Analysis of patterns of three-phase bone scintigraphy for patients with complex regional pain syndrome diagnosed using the proposed research criteria (the ‘Budapest Criteria’)

Moon, Jee Youn; Park, S. Y.; Kim, Yong Chul; Lee, S. C.; Nahm, Francis Sahngun; Kim, J. H.; Kim, H.; Oh, So Won

doi:10.1093/bja/aer500

Cited by 29 publications

(15 citation statements)

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“…Moreover, 3 prospective studies have been also published [26,27,30] confirming the usefulness of TBPS as additional tool in doubtful cases [30] and when the duration of the pathology is shorter than 3 [26] or 5 months [27]. Two other retrospective studies [36,37] using the Budapest criteria were also recently published. Moon et al [36], found a low utility of TBPS for diagnosis of CRPS and AlSharif et al [37] found a positive scintigraphy in patients with vasomotor symptoms, motor and/or trophic changes, with a duration of less than 3 months.…”

Section: Discussionmentioning

confidence: 94%

“…Two other retrospective studies [36,37] using the Budapest criteria were also recently published. Moon et al [36], found a low utility of TBPS for diagnosis of CRPS and AlSharif et al [37] found a positive scintigraphy in patients with vasomotor symptoms, motor and/or trophic changes, with a duration of less than 3 months. In our study, TBPS was also particularly helpful when it was performed in the first 6 months.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis of partial complex regional pain syndrome type 1 of the hand: retrospective study of 16 cases and literature review

2013

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BackgroundThe partial form of the complex regional pain syndrome of the hand type 1 (CRPS 1), involving only 1 to 3 fingers, is a rare condition first described in 1972. The aim of the study is to define more precisely the diagnosis workup and the prognosis of this clinical entity.MethodsRetrospective study of CRPS1 partial form observed during five years in a rehabilitation ward. Application of The Budapest criteria, evaluation of radiological exams, therapeutic results and vocational outcomes. Comparison with cases from literature review.Results132 patients were hospitalized with the diagnosis of CRPS type 1 of the hand. 16 partial forms were isolated: 11 men, 5 women with a mean age of 43 years. Among these patients, 14 (88%) met The Budapest criteria and the two remaining cases were diagnosed by using the three phase bone scintigraphy. Only moderate improvement was obtained in the majority of the patients. At the maximal time of follow-up (4 to 9 years), 50% of the patients hadn’t returned to work. From the literature review, 19 cases were eligible for clinical comparisons. The main differences between our series and the literature were: more men involved, later diagnosis and worst prognosis in term of return to work.ConclusionsThis is the largest series of consecutive partial form of CRPS. The Budapest criteria are sufficient for the diagnosis in 88% of cases. As in complete form of CRPS1 of the hand, three phase bone scintigraphy should only be used in doubtful cases in the first six months of the illness. Partial form of CRPS1 of the hand is rare and its prevalence remains unknown. Long term prognosis (4 to 9 years) is poor in our series, 50% of patients didn’t returned to work.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Diagnosis of partial complex regional pain syndrome type 1 of the hand: retrospective study of 16 cases and literature review

2013

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“…[46] The sample size ranged from 13 to 145 patients (Table 1), mean age from 35 to 63 years, and the average disease duration from 6 to 103 weeks. The reference standard for the diagnosis of CRPS was in three studies the clinical Budapest criteria, [29, 44, 45] four studies the IASP criteria, [34, 42, 43, 47] and in five studies the Kozin diagnostic criteria. [40, 41, 46, 48, 49] Seven studies [30–32, 36–38] did not report on the diagnostic criteria used for the diagnosis of CRPS 1 and two studies [33, 39] used other clinical criteria In total 13 studies were included in the analysis of the influence of patient characteristics on the proportion of positive bone scans.…”

Section: Resultsmentioning

confidence: 99%

“…While some studies support the use of BS for establishing the diagnosis of CRPS [29, 34, 42] others reported a low diagnostic value of a positive BS. [33, 44] In a recent review [57] the authors stated that little emphasis is given to the typical imaging and advocated for the use of BS to support the clinical diagnosis. In a meta-analysis BS was compared to MRI for the diagnosis of CRPS 1 and found a higher sensitivity of BS compared to MRI and a comparable specificity.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of bone scintigraphy for the diagnosis of Complex Regional Pain Syndrome 1: A systematic review and Bayesian meta-analysis

et al. 2017

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BackgroundSince 2007, the Budapest criteria are recommended for the diagnosis of Complex Regional Pain Syndrome (CRPS) 1. The usefulness of bone scintigraphy (BS, index test) for the diagnosis of CRPS 1 remains controversial. Imperfect reference tests (RT) result in underestimation of the diagnostic accuracy of BS. Further, biased results can occur when a dependency between the RT and BS exists.The objective was to assess the impact of different RTs, specifically the Budapest criteria, and the assumed imperfect nature of the RT on the diagnostic accuracy of BS. Further, we analyzed the association between baseline characteristics and positive BS in patients with CRPS 1.MethodsSystematic literature review and Bayesian meta-analysis to assess the test accuracy of BS with and without accounting for the imperfect nature of the RT. We examined correlations (Spearman correlation coefficients / Wilcoxon tests) between baseline characteristics and the proportion of positive BS in patients with CRPS 1.ResultsThe pooled sensitivity was 0.804 (95% credible interval (CI) 0.225–1.0, 21 studies) and specificity 0.853 (95%CI 0.278–1.00). Sensitivity and specificity of BS increased when accounting for the imperfect nature of the RT. However, in studies using Budapest criteria as reference, the sensitivity decreased (0.551; 95% CI 0.046–1) and the specificity increased (0.935; 95% CI 0.306–1). Shorter disease duration and a higher proportion of males were associated with a higher proportion of positive BS (27 studies, disease duration <52 weeks Wilcoxon test p = 0.047, female proportion Spearman correlation −0.63, p = 0.009).ConclusionCompared to the accepted Budapest diagnostic criteria BS cannot be used to rule-in the diagnosis of CRPS 1. In patients with negative BS CRPS 1 is less likely the underlying illness. Studies using older or no diagnostic criteria should not be used to evaluate the diagnostic accuracy of BS in CRPS 1.

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“…Danach wäre eine positive Drei-Phasen-Knochenszintigrafie unterstützend für die klinische CRPS-Diagnose, sie kann jedoch schlecht von anderen Ursachen der Mehranreicherung im Knochen unterscheiden. Laut einer aktuellen Arbeit war die Spezifität für das CRPS sogar höher, wenn in allen 3 Phasen oder zumindest in den ersten beiden Phasen eine verminderte Aufnahme des Tracers nachweisbar war [19]. Auch konventionelle Röntgenaufnahmen sind nicht geeignet, in der Frühphase nach einem Trauma ein CRPS zu diagnostizieren [20].…”

Section: Klinisches Bildunclassified

Das komplexe regionale Schmerzsyndrom

Sommer

Birklein

2014

Fortschr Neurol Psychiatr

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Lernziele ! Nach Lektüre des Artikels sollen Kenntnisse über Definition, Pathophysiologie und Therapie des CRPS vorhanden sein. Das komplexe regionale Schmerzsyndrom (CRPS) ist definiert als ein posttraumatisches Schmerzsyndrom einer Extremität, bei dem die Schmerzen im Vergleich zum erwarteten Heilungsverlauf unangemessen stark ausgeprägt sind; die Symptome gehen über die Traumastelle hinaus und beschränken sich nicht auf das Innervationsgebiet einzelner peripherer Nerven oder Nervenwurzeln. Die Inzidenz liegt bei 5/100 000 oder bei 1 -2 % aller Frakturen. Eine frühzeitige Therapie kann die Ausbildung eines chronischen CRPS, das bis zur Gebrauchsunfähigkeit der betroffenen Extremität führen kann, verhindern. Die pathophysiologisch orientierte Therapie besteht in frühzeitiger Gabe von Kortikosteroiden und Bisphosphonaten. Ergänzend wird eine symptomatische Schmerztherapie eingesetzt. Unerlässlich, in akuten und auch chronischen Stadien, ist die spezielle CRPS-Physiotherapie, die auch verhaltenstherapeutische Elemente enthält. Geschichte und Definition ! GeschichteSir Weir Mitchell beschrieb 1864 in seiner Abhandlung "Gunshot wounds and other injuries of peripheral nerves" Patienten, deren Erkrankung wir heute als komplexes regionales Schmerzsyndrom mit Nervenläsion, also als CRPS II einordnen wür-den. Sudeck schrieb 1901 über die "akute (reflektorische) Knochenatrophie nach Entzündungen und Verletzungen in den Extremitäten und ihre klinischen Erscheinungen", entsprechend dem CRPS I ohne Nervenläsion. Leriche entwickelte die therapeutische Intervention der Sympathektomie.Evans prägte 1936 den Begriff "sympathische Reflexdystrophie" (reflex sympathetic dystrophy, RSD), der auch von Bonica übernommen wurde. Bonica unterschied erstmals eine Form mit Nervenläsion, die er Kausalgie nannte. Bei einer Konsensuskonferenz 1995 einigte man sich auf den deskriptiven Begriff "komplexes regionales Schmerzsyndrom", auf Englisch "complex regional pain syndrom" (CRPS) [1]. Mit dem Begriff des CRPS wollte man jegliche Konnotation zur Pathophysiologie vermeiden. Es wurde zwischen CRPS Typ I (ohne Nervenläsion) und Typ II (mit Nervenläsion) unterschieden. Man unterscheidet CRPS I ohne Nervenläsion von CRPS II mit Nervenläsion. Die frühere Kausalgie entspricht dem CRPS II, die frühere sympathische Reflexdystrophie oder Morbus Sudeck dem CRPS I. Definition Die Begriffe CRPS I und CRPS II sind bis heute gül-tig, wenn auch die Definition des CRPS mehrfach revidiert wurde. Etwa parallel mit der CRPSBegriffsbestimmung erschien 1994 die Monografie der International Association for the Study of Pain (IASP) zur Taxonomie der Schmerzen [2]. Dort wurden folgende diagnostischen Kriterien dem CRPS zugeordnet: -auslösendes Ereignis (nicht obligatorisch) -Dauerschmerz mit Allodynie oder Hyperalgesie, dysproportional zum Ereignis -Nachweis zu irgendeinem Zeitpunkt von Ödem oder gestörter Schweißfunktion in der Schmerzregion -Ausschluss anderer Ursachen Diese Kriterien stellten sich später als zwar sensitiv, aber wenig spezifisch heraus [3]. Dazu fü...

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Analysis of patterns of three-phase bone scintigraphy for patients with complex regional pain syndrome diagnosed using the proposed research criteria (the ‘Budapest Criteria’)

Abstract: The diagnostic value of a positive TPBS for CRPS is low from the view point of the Budapest research criteria. Our findings suggest that a diagnosis of CRPS using the Budapest research criteria should be considered when decreased patterns of TPBS are observed during Phases I and II.

Cited by 29 publications

References 26 publications

Diagnosis of partial complex regional pain syndrome type 1 of the hand: retrospective study of 16 cases and literature review

Diagnosis of partial complex regional pain syndrome type 1 of the hand: retrospective study of 16 cases and literature review

Usefulness of bone scintigraphy for the diagnosis of Complex Regional Pain Syndrome 1: A systematic review and Bayesian meta-analysis

Das komplexe regionale Schmerzsyndrom

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