Usefulness of bone scintigraphy for the diagnosis of Complex Regional Pain Syndrome 1: A systematic review and Bayesian meta-analysis

Wertli, Maria M.; Brunner, Florian; Steurer, Johann; Held, Ulrike

doi:10.1371/journal.pone.0173688

Cited by 36 publications

(17 citation statements)

References 47 publications

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“…Bone scintigraphic abnormalities may be seen in patients with complex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy [95][96][97]. Meta-analyses have found only moderate concordance between bone scintigraphy and the presence or absence of CRPS [98], and low sensitivity for detection of CRPS when compared to clinical diagnostic criteria [99][100][101]. Bone scintigraphic does have high specificity, and can be used to rule out CRPS [101].…”

Section: Discussion Of Procedures By Variant Variant 1: Atraumatic Shmentioning

confidence: 99%

ACR Appropriateness Criteria® Shoulder Pain-Atraumatic

Small

Adler²,

Shah

et al. 2018

Journal of the American College of Radiology

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Shoulder pain is one of the most common reasons for musculoskeletal-related physician visits. Imaging plays an important role in identifying the specific cause of atraumatic shoulder pain. This review is divided into two parts. The first part provides a general discussion of various imaging modalities (radiographs, arthrography, nuclear medicine, ultrasound, CT, and MRI) and their usefulness in evaluating atraumatic shoulder pain. The second part focuses on the most appropriate imaging algorithms for specific shoulder conditions including: rotator cuff disorders, labral tear/ instability, bursitis, adhesive capsulitis, biceps tendon abnormalities, postoperative rotator cuff tears, and neurogenic pain.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org. Dr. Mintz helps to create the registry exam for radiology technologists for the ARRT; he is also the section editor for a journal. Dr. Subhas reports research support from Siemens Healthcare for CT techniques for metal artifact reduction. The other authors have no conflicts of interest related to the material discussed in this article.Disclaimer: The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists, and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient's clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient's condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or ...

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Section: Discussion Of Procedures By Variant Variant 1: Atraumatic Shmentioning

confidence: 99%

ACR Appropriateness Criteria® Shoulder Pain-Atraumatic

Small

Adler²,

Shah

et al. 2018

Journal of the American College of Radiology

View full text Add to dashboard Cite

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“…When utilised for evaluating CRPS I, bone scintigraphy imparts a high specificity, but sensitivity was found to be decreased when using the Budapest criteria as a reference. 43 Another recent meta-analysis concluded that scintigraphy has no benefit in the management of CRPS, as it should not be used as a confirmatory measure. 44 Electromyography has shown some validity in specific patient populations.…”

Section: Other Diagnostic Toolsmentioning

confidence: 99%

Complex regional pain syndrome: a narrative review for the practising clinician

Shim

Rose

Halle

et al. 2019

British Journal of Anaesthesia

160

152

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Complex regional pain syndrome (CRPS) is a life-altering condition that usually affects the extremities after a trauma or nerve injury. The physiologic changes that occur as a result of the inciting injury are complex, as the name of the syndrome implies. The pain and disability associated with CRPS often lead to psychological co-morbidities that create a vicious cycle of pain, isolation, and depression. We review recent developments in the understanding of CRPS and advancements in management of this syndrome. Further research in targeting specific mechanisms involved in the pathophysiology of CRPS should lead to prevention of this condition.

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“…19 This test, particularly phase 3, is highly specific, especially for the upper limb, [18][19] but when applied in patients with CRPS diagnosed with the Budapest criteria, the sensitivity is quite poor (0.551). 20 In conjunction with the TPBS imaging, serum osteoprotegerin, an osteoblast activity marker, could be used as a diagnostic tool with a sensitivity about 0.74 and a specificity of 0.8. 21 There was a significant positive correlation between increased radiotracer uptake in TPBS phase 3 and serum osteoprotegerin in patients with CRPS suggesting an increased osteoblast activity.…”

Section: Diagnosismentioning

confidence: 99%

Complex Regional Pain Syndrome: An update

Misidou¹,

Papagoras²

2019

MJR

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Complex regional pain syndrome (CRPS) is a perplexing painful syndrome of the extremities usually following a harmful event. It is distinguished in two types, mainly depending on the presence of nerve injury. Although its prevalence may vary depending on social and ethnic factors, middle-aged women seem to suffer most often and the upper limb is the most commonly affected extremity. Apart from pain, which is the dominating feature, the clinical picture unfolds across several domains: sensory, motor, autonomic and trophic. This syndrome develops in two phases, the acute (warm) phase, with the classic symptoms of inflammation, and the chronic (cold) phase, often characterized by trophic changes of the soft tissues and even bones. Although the syndrome has been studied for over two decades, no imaging or laboratory test has been established for the diagnosis and recently proposed diagnostic criteria have not yet been validated and are only occasionally applied. Its pathophysiology is still quite obscure, although the most likely mechanisms involve the classic and neurogenic paths of inflammation mediated by cytokines and neuropeptides, intertwined with changes of the autonomic and central nervous system, psychological mechanisms and, perhaps, autoimmunity. Although plenty of treatment modalities have been tried, none has been proven unequivocally efficacious. Apart from information and education, which should be offered to all patients, the most effective pharmacological treatments seem to be bisphosphonates, glucocorticoids and vasoactive mediators, while physical therapy and rehabilitation therapy also make part of the treatment.

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Usefulness of bone scintigraphy for the diagnosis of Complex Regional Pain Syndrome 1: A systematic review and Bayesian meta-analysis

Cited by 36 publications

References 47 publications

ACR Appropriateness Criteria® Shoulder Pain-Atraumatic

ACR Appropriateness Criteria® Shoulder Pain-Atraumatic

Complex regional pain syndrome: a narrative review for the practising clinician

Complex Regional Pain Syndrome: An update

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