Radiocolloids in the Management of Hemophilic Arthropathy in Children and Adolescents

Erken, Einhard H. W.

doi:10.1097/00003086-199103000-00015

Cited by 44 publications

(53 citation statements)

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“…The synovial activity in end-stage haemophilic joints goes on increasing despite dramatic bone and cartilage loss (23). It has been well known that, despite its clinical efficacy, RS does not prevent progressive severe joint degeneration in hemophilic joints as seen on both plain radiography and MRI (25,26,27,28,29,30,31,32) and our findings are also in congruence with this result as there were no significant difference between the mean scores of MRI and plain X-ray measurements before and after the procedure. …”

Section: Discussionsupporting

confidence: 90%

The Efficacy of Magnetic Resonance Imaging and X-Ray in the Evaluation of Response to Radiosynovectomy in Patients with Hemophilic Arthropathy

Özülker¹,

Özülker²,

Derin³

et al. 2011

Mirt

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Objective: We aimed to assess the role of Magnetic Resonance Imaging (MRI) and X-Ray in the evaluation of response to radiosynovectomy (RS) in patients with hemophilic arthropathy.Material and Methods: Eleven patients who suffered from hemophilic arthropathy with a mean age of 11.7 (range between 7-15) were included in this study. 148-185 MBq Yttrium 90 silicate (Y-90) was administered intraarticularly to ten knee joints and one patient was treated with intraarticular 74 MBq Rhenium 186 (Re-186) injection into his ankle. Before radiosynovectomy, plain anteroposterior and lateral X-rays of the target joints were obtained by standard technique. The follow-up MRI and X-ray studies of the patients were done 6 months after RS. Pettersson hemophilic arthropathy scales were utilized to stage the condition of the joints on plain X-ray and classification of the investigated joints on MRI were done according to Denver score. The clinical assessment of the efficacy of the RS was made with the comparison of the average bleedings before and after the intervention. Results: During the 6-month follow-up period after RS, an improvement in number of hemarthrosis 75% or greater compared with the prior six months occurred in six joints (54.5%). The Pettersson scores worsened in 1/11 (9%), remained unchanged in 9/11 (81.8%), and improved in 1/11 (9%) joints. At the 6-month follow-up, the MRI score worsened in one (9%) and was unchanged in 10/11 joints (90.9%). Conclusion: MRI is a more sensitive tool than plain radiography for evaluating and follow-up of joint disease in persons with hemophilia, but both methods don’t show correlation with the therapeutic responseConflict of interest:None declared.

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Section: Discussionsupporting

confidence: 90%

The Efficacy of Magnetic Resonance Imaging and X-Ray in the Evaluation of Response to Radiosynovectomy in Patients with Hemophilic Arthropathy

Özülker¹,

Özülker²,

Derin³

et al. 2011

Mirt

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“…Radionecrosis was the most severe symptom reported in five cases [47, 49, 50], although three cases reported needle track necrosis that resolved spontaneously [47]. The results and references are summarised in Table 3.…”

Section: Resultsmentioning

confidence: 99%

Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review

Pol

Vöö

Bucerius

et al. 2017

Eur J Nucl Med Mol Imaging

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PurposeRadiopharmaceutical extravasation can potentially lead to severe soft tissue damage, but little is known about incidence, medical consequences, possible interventions, and effectiveness of these. The aims of this study are to estimate the incidence of extravasation of diagnostic and therapeutic radiopharmaceuticals, to evaluate medical consequences, and to evaluate medical treatment applied subsequently to those incidents.MethodsA sensitive and elaborate literature search was performed in Embase and PubMed using the keywords “misadministration”, “extravasation”, “paravascular infiltration”, combined with “tracer”, “radionuclide”, “radiopharmaceutical”, and a list of keywords referring to clinically used tracers (i.e. “Technetium-99m”, “Yttrium-90”). Reported data on radiopharmaceutical extravasation and applied interventions was extracted and summarised.ResultsThirty-seven publications reported 3016 cases of diagnostic radiopharmaceutical extravasation, of which three cases reported symptoms after extravasation. Eight publications reported 10 cases of therapeutic tracer extravasation. The most severe symptom was ulceration. Thirty-four different intervention and prevention strategies were performed or proposed in literature.ConclusionsExtravasation of diagnostic radiopharmaceuticals is common. 99mTc, 123I, 18F, and 68Ga labelled tracers do not require specific intervention. Extravasation of therapeutic radiopharmaceuticals can give severe soft tissue lesions. Although not evidence based, surgical intervention should be considered. Furthermore, dispersive intervention, dosimetry and follow up is advised. Pharmaceutical intervention has no place yet in the immediate care of radiopharmaceutical extravasation.

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“…These agents vary with regard to size, half-life and emission properties-see Table I (Ingrand, 1973;Winston et al, 1973). The ideal agent should emit b-rays (which have a relatively shallow depth of penetration) and have a short halflife (Erken, 1991). The radionucleotide should be of a size that balances the risk of leakage, with a particle that is too small, with the risk of poor synovial distribution, with a particle that is too big (Erken, 1991).…”

Section: Radionucleotide Synovectomymentioning

confidence: 99%

“…The ideal agent should emit b-rays (which have a relatively shallow depth of penetration) and have a short halflife (Erken, 1991). The radionucleotide should be of a size that balances the risk of leakage, with a particle that is too small, with the risk of poor synovial distribution, with a particle that is too big (Erken, 1991). Given these considerations, there remains controversy as to which agent is optimal for radionucleotide synovectomy.…”

Section: Radionucleotide Synovectomymentioning

confidence: 99%

“…Potential complications of radionucleotide synovectomy include leakage of the isotope and a radiation effect to other tissues. Leakage is believed to be caused by drainage and accumulation of small radioactive particles in surrounding lymph nodes and reticuloendothelial system (Erken, 1991;Gratz et al, 1999). The amount of leakage that has been reported after injection ranges from little or no leakage in the majority of patients, to as high as 70% (Rivard et al, 1994;Siegel et al, 1994;Gedik et al, 2004).…”

Section: Radionucleotide Synovectomymentioning

confidence: 99%

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Modern management of haemophilic arthropathy

2007

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SummaryCurrently available factor concentrates for treatment of patients with haemophilia are virally inactivated or are made by recombinant technology and their broad use in developed nations has resulted in the dramatic elimination of the treatment‐related viral illnesses that decimated the haemophilia community in the late 20th century. The major morbidity experienced by patients with haemophilia today is joint disease, a result of repeated bleeding episodes into joint spaces. Although administration of factor concentrates to prevent bleeding has been demonstrated to prevent haemophilic joint disease when applied assiduously, repeated bleeding episodes induce synovitis that is irreversible and may progress despite subsequent prophylaxis. Surgical and nuclear medicine interventions are available to reduce the pain of haemophilic arthropathy and to reduce further bleeding episodes. Patients with high titre inhibitors are at great risk for the development of joint disease and present the greatest therapeutic challenges when joint surgery is needed.

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Radiocolloids in the Management of Hemophilic Arthropathy in Children and Adolescents

Cited by 44 publications

References 0 publications

The Efficacy of Magnetic Resonance Imaging and X-Ray in the Evaluation of Response to Radiosynovectomy in Patients with Hemophilic Arthropathy

The Efficacy of Magnetic Resonance Imaging and X-Ray in the Evaluation of Response to Radiosynovectomy in Patients with Hemophilic Arthropathy

Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review

Modern management of haemophilic arthropathy

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