Diagnostic approach to reflex sympathetic dystrophy after fracture: radiography or bone scintigraphy?

Abstract

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.

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

“…TPBS is one of widely used imaging studies in CRPS-1. Although osteoporosis on simple X-ray or marrow edema and soft tissue swelling on MRI are supportive findings for CRPS-1, they are not as sensitive or specific as TPBS [16]. However, there are wide variations in the diagnostic sensitivity and specificity of TPBS [8-10, 16, 20-23], and some authors argued that TPBS cannot provide useful information for making a clinical diagnosis of CRPS-1 [20,21].…”

“…It was suggested that CRPS-1 has clinical stages [25] and TPBS findings change according to clinical stages [15][16][17]. It was reported that F/P normalizes or even decreases, and afterward, DU normalizes as the disease progresses [15].…”

“…Most of all, the diagnostic value of the so-called "atypical" finding of decreased delayed uptake with or without decreased blood flow/pool needs to be specified. It was reported that finding on TPBS changes with a stage progression of CRPS-1 [15][16][17] and that delayed uptake can be decreased in CRPS-1 [6,18,19], especially in later stages and in children. However, there are scarce data on the diagnostic value of atypical findings.…”

Konventionelle Radiologie der Osteoporose und Röntgenabsorptiometrie

“…Die radiologische Erscheinung beinhaltet neben der Demineralisation des gelenknahen trabekulären Knochens auch endostale, intrakortikale, subperiostale und subchondrale Resorptionsvorgänge [77]. Vor allem in frühen Stadien der Erkrankungen ist die Knochenszintigraphie von diagnostischer Bedeutung [101].…”

Os efeitos da estimulação magnética transcraniana repetitiva (EMTr) aplicada sobre o córtex motor de pacientes com síndrome complexa de dor regional

“…De acordo com Todorovic-Tirnanic et al (1995), a capacidade diagnóstica da radiografia simples é igual ou superior a cintilografia óssea após a segunda fase da doença.…”