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Study for Reliability of Interpretation of the Three Phase Bone Scintigraphy in Patients with Post-traumatic Complex Regional Pain Syndrome  

Park, Jung-Mi (Department of Nuclear Medicine, Bucheon Hospital Soonchunhyang University College of Medicine)
Kim, Seon-Jung (Department of Nuclear Medicine, National Health Insurance Corporation Ilsan Hospital)
Chung, Seung-Hyun (Department of Rehabilitation Medicine, National Cancer Center)
Lee, Yong-Taek (Department of Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
Publication Information
Nuclear Medicine and Molecular Imaging / v.42, no.1, 2008 , pp. 44-51 More about this Journal
Abstract
Purpose: We performed this study to evaluate reliability on interpretation of three phase bone scintigraphy (TPBS) in patients with post-traumatic complex regional pain syndrome (PT-CRPS). Methods: Based on International Association for the Study of Pain guideline in 1994, 34 patients with PT-CRPS were selected for this study. Two nuclear medicine physicians evaluated identical TPBS according to the uptake pattern, extent and intensity of the lesion, and their agreements (kappa values) were analysed. The final diagnosis based on arbitrary criteria of each physician were compared with those obtained by the criteria for PT-CRPS established in this study, which are hyperactivity on all phases (criteria 1), hyperactivity of whole joints on delayed phase (criteria 2), and hyperactivity of either whole or FDGal joints on delayed phase (criteria 3). Results: Intra-observer agreements were good for uptake pattern, intensity, and extent on TPBS. Inter-observer agreements were also good, except extent on blood pool phase (0.55). The inter-observer agreements on final diagnosis improved when criteria 1-3 were applied (0.77-0.88), compared to when physician's own criteria were used (0.63). Those also improved from 0.29 to 0.47-0.82 for acute stage, and from 0.37 to 1.0 for chronic stage. The sensitivities of chronic stage were relatively lower to those of acute stage. Conclusions: Inter-observer's variations in diagnosis of the patients with PT-CRPS using TPBS were observed. These results were attributed to different criteria set by observers. In order to improve agreement on interpretation of TPBS, common positive criteria should be established, especially considering uptake pattern and clinical stages.
Keywords
Tc-99m deoxypyridinoline (DPD); three phase bone scintigraphy; post-traumatic complex regional pain syndrome;
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1 Baron R, Levine JD, Fields HL. Causalgia and reflex sympathetic dystrophy: does the sympathetic nervous system contribute to the generation of pain? Muscle Nerve 1999;22:678-95   DOI   ScienceOn
2 Wasner G, Schattschneider J, Heckmann K, Maier C, Baron R. Vascular abnormalities in reflex sympathetic dystrophy (CRPSII): mechanisms and diagnostic value. Brain 2001;124:587-99   DOI   ScienceOn
3 Todorovi-Tirnani M, Obradovi V, Han R, Goldner B, Stankovi D, Sekuli D, et al. Diagnostic approach to reflex sympathetic dytstrophy after fracture: radiography or bone scintigraphy? Eur J Nucl Med 1995;22:1187-93   DOI
4 Okudan B, Celik C, Serttas S, Ozgirgin N. The predictive value of additional late blood pool imaging to the three-phase bone scan in the diagnosis of reflex sympathetic dystrophy in hemiplegic patients. Rheumatol Int 2005;26:126-31   DOI
5 Merskey H, Bogduk N. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. 2nd ed. Seattle: IASP Press: 1994. p. 40-2
6 Greyson ND, Tepperman PS. Three-phase bone studies in hemiplegia with reflex sympathetic dystrophy and the effect of disuse. J Nucl Med 1984;25:423-9
7 Mackinnon SE, Holder Le. The use of three-phase radionuclide bone scanning in the diagnosis of reflex sympathetic dystrophy. J Hand Sur Am 1984;9:556-63   DOI
8 Holder Le, Cole LA, Myerson MS. Reflex sympathetic dystrophy in the foot: clinical and scintigraphic criteria. Radiology 1992;184:531-5   DOI
9 Tondeur M, Sand A, Ham H. Interobserver reproducibility in the interpretation of bone scans from patients suspected of having reflex sympathetic dystrophy. Clin Nucl Med 2005;30:4-10   DOI   ScienceOn
10 Turpin S, Taillefer R, Lambert R, Leveille J. 'Cold' reflex sympathetic dystrophy in an adult. Clin Nucl Med 1996;21:94-7   DOI
11 Leitha T, Staudenherz A, Korpan M, Fiala V. Pattern recognition in five-phase bone scintigraphy: diagnostic patterns of reflex sympathetic dystrophy in adults. Eur J Nucl Med 1996;23:256-62   DOI
12 Kurvers HA. Reflex sympathetic dystrophy: facts and hypotheses. Vasc Med 1998;3:207-14   DOI
13 Mailis A. Meindok H, Papaqapiou M, Pham D. Alterations of the three phase bone scan after sympathectomy. Clin J Pain 1994;10:146-55   DOI   ScienceOn
14 Van Der Laan L, Goris RJA. Reflex sympathetic dystrophy. An exaggerated regional inflammatory response? Hand Clin 1997;13:373-85
15 Fournier RS, Holder LE. Reflex sympathetic dystrophy: diagnosis controversies. Semin Nucl Med 1998;28:116-23   DOI   ScienceOn
16 Lee WW, Kim TU, Lim TH, Jung CY, Moon JH. Usefulness of three-phase bone scan in young male patients suspected of post-traumatic reflex sympathetic dystrophy syndrome. Korean J Nucl Med 2001;35;52-60   과학기술학회마을
17 Werner R, Davidoff G, Jackson ME, Cremer S, Ventocilla C, Wolf L. Factors affecting the sensitivity and specificity of the three-phase technetium bone scan in the diagnosis of reflex sympathetic dystrophy syndrome in the upper extremity. J Hand Surg Am 1989;14:520-3   DOI
18 O'Donoghue JP, Powe JE, Mattar AG, Hurwitz GA, Laurin NR. Three phase bone scintigraphy. Asymmetric patterns in the upper extremities of asymptomatic normals and reflex sympathetic dystrophy patients. Clin Nucl Med 1993;18:829-36   DOI
19 Intenzo C, Kim S, Millin J, Park C. Scintigraphic patterns of the reflex sympathetic dystrophy syndrome of the lower extremities. Clin Nucl Med 1989;14:57-61
20 Altman DG. Practical statistics for medical research. London: Chapman and Hall: 1991. p. 416-8