Whole-body and pinhole bone scintigraphic manifestations of Reiter's syndrome: distribution patterns and early and characteristic signs

The characteristic whole-body and pinhole scintigraphic manifestations of o steo-enthesopathy and arthropathy in Reiter's syndrome (RS) are described, with an emphasis on early diagnosis. We analysed 59 sets of whole-body and pinhole bone scintigrams of 59 patients with RS. The population comprised 4 7 men and 12 women with an age range from 15 to 53 years (mean=29.4). Bone scintigraphy was carried out 2-2.5 h after intravenous injection of technet ium-99m hydroxy diphosphonate using a single-head gamma camera (Siemens Orb iter Model 6601) with a low-energy high-resolution and a 4-mm pinhole colli mator for whole-body and pinhole scintigraphy, respectively. In total 262 l esions of osteo-enthesopathy and arthritis were detected on 59 whole-body s cintigrams, an incidence of 4.4 lesions per patient. As anticipated, the le sional distribution was asymmetrical: 68% were in the lower limb skeleton a nd 32% in the axial and upper limb skeleton. Pinhole bone scintigraphy, app lied selectively to one region of interest in each case, enabled us to accu rately diagnose arthritis and osteo-enthesopathy. It was noteworthy that os teo-enthesopathy, alone or in combination with arthritis, occur-red in 78.9 %, and had a strong predilection for the foot bones, especially the calcane us (25.6%). Pinhole scintigraphy detected enthesopathy in the absence of ra diographic alteration in 14.1% of cases and portrayed characteristic signs of RS in 6.9%. Whole-body bone scintigraphy augmented with pinhole scintigr aphy was found to be useful in order to panoramically display the systemic involvement pattern, to assess the characteristic bone and articular altera tions and to detect early signs of RS.