Sensitivity and Specificity of 3-phase Bone Scintigraphy in the Diagnosis of Complex Regional Pain Syndrome of the Upper Extremity

Wüppenhorst, Nicole; Maier, Christoph; Frettlöh, Jule; Pennekamp, Werner; Nicolas, Volkmar

doi:10.1097/ajp.0b013e3181c20207

Cited by 116 publications

(70 citation statements)

References 38 publications

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“…4,11 However, scintigraphy has been noted to have a negative effect on the fetus in all three trimesters. 12 Thus use of this technique is restricted in pregnant women or suspicions of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

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Perfusion Index is Increased in Acute Complex Regional Pain Syndrome Type 1

Tutoğlu¹

2015

Arch Rheumatol

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Objectives:This study aims to investigate whether perfusion index (PI) changes in the affected extremity of complex regional pain syndrome (CRPS) patients compared to other extremities, and define the possible value of this noninvasive method in evaluating CRPS patients' peripheral perfusion. Patients and methods: Twenty-five CRPS type 1 patients (17 males, 8 females; mean age 37.9±15.1 years; range 20 to 53 years) who fulfilled the Budapest criteria and 22 age, sex and body mass index matched healthy controls from the staff of our hospital were enrolled. The patients and controls were laid in supine position with the palms facing upward. A pulse oximeter sensor was first attached to the fourth finger of the hand with CPRS, and then to the fourth finger of the unaffected hand. PI values were recorded at five minutes after the attachment of the probe. The control group underwent the same procedure for both extremities. Results:The PI values were significantly different between healthy and affected hands of the patients (p=0.007). PI values did not show a significant difference between the left and right hands of the subjects in the control group (p>0.05). Conclusion: This study suggests that peripheral PI of the extremities of early stage CRPS type 1 patients may be useful in the diagnosis process.

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Section: Discussionmentioning

confidence: 99%

“…3 An increment in the blood flow is noted in the first phase of three phase bone scintigraphy (TPBS) in the acute stage of CRPS 4 with high specificity in the diagnosis of CRPS.…”

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confidence: 99%

Perfusion Index is Increased in Acute Complex Regional Pain Syndrome Type 1

Tutoğlu¹

2015

Arch Rheumatol

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“…1), and an ROI of same size and symmetric shape was drawn in contralateral side. Focal increase or decrease in carpal (or tarsal for foot) without abnormality in phalangeal periarticular area was excluded because of other possible pathology rather than CRPS-1 per se [27]. Afterward, a lesion-to-contralateral ratio (LCR) was calculated from the ratio of total radioactivity counts of ROIs (affected side/contralateral side).…”

Section: Patientsmentioning

confidence: 99%

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

Kwon

Paeng

Nahm

et al. 2011

Nucl Med Mol Imaging

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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.

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“…Sensitivity and specificity of TPBS were found to be 31-50% and 83-100%, respectively (6). On the other hand, authors reported that findings in TPBS were not expected until at least 6 months.…”

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confidence: 99%

“…Again in contrast, after 5 months, specificity of TPBS begins to decrease. Sensitivity and specificity in the first 5 months were reported to be higher than they were after 5 months (6). Optimum time to use TPBS to diagnose CRPS was reported to be within the first 5 months and the shorter the duration, the higher the sensitivity.…”

mentioning

confidence: 99%