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These results suggest that leakage on imaging does not necessarily correlate with extra-articular activity.
Of the three joints with extra-articular activity, none had any treatment response.
These three patients with extra-articular activity had no response to treatment (CCI = 0 in all) and no local complications at 6 months follow-up.
There remained no association between the planar imaging pattern and clinical outcome even after exclusion of patients with extra-articular activity on Y-90 PET/CT.
While all three had a non-diffuse pattern on planar imaging, the majority of patients with non-diffuse planar imaging patterns did not have extra-articular activity.
This is important given that patients with extra-articular activity are unlikely to respond to treatment and are at risk for potentially serious local complications.
Identification of extra-articular activity on Y-90 PET/CT may therefore expedite alternative therapeutic approaches and guide monitoring for potential sites of radionecrosis.
In one patient with extra-articular activity on PET/CT, SPECT/CT was unable to definitively localise the activity to the intra or extra-articular space.
Given that patients with extra-articular activity are unlikely to respond to treatment, Y-90 PET/CT has the potential to aid in predicting treatment response and also identify patients at risk for local complications.
However, in patients with non-diffuse planar imaging patterns, Y-90 PET/CT should be considered to exclude extra-articular activity with PET providing superior image quality compared to SPECT.
Comparison of patient demographics, clinical response variables and extra-articular activity between the groups with diffuse and non-diffuse planar imaging Y-90 distributions was performed using the chi-square test, Fisher's exact test, Wilcoxon-Mann-Whitney test and unpaired Student's t test.
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