A technic for visualization of inflamed joints using intravenously injected technetium-99m as pertechnetate and an Anger (scintillation) camera for detection will be described. Contrast between inflamed and normal tissue was usually greatest in the first few minutes after isotope injection, presumably, at the time of maximal difference in concentration of 99mTc between blood and extravascular tissue. Inflamed joints with moderate to large effusions were often visualized best 1-2 hr after injection. The extensive binding of pertechnetate by plasma and joint fluid proteins found in equilibrium dialysis experiments was evoked as an explanation of this phenomenon.Technetium-99m ("9mTc) scheme for 99M0 is given in Fig 1.4 Many clinical uses of 99mTc have been developed, including joint scans.6-7 A technic for the visualization of diseased joints using 9 s m T~ and a scintillation (Anger) camera is the subject of this report. The data are interpreted in terms of isotope kinetics. MATERIALS AND METHODSSubjects. T h e optimal time of exposure was determined after scintiphotographs of the hands and wrists of 6 patients without joint disease had demonstrated a nearly uniform distribution of radioactivity (Fig 2). The "normals" were individuals receiving intravenous pertechnetate-99m for other diagnostic studies such as brain tumor localization. The hand, "wrist" and knee joints of patients with classical rheumatoid arthritis (RA) were then examined serially. Serial frontal images (ie, patella to collimator) were obtained of an inflamed knee containing a large effusion in patient E.M.Podtfonlng. Five mc lomTc, as sodium pertechnetate (NaTcO,) , were given intravenously. The

Intussusception of the distal esophagus into a reducible hiatus hernia is described in nine female and three male patients. The main radiographic feature is demonstration of a lobulated fundal mass of changeable size and configuration surrounding the narrowed distal esophageal segment. This pseudotumor is produced by inversion of the hiatus hernia into the stomach, and may be mistaken for a neoplasm. Disinvagination invariably occurs when maneuvers directed toward demonstration of a sliding hernia are utilized during upper gastrointestinal fluoroscopy. It is emphasized that esophago-gastric invagination frequently accounts for masses shown in the cardia of older women with intermittent dysphagia and crampy epigastric pain.

Technetium-99m scintiphotography of the hands, wrists and knee joints of 24 patients with rheumatoid arthritis (RA) showed abnormal localization of isotope in one or more synovial structures in 96% of hands, in 94% of wrists and in 74% of knees. The results of scintiphotography correlated well with clinical assessment of synovial thickening and tenderness in the proximal interphalangeal and metacarpophalangeal joints of 9 consecutive RA patients. Scintiphotography proved more sensitive than clinical examination only in knee joints; in 2 patients clinical involvement was antedated by positive scintiphotos. Joint visualization after intravenous pertechnetate was nonspecific, and positive scintigrams were obtained in other diseases associated with increased articular or periarticular vascularity. The technic is definitely useful in the serial evaluation of the results of local medical and surgical treatment of arthritis and as an aid in the diagnosis of psychogenic rheumatism.A technic for visualization of inflamed joints using DDmTechnetiurn as the pertechnetate (NaTcO,) and an Anger (scintillation) camera is described in an accompanyFrom the Section of Arthritis and Metabolism.