Nucl Med Mol Imaging.
2011 Dec;45(4):261-267.
Diagnostic Performance of Three-Phase Bone Scan for Complex Regional Pain Syndrome Type 1 with Optimally Modified Image Criteria
- Affiliations
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- 1Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea. paengjc@snu.ac.kr
- 2Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.
- 3Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166 Gumi-Ro, Bundang-Gu, Seongnam 463-707, Korea. hiitsme@hanmail.net
- 4Nuclear Medicine, Oncology and Radiotheraphy Institute, Pakistan Atomic Energy Commission, Islamabad, Pakistan.
- 5Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology and College of Medicine/College of Pharmacy, Seoul National University, Seoul, Korea.
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 METHODS
The 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 (TIevent-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 TIevent-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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