Bone scintigraphy in patients with pain

Shin, Seunghyeon; Kim, Seong Jang

doi:10.3344/kjp.2017.30.3.165

Cited by 17 publications

(8 citation statements)

References 59 publications

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“…On plain radiography, CRPS has been associated with periarticular osteopenia and patchy osteoporosis. 28 Three-phase bone scanning has been reported to have a high negative predictive value to rule out CRPS type I, 3,29,30 which presents without an identifiable nerve lesion and accounts for approximately 80% to 90% of CRPS cases. 2,4 In a three-phase bone scan, abnormal flow patterns and vasomotor instability are seen in the first and second phases while increased periarticular uptake is seen in the third phase.…”

Section: Discussionmentioning

confidence: 99%

Glomus Tumor of the Lower Extremity Previously Misdiagnosed as Complex Regional Pain Syndrome in Close Proximity to a Myxofibrosarcoma: A Case Report

Nazemi¹,

Grossi²,

Tavernier³

et al. 2022

JAAOS Glob Res Rev

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Complex regional pain syndrome (CRPS) is a potentially devastating condition that can result in severe psychological and social morbidity. It is a diagnosis of exclusion, and other pathologic entities must be ruled out first. Glomus tumors are exquisitely painful benign vascular tumors that are most common in the hand and are rarely found in the lower extremity. Here, we present a case of a patient who developed a focus of severe anterior knee pain and tenderness a few months after a car accident that had been misdiagnosed as CRPS for 15 years. She coincidentally developed a sarcoma of her ipsilateral leg distal to this site. Magnetic resonance imaging of the sarcoma included the area of knee pain where, interestingly, it identified a separate small soft-tissue mass. A glomus tumor was diagnosed histologically in a needle biopsy specimen from this mass, which was resected along with the sarcoma. For the first time in 15 years, despite the additional sarcoma surgery, she reported relief of her pain and complete resolution of her “CRPS.”

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Section: Discussionmentioning

confidence: 99%

Glomus Tumor of the Lower Extremity Previously Misdiagnosed as Complex Regional Pain Syndrome in Close Proximity to a Myxofibrosarcoma: A Case Report

Nazemi¹,

Grossi²,

Tavernier³

et al. 2022

JAAOS Glob Res Rev

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“…Therefore, the symptoms and signs of this patient met the Budapest diagnostic criteria based on the following four categories: sensory, vasomotor, sudomotor and motor/trophic [ 22 , 23 ]. In addition, the three-phase bone scan supported the diagnosis of CRPS, which was decreased uptake in the right foot during the blood pooling phase [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Leriche Syndrome Misdiagnosed as Complex Regional Pain Syndrome in a Patient with Neuropathic Pain Caused by a Chip Fracture: A Case Report

Lee

et al. 2021

Medicina

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Introduction: Leriche syndrome is an aortoiliac occlusive disease caused by atherosclerotic occlusion. We report a case of Leriche syndrome with a fracture that was suspected as complex regional pain syndrome (CRPS), as the post-traumatic pain gradually worsened in the form of excruciating neuropathic pain. Case Report: A 52-year-old woman with a history of hypertension was referred to the Department of Pain Medicine from a local orthopedic clinic because of suspected CRPS for excruciating neuropathic pain for one month. She complained of gait dysfunction and severe pain in the right foot following an incident of trauma with the right first toe. The average pain intensity assessed using the visual analog scale (VAS) was 90 (0: no pain, 100: the worst pain imaginable), and the neuropathic pain was evident as a score of 6/10 on Douleur neuropathique 4. Allodynia, hyperalgesia, blue discoloration of the skin, asymmetric temperature change (1.38 °C), and edematous soft tissue changes were observed. Ultrasonography showed a chip fracture in the first distal phalanx of the right first toe. The diagnosis was most probably CRPS type I according to the Budapest research criteria for CRPS. However, multiple pain management techniques were insufficient in controlling the symptoms. A month and a half later, an ankle-brachial index score of less than 0.4 suggested severe peripheral artery disease. Computed tomography angiography showed total occlusion between the infrarenal abdominal aorta and the bilateral common iliac arteries. Therefore, she underwent aortic-bifemoral bypass surgery with a diagnosis of Leriche syndrome. Three months after the surgery, the average pain intensity was graded as 10 on the VAS (0–100), the color of the skin of the right first toe improved and no gait dysfunction was observed. Conclusion: A chip fracture in a region with insufficient blood flow could manifest as excruciating neuropathic pain in Leriche syndrome.

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“…SPECT (single photon emission computed tomography)/CT (computed tomography) is an imaging modality for evaluating extremity pain. SPECT/CT has an additional role in excluding other diagnoses such as arthritis, pseudoarthropathy, benign or malignant bony lesions, and even metabolic bone diseases such as Paget disease [30,31]. However, no studies are using SPECT/CT to evaluate the diagnostic performance of CRPS.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of Three-Phase Bone Scintigraphy and Digital Infrared Thermography Imaging for Chronic Post-Traumatic Complex Regional Pain Syndrome

et al. 2021

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This study aimed to evaluate the diagnostic performance of three-phase bone scintigraphy (TPBS) and digital infrared thermography imaging (DITI) in the chronic post-traumatic CRPS and propose new imaging diagnostic criteria that combine the two tests. We retrospectively enrolled 44 patients with suspected symptoms of CRPS from various injuries during obligatory military service. We analyzed the following findings: (1) uptake pattern on TPBS, (2) uptake ratios of affected and unaffected sides in each phase of TPBS, (3) difference in body skin temperature on DITI. New criteria combining the above findings were also evaluated. Eighteen patients were finally defined as CRPS according to the Budapest criteria. Uptake pattern and uptake ratio in blood pool phase on the TPBS were significantly different between CRPS and non-CRPS groups (both p < 0.05). The DITI could not discriminate significantly between the groups (p = 0.334). The diagnostic criteria considering both the pattern analysis and quantitative analysis in TPBS exhibited the highest positive likelihood ratio. On the other hand, the diagnostic criteria combining DITI and TPBS showed the lowest negative likelihood ratio value. TPBS can be useful in diagnosing chronic post-traumatic CRPS. Moreover, we can suggest that different diagnostic criteria be applied depending on the purpose.

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Bone scintigraphy in patients with pain

Cited by 17 publications

References 59 publications

Glomus Tumor of the Lower Extremity Previously Misdiagnosed as Complex Regional Pain Syndrome in Close Proximity to a Myxofibrosarcoma: A Case Report

Glomus Tumor of the Lower Extremity Previously Misdiagnosed as Complex Regional Pain Syndrome in Close Proximity to a Myxofibrosarcoma: A Case Report

Leriche Syndrome Misdiagnosed as Complex Regional Pain Syndrome in a Patient with Neuropathic Pain Caused by a Chip Fracture: A Case Report

Diagnostic Performance of Three-Phase Bone Scintigraphy and Digital Infrared Thermography Imaging for Chronic Post-Traumatic Complex Regional Pain Syndrome

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