Knee

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The knee is a common site of rheumatoid arthritis. It is the largest synovial joint, rendering the arthritic changes most clearly observable both on the radiograph and the pinhole scinti-graph. Radiographic features include synovitis,

Bone Scan Mrsa

Fig. 10.32 Irregular, spotty tracer uptake in marginal rheumatoid bone erosions in the knee. Anterior pinhole scan of the left knee in a 26-year-old woman with relatively early rheumatoid arthritis shows small segmental and spotty areas of increased tracer uptake in the peripheries of the femoral condyles, the medial tibial plateau, and the medial proximal tibial metaphysis (arrows). The lesions are rather discrete and asymmetrical strongly resembling osteoarthritis (Figs. 9.3-9.6 and 9.13), but nevertheless are typically peripheral and attended by an associated symmetrical increase in the background uptake

Fig. 10.32 Irregular, spotty tracer uptake in marginal rheumatoid bone erosions in the knee. Anterior pinhole scan of the left knee in a 26-year-old woman with relatively early rheumatoid arthritis shows small segmental and spotty areas of increased tracer uptake in the peripheries of the femoral condyles, the medial tibial plateau, and the medial proximal tibial metaphysis (arrows). The lesions are rather discrete and asymmetrical strongly resembling osteoarthritis (Figs. 9.3-9.6 and 9.13), but nevertheless are typically peripheral and attended by an associated symmetrical increase in the background uptake chondrolysis, subchondral osteolysis, and cyst formation, more typically in the articular margins. In the late stage, ankylosis, crooking, and subluxation or dislocation may ensue. Pinhole scintigraphy can show most of these articular changes. Thus, synovitis is indicated by diffusely increased tracer uptake in the synoviosub-chondral bones of the whole knee joint and the patella, giving rise to the "wrapped bone" appearance (Fig. 10.31). The subchondral bone erosions in the chronic stage are shown as spotty or segmental uptake (Fig. 10.32). These findings and nonstress area localization of spotty uptake are characteristic of rheumatoid arthritis in the early chronic stage. Sooner or later, the erosions spread to the stress area. As in other joints, the intraosseous rheumatoid cysts in the

Condylar Rheumatoid Arthritis Images

Fig. 10.33 Rheumatoid bone cyst and ankylosis in the knee. A Medial pinhole scintigraph of the right knee in a 25-year-old woman with longstanding juvenile rheumatoid arthritis portrays a small, very intense tracer uptake in a rheumatoid bone cyst in the posterior tibial condyle (arrow) (P patella, c cyst, a ankylosis. Another intense tracer accumulation is seen in the bony ankylosis in the anterior compartment (arrowheads). B Anteroposterior radiograph demonstrates the presence of twin cysts deep within the bony substance of the medial tibial condyle (c) and bony ankylosis in the lateral femorotibial compartment (a). Each of these lesions was confirmed by CT (not shown)

Fig. 10.33 Rheumatoid bone cyst and ankylosis in the knee. A Medial pinhole scintigraph of the right knee in a 25-year-old woman with longstanding juvenile rheumatoid arthritis portrays a small, very intense tracer uptake in a rheumatoid bone cyst in the posterior tibial condyle (arrow) (P patella, c cyst, a ankylosis. Another intense tracer accumulation is seen in the bony ankylosis in the anterior compartment (arrowheads). B Anteroposterior radiograph demonstrates the presence of twin cysts deep within the bony substance of the medial tibial condyle (c) and bony ankylosis in the lateral femorotibial compartment (a). Each of these lesions was confirmed by CT (not shown)

Lateral Femorotibial Compartment

Fig. 10.34A, B Ankylosis with flexion deformity of the knee. A Anteroposterior radiograph of the right knee in a 69-year-ld female with malalignment and ankylosis of rheumatoid origin shows fusion and narrowing of the joint (arrows). B Lateral pinhole scan portrays extremely intense tracer uptake in the malaligned joint (arrow)

Fig. 10.34A, B Ankylosis with flexion deformity of the knee. A Anteroposterior radiograph of the right knee in a 69-year-ld female with malalignment and ankylosis of rheumatoid origin shows fusion and narrowing of the joint (arrows). B Lateral pinhole scan portrays extremely intense tracer uptake in the malaligned joint (arrow)

tibial head and distal femur accumulate tracer intensely, and fibrous or bony ankylosis is indicated by band-like uptake in the narrowed joint (Fig. 10.33). Articular narrowing occurs much earlier and is severer in rheumatoid arthritis than in osteoarthritis, in which the joint space remains not closed until the late stage (Fig. 9.13). Such difference can be attributed to the fact that the rheumatoid pannus with active proteolysis is wildly destructive while arid bone hypertrophy in osteoarthritis is relatively innocuous. Subluxation or flexion of the knee, a common sequela of long-standing rheumatoid arthritis, shows extremely intense tracer uptake in the malaligned joint (Fig. 10.34).

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