Reflex sympathetic dystrophy in the foot: clinical and scintigraphic criteria.

Abstract

To establish strict clinical criteria for reflex sympathetic dystrophy (RSD) of the foot and to characterize any associated scintigraphic pattern, the authors performed three-phase radionuclide bone scanning in 51 patients prospectively referred because RSD was a diagnostic consideration. To establish sensitivity and specificity data, the cases of an additional 100 consecutive patients referred for a variety of foot problems were retrospectively reviewed. The authors defined RSD of the foot as a pain syndrome characterized by diffuse nonanatomic, often unrelenting pain; autonomic-vasomotor signs including warm or cool skin temperatures and moist-sweaty or dry-scaly skin; and a positive response to a lumbar sympathetic block. Patients with RSD have a characteristic delayed bone-scan pattern consisting of diffuse increased tracer throughout the foot, with juxta-articular accentuation of tracer uptake. Overall, sensitivity in this study was 100%; specificity, 80%; positive predictive value, 54%; and negative predictive value, 100%. False-positive images were obtained in patients with infection, diabetes, and chronic pain. Specificity was 66% in the subgroup of patients who underwent sympathetic block, with a positive-predictive value of 88%. There were no differences in scan pattern related to duration of symptoms prior to imaging.

Algodystrophie versus infection postopératoire : intérêt de la scintigraphie aux polynucléaires marqués à propos d’un cas clinique à la main

“…Les formes radiaires, unidigitales sont plus rares et d'expression plus difficile à reconnaître, facilement [5]. La scintigraphie osseuse aux biphosphonates marqués ( 99m Tc-MDP) est très sensible pour détecter des sites inflammatoires articulaire ou osseux mais manque de spécificité [6], limitée à 80 % lorsqu'il s'agit de différencier l'algodystrophie d'une autre cause inflammatoire [7].…”

Impact of Three-Phase Bone Scintigraphy on the Diagnosis and Treatment of Complex Regional Pain Syndrome Type I or Reflex Sympathetic Dystrophy

“…Any discrepancies were later resolved by consensus. Previously described scintigraphic criteria for RSD were used [10,12] . Typically, the TPBS demonstrated diffusely increased fl ow on the fl ow study, diffusely increased activity on the blood pool images and/or increased activity on the 3-hour delayed bone scan images with prominent juxta-articular uptake.…”

“…Previous reports have shown that TPBS has a sensitivity of up to 100% and a specifi city of up to 98% for the diagnosis of RSD [8][9][10][11][12] . For hemiplegics, a positive TPBS accurately predicts subsequent development of clinical symptoms of RSD [13] .…”

“…Despite these favorable reports, some clinicians are reluctant to perform TPBS for patients thought to have RSD because the diagnostic effi cacy of TPBS across the three stages of RSD is less certain [12,[13][14][15][16][17] , and rheumatologists, neurologists and other treating physicians are not certain whether or not TPBS will signifi cantly alter treatment.…”

Abstracts der ÖSG Jahrestagung 2010

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