Case study: the use of technescan HIG to differentiate between old damage and active inflammation in arthritis in a 11-year-old-boy

Full text: A 99mTc Technescan HIG (Polyclonal Human Immunoglobulin G, 'Mallinkrodt Medical') scan was undertaken on an 11 year old boy with a nine year history of juvenile arthritis. He recently suffered in creased pain in his neck with tenderness over the right C6 dorsal facet joint. The question was posed as to whether this represented an area of old damage or new active inflammation. Whole body imaging was carried out following an IV injection of 600 MBq of 99mTc HIG at four and 24 hours using a rectangular Millenium gamma camera. (GE Milwaukee) Both four and 24 hour images failed to show any area of focal uptake in the neck. Focal uptake was demonstrated in both knees, the right more pronounced than the left in keeping with the patient current symptoms. From this scan it was decided that the cervical problem was related to old damage. Scintigraphy with HIG labelled with either 111ln or 99mTc is recognised as a reliable method for the detection of infection and inflammation. Recently, reports have suggested that it may be useful in detecting synovitis, identifying those joints which have current active inflammation. We conclude that this modality is a non-invasive accurate diagnostic tool which may be used to routinely monitor the status of arthritic joints. In addition, we feel that serial scanning may provide a more accurate insight into the nature of the disease progression within an individual than is available with current practices