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A Journal on Nuclear Medicine and Molecular Imaging
Affiliated to the and to the International Research Group of Immunoscintigraphy
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index (SciSearch), Scopus
Impact Factor 2,413
Online ISSN 1827-1936
Hongjuan LIU 1, Huili GUO 1, Shunong GUO 1, Junhui WANG 1, Yanju YE 1, Chao MA 2
1 Nuclear Medicine of Bone and Joint, Henan Luoyang Zhenggu Hospital and Henan Orthopedics Hospital, Luoyang, China; 2 Nuclear Medicine, Affiliated Xinhua Hospital School of Medicine Shanghai Jiaotong University, Shanghai, China
BACKGROUND: Management of osteochondral lesions of talus (OLT) remains controversial. 99Tc-MDP,a decay product of 99mTc-MDP which is widely used for bone scan, is effective in the clinical treatment of rheumatoid arthritis. The purpose of the study is to investigate the effects of 99Tc-MDP treatment on OLT.
METHODS: In the clinical evaluation, 66 patients with a total of 83 lesions of OLT who failed appropriate nonoperative treatment and surgery were retrospectively included and treated with intravenous injection of 99Tc-MDP and Chinese herbal fumigation (CHF). The effects of 99Tc-MDP and CHF on OLT were evaluated by the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS), visual analog scale (VAS), activities of daily living (Barthel index), and MRI, 99mTc-MDP SPECT/CT and CT. Radiographic changes were also assessed by the transverse long diameter of the cyst on CT.
RESULTS: At the last follow up, AOFAS, VAS and Barthel index improved significantly from 68.66±9.76, 3.05±0.34 and 85±8.31 to 85.4±8.31, 1.85±0.36 and 94.7±4.99 (p<0.01), respectively after one course treatment in 66 patients with OLT. Thirty one (31/66) patients had a second treatment course. Their AOFAS, VAS and Barthel index also improved significantly after the mean follow-up of 7 ±2 (6-15) months. And the average diameter of the cysts decreased from 8.01 ± 3.35 mm to 4.74± 2.83mm (p<0.01) in the 31 patients.
CONCLUSIONS: The retrospective study indicates that a combination treatment of 99Tc-MDP and CHF is effective in pain relief and return of function in a short term of follow up for patients with OLT. Our results suggest that the small cystic lesions with increased uptake of 99mTc-MDP on SPECT/CT can be well treated by 99Tc-MDP and CHF. This novel technique holds the potential to emerge as an effective conservative treatment for OLT without adverse effects. The Level of Evidence for 99Tc-MDP is medium for the number of patients and retrospective study.