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Utility of Radionuclide Bone Scintigraphy in Complex Regional Pain Syndrome

  • Other Pain (A Kaye and N Vadivelu, Section Editors)
  • Published:
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Abstract

Purpose of Review

To describe the current understanding of the role of three-phase bone scintigraphy (TPBS) in the diagnosis and management of complex regional pain syndrome (CRPS), discuss its advantages and limitations, and present three examples of TPBS patterns typically seen in CRPS patients.

Recent Findings

CRPS is a debilitating disorder frequently presenting with pain to ordinarily non-painful stimuli, redness, swelling, following fractures, stroke, myocardial infarction, surgery, or even minor trauma, and its diagnosis, based on clinical criteria and supportive imaging findings, is difficult. Of the available adjunctive diagnostic imaging modalities, radionuclide bone scintigraphy using a TPBS protocol is the most sensitive and specific for detecting abnormalities commonly seen with this condition—classically, increased periarticular uptake on delayed phase of TPBS, with variable increased uptake on perfusion phases, depending on chronicity. Recent studies have (1) demonstrated a more heterogeneous correlation of TPBS findings with CRPS diagnosis using the current Budapest criteria than in studies using older criteria, (2) pointed to the utility of novel quantitative scintigraphic techniques, and (3) highlighted the value of the early perfusion phases of TPBS in predicting treatment response.

Summary

TPBS remains a valuable imaging adjunct to clinical diagnosis of CRPS. In combination with a multi-modal analgesic approach, TPBS can be used to follow disease course and potentially treatment response, although prospective trials are needed to further delineate its role.

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Authors and Affiliations

  1. Division of Nuclear Medicine, Department of Radiology, Duke University Medical Center, Durham, NC, 27710, USA

    Brandon A. Howard

  2. Department of Anesthesiology, Duke University Medical Center, Durham, NC, 27710, USA

    Lance Roy & Srinivas Pyati

  3. Department of Anesthesiology, Louisiana State University, New Orleans, LA, 70112, USA

    Alan David Kaye

  4. Department of Anesthesiology, Durham Veterans Affairs Medical Center, Durham, NC, 27710, USA

    Srinivas Pyati

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  1. Brandon A. Howard
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  2. Lance Roy
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Correspondence to Srinivas Pyati.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Other Pain

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Howard, B.A., Roy, L., Kaye, A.D. et al. Utility of Radionuclide Bone Scintigraphy in Complex Regional Pain Syndrome. Curr Pain Headache Rep 22, 7 (2018). https://doi.org/10.1007/s11916-018-0659-7

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  • DOI: https://doi.org/10.1007/s11916-018-0659-7

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