Diagnostic Performance of Three-Phase Bone Scan for Complex Regional Pain Syndrome Type 1 with Optimally Modified Image Criteria

Abstract

Purpose Although the three-phase bone scan (TBPS) is one of the widely used imaging studies for diagnosing complex regional pain syndrome type I (CRPS-1), there is some controversy regarding the TPBS image criteria for CRPS-1.In this study, we modified the image criteria using image pattern and quantitative analysis in the patients diagnosed using the most recent consensus clinical diagnostic criteria. Materials and MethodsThe study included 140 patients with suspected CRPS-1 (CRPS-1, n=79; non-CRPS, n=61; mean age 39±15 years) who underwent TPBS. The clinical diagnostic criteria for CRPS-1 revised by the Budapest consensus group were used for confirmative diagnosis. Patients were classified according to flow/pool and delayed uptake (DU) image patterns, and the time interval between the initiating event and TPBS (TI event-scan ). Quantitative analysis for lesion-to-contralateral ratio (LCR) was performed. Modified TPBS image criteria were created and evaluated for optimal diagnostic performance. Results Both increased and decreased periarticular DU were significant image findings for CRPS-1 (CRPS-1 positive-rate=73% in the increased DU group, 75% in the decreased DU group). The TI event-scan did not differ significantly between the different image pattern groups. Quantitative analysis revealed an LCR of 1.43 was the optimal cutoff value for CRPS-1 and diagnostic performance was significantly improved in the increased DU group (area under the curve=0.732). Given the modified image criteria, the sensitivity and specificity of TPBS for diagnosing CRPS-1 were 80% and 72%, respectively. Conclusions Optimally modified TPBS image criteria for CRPS-1 were suggested using image pattern and quantitative analysis. With the criteria, TPBS is an effective imaging study for CRPS-1 even with the most recent consensus clinical diagnostic criteria.

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

“…In studies on diagnostic accuracy of BS the study design was prospective in seven studies [ 29 – 34 ] retrospective in 13 studies, [ 35 – 45 ] and mixed prospective and retrospective in one study. [ 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.…”

Poststroke Pain

“…44,45 Recently, the Budapest criteria were developed to aid in the standardization of the diagnosis of CRPS (►Table 2). 46 Three-phase bone scan and digital infrared thermal imaging can be used as supportive 47,48 Wüppenhorst et al reported that the sensitivity and specificity of three-phase bone scan for diagnosing CRPS were 31 to 50% and 83 to 100%, respectively. 49 Thus far, no studies on the sensitivity and specificity in digital infrared thermal imaging have been conducted.…”

Bone scintigraphy in patients with pain

“…Diagnostic performance of TPBS in CRPS ranged widely as a sensitivity between 14% and 100% and a specificity between 50% and 100% [ 39 ]. Ringer et al [ 40 ] showed the pooled sensitivity of 87% and the pooled specificity of 69% in a meta-analysis.…”

“…However, including decreased uptake on a delayed image as a positive finding of CRPS is controversial. Decreased uptake on a delayed image might be a supportive finding for CRPS [ 39 ], however, it could be caused by disuse of affected limb [ 46 ].…”