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KMID : 1148920110450040261
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Nuclear Medicine and Molecular Imaging
2011 Volume.45 No. 4 p.261 ~ p.267
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Diagnostic Performance of Three-Phase Bone Scan for Complex Regional Pain Syndrome Type 1 with Optimally Modified Image Criteria
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Kwon Hyun-Woo
Paeng Jin-Chul
Nahm Francis Sahngun
Kim Seog-Gyun
Zehra Tanzeel
Oh So-Won
Lee Hyo-Sang
Kang Keon-Wook
Chung June-Key
Lee Myung-Chul
Lee Dong-Soo
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Abstract
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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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KEYWORD
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Complex regional pain syndrome type I, Diagnosis, Three-phase bone scan, Optimal criteria
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