The Biodistribution and Utility of 99mTc-Ethylenedicysteine-Deoxyglucose (99mTc-Glucosamine) in the Identification of Active Disease in Patients with Rheumatoid Arthritis-a Single Center Prospective Study

  • Nucl Med Mol Imaging. 2024 Apr;58(2):52-61. doi: 10.1007/s13139-023-00823-4.
Osayande Evbuomwan  1 ,  Barend Jansen Van Rensburg  2 ,  Gerrit Engelbrecht  1 ,  Cathryn H S Driver  3 ,  Mathys Labuschagne  2 ,  Joseph Sempa  2 ,  Je'nine Horn-Lodewyk  4  5
Affiliations
  • 1. Nuclear Medicine Department, University of The Free State, Universitas Academic Hospital, Lower Ground Floor, Logeman Street, Bloemfontein, 9301 South Africa.
  • 2. University of The Free State, Bloemfontein, South Africa.
  • 3. Department of Radiochemistry, South African Nuclear Energy Corporation, Pretoria, South Africa.
  • 4. Central University of Technology, Bloemfontein, South Africa.
  • 5. Te Whatu Ora Health, Wellington, New Zealand.
PMID: 38510821 DOI: 10.1007/s13139-023-00823-4
Abstract

Purpose: Our objectives were to investigate the utility of 99mTc-ethylenedicysteine-deoxyglucose (ECDG) in identifying active disease in the joints of patients with rheumatoid arthritis (RA), as well as to evaluate the biodistribution of this radiopharmaceutical.

Methods: A prospective study was conducted at the Department of Nuclear Medicine of the University of the Free State/Universitas Academic Hospital in Bloemfontein, South Africa. Twenty-two participants from the rheumatology department diagnosed with RA according to the ACR/EULAR classification criteria were enrolled. Participants were injected with 20-25 mCi of 99mTc-ECDG. Flow, blood pool, whole body, delayed static, and SPECT/CT images were acquired. Known sites of disease were qualitatively assessed for intensity of uptake, and disease severity was graded (Grade 0-3).

Results: Twenty-two participants were studied. The median (interquartile range) age was 59 (49-68) years, and the majority (n = 21; 95.5%) were females. There was abnormal increased uptake of 99mTc-ECDG noted in majority of the sites of known disease, including unknown sites. SPECT/CT imaging localized radiotracer uptake specifically to the synovial space. Similar biodistribution of radiotracer was noted in all patients, irrespective of disease severity or fasting status.

Conclusion: 99mTc-ECDG can efficiently assess disease activity in the joints of patients with RA. It accumulates in sites of both clinical and subclinical disease and might be a very useful tool for the rheumatologist in the management of patients with RA.

Keywords
99mTc-ECDG; Glucosamine; Rheumatoid arthritis; SPECT/CT.
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