The aim of this paper was to compare the value of bone scintigraphy and radiography in the early diagnosis of post-fracture reflex sympathetic dystrophy (RSD). Thirty-seven adult patients with post-fracture RSD (28 in the first and nine in the second clinical stage of RSD), as well as seven patients with fracture but without RSD (control group), were investigated by radiography and bone scintigraphy. All of them were immobilized (duration of immobilization: 4-22 weeks). In 21 persons three phase bone scintigraphy was performed. The best distinction between the control group and the RSD patients was achieved by delayed bone scintigrams. The sensitivity (97%), positive predictive value (97%) and accuracy (95%) of delayed bone scintigraphy were very high compared to the values for radiography, which were 73%, 90% and 70% respectively. Bone scintigraphy also displayed higher specificity (86%) and negative predictive value (86%) than radiography (57% and 29% respectively). In the first clinical stage the difference between the accuracy of bone scintigraphy (97%) and radiography (63%) was greater than for the whole group. In the second stage of RSD the accuracy of bone scintigraphy (86%) and radiography (81%) was similar. Three-phase bone scintigraphy is not necessary for the diagnosis of post-fracture RSD: it is sufficient to perform delayed bone scintigraphy. It is concluded that bone scintigraphy is to be preferred to radiography for the early diagnosis of post-fracture RSD in the first clinical stage. In the second stage the diagnostic capabilities of bone scintigraphy and radiography are more comparable.
Insignificant degree of accordance, especially in the assessment of scars necessitates the standardization of criteria and terminology in order to interprete the renal scintigraphy with more accuracy and objectivity.
Cytological finding of nonfunctional nodules determines of the decision on radical therapy, and our preliminary results imply the need of FNAB routine use in nuclear medicine practice.
188Re is expected to have wide applications after development of a chromatographic 188W/188Re generator. One of the advantages of rhenium is tis chemical similarity with technetium. So technetium analogues labeled with 186,188Re can be developed for several specific applications.
Our preliminary results indicate the potential usefulness of 99mTc-PAH for routine renal scintigraphy. Owing to its fast kinetics, excretion properties and high-quality images, it could be a suitable substitute for 99mTc-DTPA. 99mTC-PAH clearance values, however, were significantly lower than those of MAG3, and could not be used for the estimation of renal plasma flow.
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