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.2023 Nov 13;13(1):19751.
doi: 10.1038/s41598-023-47197-3.

Dynamic blood flow imaging with99mTc-hydroxymethylene diphosphonate as a therapeutic response marker in patients with Raynaud's phenomenon

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Dynamic blood flow imaging with99mTc-hydroxymethylene diphosphonate as a therapeutic response marker in patients with Raynaud's phenomenon

Jang Yoo et al. Sci Rep..

Abstract

We evaluated the predictive value of dynamic blood flow scintigraphy with99mTc-HDP (hydroxymethylene diphosphonate) for therapeutic response in patients with Raynaud's phenomenon (RP). Eighty patients who underwent dynamic blood flow scintigraphy using the one-hand chilling method were enrolled. We analyzed the quantitative variables as the ratio of chilled fingers to ambient fingers (CAfinger), that of the chilled hand to ambient hand (CAhand), and that of chilled fingers to ambient palm (FPR) (CAFPR) at 15 and 30 s after99mTc-HDP bolus injection. Total cumulative radioactivity counts for 180 s were obtained. We evaluated the clinical utility of these quantitative parameters with other clinical variables, including RP severity, therapeutic compliance, types of RP, and scintigraphic interpretation of findings in patients with RP. Fifty-two patients showed poor therapeutic response. There were significant differences between good- and poor-therapeutic responder groups in RP intensity (p = 0.003), CAfinger15s (p = 0.008), CAfinger30s (p = 0.002), CAfinger180s (p = 0.011), CAhand15s (p = 0.008), CAhand30s (p = 0.007), CAhand180s (p = 0.017), CAFPR30s (p = 0.004), and CAFPR180s (p = 0.002). After multivariate logistic regression analysis, only CAfinger30s (p = 0.002) had an independent predictive value of the therapeutic response.99mTc-HDP dynamic blood flow scintigraphy could be helpful in predicting the therapeutic response in patients with RP.

© 2023. The Author(s).

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
(a)99mTc-HDP blood flow scintigraphy in a patient with Raynaud’s phenomenon. (b) An example of regions of interest (ROI) for calculating chilled–ambient uptake ratios. Four ROIs were manually drawn around all fingers except the thumb (a,b) and palmar area (c,d) of both hands.
Figure 2
Figure 2
Representative dynamic blood flow scintigraphy images with different therapeutic responses. (a) Scintigraphy of 38-year-old woman with mild RP in both hands (dominant in right hand). This image showed no significantly reduced radioactivity uptake in the chilled hand. The chilled–ambient finger ratio at 30 s (CAfinger30s) was 1.16. She had a good therapeutic response in the follow-up period. Her symptoms improved significantly after one year of treatment. (b) Scintigraphy of 45-year-old woman with moderate RP only in the right hand. After cold stimulation, the radioactivity uptake of the right fingers was observed to be somewhat reduced, and CAfinger30s was 0.89. She appropriately underwent lifestyle modification and medication during follow-up, but the therapeutic response was poor. (c) Scintigraphy of 42-year-old woman with moderate RP in both hands (dominant in right hand). The right fingers had decreased blood pool activity compared with the opposite fingers of the hand not undergoing cold stimulation. The CAfinger30s was 0.74. She also had a poor therapeutic response in the follow-up period.
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