Nuklearmedizin in Diagnostik und Therapie rheumatischer Erkrankungen: Skelettszintigrafie, Hybridbildgebung mit SPECT/CT und PET/CT sowie Radiosynoviorthese

Zusammenfassung

Ziel der modernen nuklearmedizinischen Diagnostik sind neben der im Fokus stehenden Früherkennung der Erkrankungen auch die Kontrolle und das Monitoring der Therapie und damit des Krankheitsverlaufes. Die Hybridmethoden nehmen inzwischen einen hohen Stellenwert in der Forschung ein, in der klinischen Routine und v. a. im Follow-up sollten ihre Indikation und Anwendung neben Kosten/Nutzenabwägungen unter Strahlenexpositionsgründen kritisch geprüft werden. Die Arbeit gibt einen Überblick über die aktuell in Diagnostik und Therapie eingesetzten Verfahren.

Abstract

The aim of modern nuclear medicine diagnostics is not only to detect diseases at an early point in time, which is certainly the main focus, but also to monitor treatment and, thus, the course of the disease. Hybrid imaging methods have recently gained a lot of interest in research. In clinical routine use, and especially during follow-up, however, their indications and application should be carefully evaluated both in terms of cost-effectiveness and for radiation exposure reasons. This article gives an overview of the methods currently used for diagnostics and treatment of rheumatic diseases.

Schlüsselwörter

SPECT/CT - PET/CT - Radiosynoviorthese - Arthritis - Vaskulitis

Key words

SPECT/CT - PET/CT - radiosynovectomy - arthritis - vasculitis

• Literatur

• 1 Brix G, Nekolla EA, Borowski M. et al. Radiation risk and protection of patients in clinical SPECT/CT. Eur J Nucl Med Mol Imaging 2014; 41 (Suppl. 01) S125-S136 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/24052089
• 2 Bares R, Brenner W, Kirsch C-M. Bone scintigraphy. German Guideline S1. Nuklearmedizin 2013; 52: 207-211
• 3 Höpfner S, Treitl M, Krolak C. et al. Diagnosis of initial changes in the hand of patients with rheumatoid arthritis--comparison between low-field magnetic resonance imaging, 3-phase bone scintigraphy and conventional x-ray. Nuklearmedizin 2002; 41: 135-142 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/12109033
• 4 Höpfner S, Treitl M, Becker-Gaab C. et al. Diagnosis of initial changes in patients suffering from rheumatoid arthritis. Two years follow up control with a low-field magnetic resonance scanner, 3-phase bone scintigraphy and conventional x-ray. Nuklearmedizin 2004; 43: 195-202 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/15586215
• 5 Huellner MW, Strobel K, Hug U. et al. SPECT/CT in diagnostics of the hand joint. Radiologe 2012; 52: 621-628
• 6 McQueen FM. Imaging in early rheumatoid arthritis. Best Pract Res Clin Rheumatol 2013; 27: 499-522 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/24315051
• 7 de Bois MH, Arndt JW, Speyer I. et al. Technetium-99m labelled human immunoglobulin scintigraphy predicts rheumatoid arthritis in patients with arthralgia. Scand J Rheumatol 1996; 25: 155-158 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/8668958
• 8 Palosaari K, Vuotila J, Takalo R. et al. Bone oedema predicts erosive progression on wrist MRI in early RA--a 2-yr observational MRI and NC scintigraphy study. Rheumatology (Oxford) 2006; 45: 1542-1548 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/16670155
• 9 Duer A, Østergaard M, Hørslev-Petersen K. et al. Magnetic resonance imaging and bone scintigraphy in the differential diagnosis of unclassified arthritis. Ann Rheum Dis 2008; 67: 48-51 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/17289759
• 10 Kim JY, Cho S-K, Han M. et al. The role of bone scintigraphy in the diagnosis of rheumatoid arthritis according to the 2010 ACR/EULAR classification criteria. J Korean Med Sci 2014; 29: 204-209 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/24550646
• 11 Ezziddin S, Khalaf F, Seidel M. et al. Introduction of a metabolic joint asymmetry score derived from conventional bone scintigraphy. A new tool to differentiate psoriatic from rheumatoid arthritis. Nuklearmedizin 2015; 54: 183-189 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/25864944
• 12 Roimicher L, Lopes FPPL, de Souza SAL. et al (99m)Tc-anti-TNF-α scintigraphy in RA: a comparison pilot study with MRI and clinical examination. Rheumatology (Oxford) 2011; 50: 2044-2050 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/21873267
• 13 Shearman J, Esdaile J, Hawkins D. et al. Predictive value of radionuclide joint scintigrams. Arthritis Rheum 1982; 25: 83-86 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/6978136
• 14 Levy G, Chow C, Cimmino MA. et al. RA Imaging Study Group: which imaging in rheumatoid arthritis?. Joint Bone Spine 2009; 76: 438-439 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/19559638
• 15 Ozgul A, Yasar E, Arslan N. et al. The comparison of ultrasonographic and scintigraphic findings of early arthritis in revealing rheumatoid arthritis according to criteria of American College of Rheumatology. Rheumatol Int 2009; 29: 765-768 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/19037610
• 16 Kleyer A, Krieter M, Oliveira I. et al. High prevalence of tenosynovial inflammation before onset of rheumatoid arthritis and its link to progression to RA-A combined MRI/CT study. Semin Arthritis Rheum 2016; 46: 143-150 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/27342772
• 17 Scarpa R, Cuocolo A, Peluso R. et al. Early psoriatic arthritis: the clinical spectrum. J Rheumatol 2008; 35: 137-141 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/18050372
• 18 Tan AL, McGonagle D. Psoriatic arthritis: correlation between imaging and pathology. Joint Bone Spine 2010; 77: 206-211 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/20409741
• 19 Montes C, Tamayo P, Hernandez J. et al. Estimation of the total effective dose from low-dose CT scans and radiopharmaceutical administrations delivered to patients undergoing SPECT/CT explorations. Ann Nucl Med 2013; 27: 610-617 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/23568252
• 20 Siegel Y, Golan H, Thein R. 99mTc-methylene diphosphonate single photon emission tomography of the knees: intensity of uptake and its correlation with arthroscopic findings. Nucl Med Commun 2006; 27: 689-693 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/16894322
• 21 Rosado-de-Castro PH, Lopes de Souza SA, Alexandre D. et al Rheumatoid arthritis: Nuclear Medicine state-of-the-art imaging. World J Orthop 2014; 5: 312-318 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/25035834
• 22 Papathanassiou D, Bruna-Muraille C, Jouannaud C. et al. Single-photon emission computed tomography combined with computed tomography (SPECT/CT) in bone diseases. Joint Bone Spine 2009; 76: 474-480 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/19800831
• 23 Strobel K, Burger C, Seifert B. et al. Characterization of focal bone lesions in the axial skeleton: performance of planar bone scintigraphy compared with SPECT and SPECT fused with CT. AJR Am J Roentgenol 2007; 188: W467-W474 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/17449746
• 24 Gotthardt M, Bleeker-Rovers CP, Boerman OC. Imaging of inflammation by PET, conventional scintigraphy, and other imaging techniques. J Nucl Med 2010; 51: 1937-1949 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/21078798
• 25 Huellner MW, Strobel K. Clinical applications of SPECT/CT in imaging the extremities. Eur J Nucl Med Mol Imaging 2014; 41 (Suppl. 01) S50-S58 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/23963296
• 26 Strobel K, Steurer-Dober I, Da Silva AJ. et al. Feasibility and preliminary results of SPECT/CT arthrography of the wrist in comparison with MR arthrography in patients with suspected ulnocarpal impaction. Eur J Nucl Med Mol Imaging 2014; 41: 548-555 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/24177809
• 27 Strobel K, Wiesmann R, Tornquist K. et al. SPECT/CT arthrography of the knee. Eur J Nucl Med Mol Imaging 2012; 39: 1975-1976 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/22949082
• 28 Schleich FS, Schürch M, Huellner MW. et al. Diagnostic and therapeutic impact of SPECT/CT in patients with unspecific pain of the hand and wrist. EJNMMI Res 2012; 2: 53 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/23021154
• 29 Buchbender C, Schneider M, Ostendorf B. Magnetic resonance tomography and hybrid imaging in rheumatology. Z Rheumatol 2013; 72: 137-144 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/23446460
• 30 Huellner MW, Bürkert A, Schleich FS. et al. SPECT/CT versus MRI in patients with nonspecific pain of the hand and wrist - a pilot study. Eur J Nucl Med Mol Imaging 2012; 39: 750-759 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/22237845
• 31 Ostendorf B, Wirrwar A, Mattes-György K. et al. High-resolution SPECT imaging of bony pathology in early arthritis of finger joints. Rheumatology (Oxford) 2009; 48: 853-854 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/19443559
• 32 Ostendorf B, Mattes-György K, Reichelt DC. et al. Early detection of bony alterations in rheumatoid and erosive arthritis of finger joints with high-resolution single photon emission computed tomography, and differentiation between them. Skeletal Radiol 2010; 39: 55-61 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/19669137
• 33 Buchbender C, Ostendorf B, Mattes-György K. et al. Synovitis and bone inflammation in early rheumatoid arthritis: high-resolution multi-pinhole SPECT versus MRI. Diagn Interv Radiol 19: 20-24 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/23255070
• 34 Buchbender C, Sewerin P, Mattes-György K. et al. Utility of combined high-resolution bone SPECT and MRI for the identification of rheumatoid arthritis patients with high-risk for erosive progression. Eur J Radiol 2013; 82: 374-379 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/23181974
• 35 Mountz JM, Alavi A, Mountz JD. Emerging optical and nuclear medicine imaging methods in rheumatoid arthritis. Nat Rev Rheumatol 2012; 8: 719-728 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/23007740
• 36 Brix G, Nosske D, Lechel U. Radiation exposure of patients undergoing whole-body FDG-PET/CT examinations: an update pursuant to the new ICRP recommendations. Nuklearmedizin 2014; 53: 217-220 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/24919708
• 37 Brix G, Lechel U, Glatting G. et al. Radiation exposure of patients undergoing whole-body dual-modality 18F-FDG PET/CT examinations. J Nucl Med 2005; 46: 608-613 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/15809483
• 38 Hellwig D, Krause B-J, Schirrmeister H. et al. Bone scanning with sodium 18F-fluoride PET and PET/CT. German guideline Version 1.0.. Nuklearmedizin 2010; 49: 195-201 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/20838734
• 39 Beheshti M, Mottaghy FM, Payche F et al. (18)F-NaF PET/CT: EANM procedure guidelines for bone imaging. Eur J Nucl Med Mol Imaging. 2015: 42: 1767–1777; Im Internet: http://www.ncbi.nlm.nih.gov/pubmed/26201825
• 40 Beckers C, Ribbens C, André B. et al. Assessment of disease activity in rheumatoid arthritis with (18)F-FDG PET. J Nucl Med 2004; 45: 956-964 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/15181130
• 41 Beckers C, Jeukens X, Ribbens C. et al. (18)F-FDG PET imaging of rheumatoid knee synovitis correlates with dynamic magnetic resonance and sonographic assessments as well as with the serum level of metalloproteinase-3. Eur J Nucl Med Mol Imaging 2006; 33: 275-280 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/16247604
• 42 Goerres GW, Forster A, Uebelhart D. et al. F-18 FDG whole-body PET for the assessment of disease activity in patients with rheumatoid arthritis. Clin Nucl Med 2006; 31: 386-390 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/16785804
• 43 Vijayant V, Sarma M, Aurangabadkar H. et al. Potential of (18)F-FDG-PET as a valuable adjunct to clinical and response assessment in rheumatoid arthritis and seronegative spondyloarthropathies. World J Radiol 2012; 4: 462-468 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/23320137
• 44 Sato M, Inubushi M, Shiga T. et al. Therapeutic effects of acupuncture in patients with rheumatoid arthritis: a prospective study using (18)F-FDG-PET. Ann Nucl Med 2009; 23: 311-316 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/19337783
• 45 Vogel WV. van Riel PLCM Oyen WJG. FDG-PET/CT can visualise the extent of inflammation in rheumatoid arthritis of the tarsus. Eur J Nucl Med Mol Imaging 2007; 34: 439 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/17048035
• 46 Yamashita H, Kubota K, Mimori A. Clinical value of whole-body PET/CT in patients with active rheumatic diseases. Arthritis Res Ther 2014; 16: 423 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/25606590
• 47 Yamashita H, Kubota K, Takahashi Y. et al. Similarities and differences in fluorodeoxyglucose positron emission tomography/computed tomography findings in spondyloarthropathy, polymyalgia rheumatica and rheumatoid arthritis. Joint Bone Spine 2013; 80: 171-177 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/22749663
• 48 Roivainen A, Hautaniemi S, Möttönen T. et al. Correlation of 18F-FDG PET/CT assessments with disease activity and markers of inflammation in patients with early rheumatoid arthritis following the initiation of combination therapy with triple oral antirheumatic drugs. Eur J Nucl Med Mol Imaging 2013; 40: 403-410
• 49 Elzinga EH, van der Laken CJ, Comans EFI. et al. 18F-FDG PET as a tool to predict the clinical outcome of infliximab treatment of rheumatoid arthritis: an explorative study. J Nucl Med Off Publ Soc Nucl Med 2011; 52: 77-80
• 50 Okamura K, Yonemoto Y, Arisaka Y. et al. The assessment of biologic treatment in patients with rheumatoid arthritis using FDG-PET/CT. Rheumatology (Oxford) 2012; 51: 1484-1491
• 51 Gent YYJ, Voskuyl AE, Kloet RW. et al. Macrophage positron emission tomography imaging as a biomarker for preclinical rheumatoid arthritis: findings of a prospective pilot study. Arthritis Rheum 2012; 64: 62-66 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/21898356
• 52 Taniguchi Y, Kumon Y, Nakayama S. et al. F-18 FDG PET/CT provides the earliest findings of enthesitis in reactive arthritis. Clin Nucl Med 2011; 36: 121-123 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/21220974
• 53 Takata T, Taniguchi Y, Ohnishi T. et al. (18)FDG PET/CT is a powerful tool for detecting subclinical arthritis in patients with psoriatic arthritis and/or psoriasis vulgaris. J Dermatol Sci 2011; 64: 144-147 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/21889880
• 54 Bakshi A, Gholami S, Alavi A. et al. Assessing Cutaneous Psoriasis Activity Using FDG-PET: Nonattenuation Corrected Versus Attenuation Corrected PET Images. Clin Nucl Med 2015; 40: 727-729 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/26053710
• 55 Naik HB, Natarajan B, Stansky E. et al. Severity of Psoriasis Associates With Aortic Vascular Inflammation Detected by FDG PET/CT and Neutrophil Activation in a Prospective Observational Study. Arterioscler Thromb Vasc Biol 2015; 35: 2667-2676 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/26449753
• 56 Rose S, Dave J, Millo C. et al. Psoriatic arthritis and sacroiliitis are associated with increased vascular inflammation by 18-fluorodeoxyglucose positron emission tomography computed tomography: baseline report from the Psoriasis Atherosclerosis and Cardiometabolic Disease Initiative. Arthritis Res Ther 2014; 16: R161 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/25078679
• 57 Rose S, Sheth NH, Baker JF. et al. A comparison of vascular inflammation in psoriasis, rheumatoid arthritis, and healthy subjects by FDG-PET/CT: a pilot study. Am J Cardiovasc Dis 2013; 3: 273-278 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/24224139
• 58 Skelettdiagnostik mittels 18F-Natriumfluorid-PET und -PET/CT. 2011;
• 59 Strobel K, Fischer DR, Tamborrini G. et al. 18F-fluoride PET/CT for detection of sacroiliitis in ankylosing spondylitis. Eur J Nucl Med Mol Imaging 2010; 37: 1760-1765 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/20505935
• 60 Taniguchi Y, Arii K, Kumon Y. et al. Positron emission tomography/computed tomography: a clinical tool for evaluation of enthesitis in patients with spondyloarthritides. Rheumatology (Oxford) 2010; 49: 348-354 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/20007287
• 61 Fischer DR, Pfirrmann CWA, Zubler V. et al. High bone turnover assessed by 18F-fluoride PET/CT in the spine and sacroiliac joints of patients with ankylosing spondylitis: comparison with inflammatory lesions detected by whole body MRI. EJNMMI Res 2012; 2: 38
• 62 Bruijnen STG, van der Weijden MAC, Klein JP. et al. Bone formation rather than inflammation reflects ankylosing spondylitis activity on PET-CT: a pilot study. Arthritis Res Ther 2012; 14: R71 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/22471910
• 63 Wendling D, Blagosklonov O, Streit G. et al. FDG-PET/CT scan of inflammatory spondylodiscitis lesions in ankylosing spondylitis, and short term evolution during anti-tumour necrosis factor treatment. Ann Rheum Dis 2005; 64: 1663-1665 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/16227425
• 64 Soussan M, Nicolas P, Schramm C. et al. Management of large-vessel vasculitis with FDG-PET: a systematic literature review and meta-analysis. Medicine (Baltimore) 2015; 94: e622 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/25860208
• 65 Hautzel H, Sander O, Heinzel A. et al. Assessment of large-vessel involvement in giant cell arteritis with 18F-FDG PET: introducing an ROC-analysis-based cutoff ratio. J Nucl Med 2008; 49: 1107-1113 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/18552151
• 66 Khan A, Dasgupta B. Imaging in Giant Cell Arteritis. Curr Rheumatol Rep 2015; 17: 52 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/26113013
• 67 Fuchs M, Briel M, Daikeler T. et al. The impact of 18F-FDG PET on the management of patients with suspected large vessel vasculitis. Eur J Nucl Med Mol Imaging 2012; 39: 344-353 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/22072285
• 68 Walter MA, Melzer RA, Schindler C. et al. The value of [18F]FDG-PET in the diagnosis of large-vessel vasculitis and the assessment of activity and extent of disease. Eur J Nucl Med Mol Imaging 2005; 32: 674-681 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/15747154
• 69 Blockmans D, de Ceuninck L, Vanderschueren S. et al Repetitive 18F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: a prospective study of 35 patients. Arthritis Rheum 2006; 55: 131-137 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/16463425
• 70 Blockmans D, Coudyzer W, Vanderschueren S. et al. Relationship between fluorodeoxyglucose uptake in the large vessels and late aortic diameter in giant cell arteritis. Rheumatology (Oxford) 2008; 47: 1179-1184 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/18515868
• 71 Blockmans D, De Ceuninck L, Vanderschueren S. et al. Repetitive 18-fluorodeoxyglucose positron emission tomography in isolated polymyalgia rheumatica: a prospective study in 35 patients. Rheumatology (Oxford) 2007; 46: 672-677 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/17114803
• 72 Wendling D, Blagosklonov O, Boulahdour H. et al. Positron emission tomography: the ideal tool in polymyalgia rheumatica?. Joint Bone Spine 2014; 81: 381-383 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/24962975
• 73 Löffler C, Hoffend J, Benck U et al. The value of ultrasound in diagnosing extracranial large-vessel vasculitis compared to FDG-PET/CT: A retrospective study. Clin Rheumatol 2017; Im Internet: http://www.ncbi.nlm.nih.gov/pubmed/28503707
• 74 Miese F, Scherer A, Ostendorf B. et al. Hybrid 18F-FDG PET-MRI of the hand in rheumatoid arthritis: initial results. Clin Rheumatol 2011; 30: 1247-1250 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/21590292
• 75 Fischer DR, Maquieira GJ, Espinosa N. et al. Therapeutic impact of [(18)F]fluoride positron-emission tomography/computed tomography on patients with unclear foot pain. Skeletal Radiol 2010; 39: 987-997 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/20174985
• 76 Buchbender C, Ostendorf B, Ruhlmann V. et al. Hybrid 18F-labeled Fluoride Positron Emission Tomography/Magnetic Resonance (MR) Imaging of the Sacroiliac Joints and the Spine in Patients with Axial Spondyloarthritis: A Pilot Study Exploring the Link of MR Bone Pathologies and Increased Osteoblastic Ac. J Rheumatol 2015; 42: 1631-1637 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/26136491
• 77 Schneider P, Farahati J, Reiners C. Radiosynovectomy in Rheumatology, Orthopedics, and Hemophilia. J Nucl Med 2005; 46: 48-54
• 78 Beil FT, Rüther W. Indications and contraindications for radiosynoviorthesis. Z Rheumatol 2015; 74: 780-785 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/26555659
• 79 Farahati J, Reiners C, Fischer M. et al. Guidelines for radiosynorviorthesis. Nuklearmedizin 1999; 38: 254-255 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/10510824
• 80 Seidel W. Radiosynoviorthesis. Z Rheumatol 2006; 65: 239-244
• 81 Wong Y, Cherk MH, Powell A. et al. Efficacy of yttrium-90 synovectomy across a spectrum of arthropathies in an era of improved disease modifying drugs and treatment protocols. Int J Rheum Dis 2014; 17: 78-83
• 82 Linke R, Gelse K, Schuch F. The indication for radiosynoviorthesis. From the perspective of the nuclear medicine expert, rheumatic orthopedist and internist. Z Rheumatol 2011; 70: 34-44 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/21267739
• 83 Bielińska A, Korkosz M, Gąsowski J. et al. Yttrium-90 distribution following radiosynoviorthesis of the knee joint in rheumatoid arthritis patients: a SPECT/CT study. Ann Nucl Med 2014; 28: 688-692 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/24595462
• 84 Jalilian AR, Anvari A, Bahrami-Samani A. et al. Development of (166)Ho-phytate Complex for Radiosynovectomy. Nucl Med Mol Imaging (2010) 2011; 45: 87-92
• 85 Knut L. Radiosynovectomy in the therapeutic management of arthritis. World J Nucl Med 14: 10-15 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/25709538
• 86 Merashli M, Al-Nahhas A, Jawad AS. Yttrium-90 radiation synovectomy revisited. Nucl Med Commun 2016; 37: 99-100 Im Internet http://www.ncbi.nlm.nih.gov/pubmed/26587984