doses delivered to non-target organ systems due to leakage of radioactive material from the articular cavity are an important disadvantage of this procedure. In this study we compared extraarticular leakage values of the 3 commonly used radiopharmaceuticals;90Y-citrate,90Y-silicate and186Re-sulfide colloid.

Materials and Methods

Thirty-five patients with persistent synovitis were enrolled in the study. Twenty-two hemophilic, 8 rheumatoid arthritis and 5 patients with pigmented villonodular synovitis were studied.90Y labeled silicate and citrate were used for knee joints and186Re-sulfide for intermediate sized joints. Radiocolloid leakage values were evaluated using a gamma camera with 20% window centered over the bremsstrahlung photopeak of90Y and a respective window over the 137 keV photopeak of186Re. Regions of interest were drawn over the injection site, the regional lymph nodes and the background areas. Leakage of radiocolloid was calculated by dividing the counts/pixel in the regional lymph node area to the counts/pixel in the injection site.


No visible leakage was observed. The median leakage values calculated for90Y-citrate,90Y-silicate and186Re-sulfide were found as 1.9%, 2.4% and 2.7%, respectively. The difference between the variability of leakage values was not statistically significant (p > 0.05).Conclusion: There was no significant difference in terms of extraarticular leakage between90Y-citrate,90Y-silicate and186Re-sulfide radiocolloids.

Key words

90Y-citrate 90Y-silicate 186Re-sulfide chronic synovitis radionuclide synovectomy 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Gratz S, Göbel D, Behr TM, Herrmann A, Becker W. Correlation Between Radiation Dose, Synovial Thickness, and Efficacy of Radiosynoviorthesis.J Rheumatology 1999; 26: 1242–1249.Google Scholar
  2. 2.
    Harbert JC. Radionuclide Therapy in Joint Diseases. In: Harbert JC, ed.Nuclear Medicine Diagnosis and Therapy. New York; Thieme Medical Publishers, Inc., 1996: 1093–1110.Google Scholar
  3. 3.
    Silva M, Luck JV, Siegel E.32P chromic phosphate radiosynovectomy for chronic haemophilic synovitis.Haemophilia 2001; 7: 40–49.PubMedCrossRefGoogle Scholar
  4. 4.
    Deutsch E, Brodack JW, Deutsch KF. Radiation synovectomy revisited.Eur J Nucl Med 1993; 20: 1113–1127.PubMedCrossRefGoogle Scholar
  5. 5.
    Kasteren MEE, Novakava IRO, Boerbooms AMT, Lemmens JAM. Long term follow up of radiosynovectomy with yttrium-90 silicate in haemophilic haemarthrosis.Ann Rheum Dis 1993; 52: 548–550.PubMedCrossRefGoogle Scholar
  6. 6.
    Davis MA, Chinol M. Radiopharmaceuticals for Radiation Synovectomy: Evaluation of Two Yttrium-90 Pariculate Agents.J Nucl Med 1989; 30: 1047–1055.PubMedGoogle Scholar
  7. 7.
    Virkkunen M, Krusius FE, Heiskanen T. Experiences of intra-articular administration of radioactive gold.Acta Rheunatol Scand 1967; 13 (2): 81–91.Google Scholar
  8. 8.
    Dolphin GW. Biological hazards of radiation.Ann Rheum Dis 1973; 32: 23–28.PubMedCrossRefGoogle Scholar
  9. 9.
    Schneider P, Farahati J, Reiners C. Radiosynovectomy in Rheumatology, Orthopedics, and Hemophilia.J Nucl Med 2005; 46: 48S-54S.PubMedGoogle Scholar
  10. 10.
    EANM Procedure Guidelines for Radiosynovectomy.Eur J Nucl Med 2003; 30: BP12–BP16.Google Scholar
  11. 11.
    Siegel M, Siegel HJ, Luck JV. Radiosynovectomy’s Clinical Applications and Cost Effectiveness: A Review.Semin Nucl Med 1997; 27: 364–371.PubMedCrossRefGoogle Scholar
  12. 12.
    Franssen MJ, Boerbooms AM, Karthaus RP, Buijs WC, Putte LB. Treatment of pigmented villonodular synovitis of the knee with yttrium-90 silicate: prospective evaluations by arthroscopy, histology, and Tc 99m pertechnetate uptake measurements.Ann Rheum Dis 1989; 48 (12): 1007–1013.PubMedCrossRefGoogle Scholar
  13. 13.
    Johnson LS, Yanch JC, Shortkroff S, Barnes CL, Spitzer AI, Sledge CB. Beta particle dosimetry in radiation synovectomy.Eur J Nucl Med 1995; 22: 977–988.PubMedCrossRefGoogle Scholar
  14. 14.
    Sledge CB, Atcher RW, Shortkroff S, Anderson RJ, Bloomer WD, Hurson BJ. Intra-articular radiation synovectomy.Clin Orthop Relat Res 1984; 182: 37–40.PubMedGoogle Scholar
  15. 15.
    Fischer M, Modder G. Radionuclide therapy of inflammatory joint diseases.Nucl Med Commun 2002; 23: 829–831.PubMedCrossRefGoogle Scholar
  16. 16.
    Gedik GK, Uğur Ö, Atilla B, Dündar S. Is Corticosteroid Coinjection Necessary in Radiosynoviorthesis of Patients with Hemophilia?Clin Nucl Med 2004; 29 (9): 538–541.PubMedCrossRefGoogle Scholar
  17. 17.
    Spooren PFMJ, Raske JJ, Arens RPJH. Synovectomy of the knee with90Y.Eur J Nucl Med 1985; 10: 441–445.PubMedCrossRefGoogle Scholar
  18. 18.
    Song J, Suh CH, Park YB, Lee SH, Yoo NC, Lee JD, et al. A phase I/II a study on intra-articular injection of holimium-166-chitosan complex for the treatment of knee synovitis of rheumatoid arthritis.Eur J Nucl Med 2001; 28 (4): 489–497.PubMedCrossRefGoogle Scholar
  19. 19.
    Manil L, Voisin P, Aubert B, Guerreau D, Verrier P, Lebegue L, et al. Physical and biological dosimetry in patients undergoing radiosynoviorthesis with erbium-169 and rhenium-186.Nucl Med Commun 2001; 22 (4): 405–416.PubMedCrossRefGoogle Scholar
  20. 20.
    Sorenson JA. Passage of Charged Particles Through Matter. In: Sorenson JA, Phelps ME, eds.Physics in Nuclear Medicine. Orlando, Florida; Grune & Stratton, Inc., 1987: 161–177.Google Scholar

Copyright information

© Springer 2006

Authors and Affiliations

  • Gonca Kara Gedik
    • 1
  • Ömer Uğur
    • 1
  • Bülent Atilla
    • 2
  • Murat Pekmezci
    • 2
  • Mustafa Yildirim
    • 3
  • Bedri Seven
    • 3
  • Erhan VaroĞlu
    • 3
  1. 1.Department of Nuclear MedicineHacettepe University, Faculty of MedicineSihhiye, AnkaraTurkey
  2. 2.Department of Orthopedics and TraumatologyHacettepe University, Faculty of MedicineAnkaraTurkey
  3. 3.Department of Nuclear MedicineAtatiirk University, Faculty of MedicineErzurumTurkey

Personalised recommendations