Skip to main content
SpringerLink
Log in

Pattern recognition in five-phase bone scintigraphy: diagnostic patterns of reflex sympathetic dystrophy in adults

  • Original Article
  • Published:
European Journal of Nuclear Medicine Aims and scope Submit manuscript

Abstract

The objective of this study was to assess qualitative and quantitative patterns of tracer accumulation to increase the diagnostic utility of bone scintigraphy in reflex sympathetic dystrophy (RSD). Of 120 patients with high clinical suspicion for RSD, 96 were confirmed as having RSD during follow-up, while the remaining 24 were used as controls. Clinical parameters were measured and correlated to five activity ratios (0–30 s, 0.5–5 min, 5–15 min, 3 h, 24 h) and five scintigraphic signs. Monitoring three dynamic phases revealed different tracer kinetics of potential diagnostic utility; however, the 24-h bone phase offered no additional diagnostic contribution and can be omitted. Quantification provided objective parameters for the duration of symptoms, pain and impairment of movement but not for surface temperature differences, swelling and impairment of physical force. It is of limited use for diagnosis except for the exclusion of disease. Discriminant analysis revealed the combination of three signs (diffuse uptake in carpus/tarsus+diffuse uptake in all small joints+increased activity ratio in the late blood pool phase) to be the pattern with the highest diagnostic accuracy independent of localisation, sex, age and precipitating factors. It is concluded that the scintigraphic confirmation of RSD is based on lateralisation in the late blood pool phase and the described pattern in the early bone phase.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Roberts WJ. A hypothesis on the physiological basis for causalgia and related pains. Pain 1986; 24: 297–311.

    PubMed  Google Scholar 

  2. Genant HD, Kozin F, Bekerman C, McCarthy DJ, Sims J. The reflex sympathetic dystrophy syndrome: a comprehensive analysis using fine detail radiography, photon absorptiometry and bone and joint scintigraphy.Radiology 1975; 117: 21–23.

    PubMed  Google Scholar 

  3. Sambrook P, Champion GD. Reflex sympathetic dystrophy: characteristic changes in bone on CT Scan.J Rheumatol 1990; 17: 10–11.

    Google Scholar 

  4. Koch ES, Hofer HO, Sealer G, Marincek B, Schulthess GKV. Failure of MR imaging to detect reflex sympathetic dystrophy of the extremities.Am J Roentgenol 1991; 156: 113–115.

    Google Scholar 

  5. Moesker A, Boersma FP, Schijgrond HW, Cortvriendt W. Treatment of posttraumatic sympathetic dystrophy (Sudeck's atrophy) with guanethidine and ketanserin.The Pain Clinic 1985; 1: 171–176.

    Google Scholar 

  6. Bekerman C, Genant HK, Hofer PB, et al. Radionuclide imaging of the bones and joints of the hand.Radiology 1976; 118: 653.

    PubMed  Google Scholar 

  7. Kozin F, Genant HK, Bekerman C, McCarty DJ. The reflex sympathetic dystrophy syndrome. II. Roentgenographic and scintigraphic evidence of bilaterality and of periarticular accentuation.Am J Med 1976; 60: 332–338.

    PubMed  Google Scholar 

  8. Simon H, Carlson DH. The use of bone scanning in the diagnosis of reflex sympathetic dystrophy.Clin Nucl Med 1980; 3: 116–121.

    Google Scholar 

  9. Kotzin F, Soin JS, Ryan LM, Carrera GF, Wortmann RL. Bone scintigraphy in the reflex sympathetic dystrophy syndrome.Radiology 1981; 138: 437–443.

    PubMed  Google Scholar 

  10. Intenzo C, Kim S, Millin J, Park C. Scintigraphic patterns of the reflex sympathetic dystrophy syndrome of the lower extremities.Clin Nucl Med 1989; 106: 437–440.

    Google Scholar 

  11. Greyson ND, Tepperman PS. Three-phase bone studies in hemiplegia with reflex sympathetic dystrophy and the effect of disuse.J Nucl Med 1984; 25: 423–429.

    PubMed  Google Scholar 

  12. Holder LE, Mackinnon SE. Reflex sympathetic dystrophy in the hands: clinical and scintigraphic criteria.Radiology 1984; 152: 517–522.

    PubMed  Google Scholar 

  13. Kozin F, Rayan LM, Carerra GF, Soin JS, Wortmann RL. The reflex sympathetic dystrophy syndrome (RSDS). III. Scintigraphic studies, further evidence for the therapeutic efficacy of systemic corticosteroids and proposed diagnostic criteria.Am J Med 1981; 70: 23–30.

    PubMed  Google Scholar 

  14. Demangeat JL, Constantinesco A, Bruno B, Foucher G, Farcot JM. Three-phase bone scanning in reflex sympathetic dystrophy of the hand.J Nucl Med 1988; 29: 26–32.

    PubMed  Google Scholar 

  15. Willame LMA, Scand A. Hypofixation on bone scintigraphy in reflex sympathetic dystrophy syndrome.Clin Rheumatol 1991; 10: 73–75.

    PubMed  Google Scholar 

  16. Kline SC, Holder LE. Segmental reflex sympathetic dystrophy: clinical and scintigraphic criteria.J Hand Surg [Am] 1993; 18: 853–859.

    Google Scholar 

  17. Koppers B. Drei-Phasen-Szintigraphie beim Sudeck-Syndrom. Vergleich mit radiologischen und klinischen Untersuchungsergebnissen.Fortschr Röntgenstr 1982; 137: 564–579.

    Google Scholar 

  18. Davidoff G, Werner R, Cremer S, Jackson D, Ventocella C, Wolf L. Predictive value of the three-phase technetium bone scan in diagnosis of reflex sympathetic dystrophy syndrome.Arch Phys Med Rehabil 1989; 70: 135–137.

    PubMed  Google Scholar 

  19. Carlson DH, Simon H, Wegner W. Bone scanning and diagnosis of reflex sympathetic dystrophy secondary to herniated lumbar disks.Neurology 1977; 27: 791–793.

    PubMed  Google Scholar 

  20. Prakash V, Kamel NJ, Lin MS. Increased skeletal localization of99mTc-diphosphonate in paralyzed limbs.Clin Nucl Med 1976; 1: 48–50.

    Google Scholar 

  21. Tepperman PS, Greyson ND, Hilbert L, et al. Reflex sympathetic dystrophy in hemiplegia.Arch Phys Med Rehabil 1984; 65: 442–447.

    PubMed  Google Scholar 

  22. Schurawitzki H, Wickenhauser J, Fezoulidis I, Sadil V, Fialka V, Das Sudeck Syndrom — eine kombinierte klinischröntgenologisch-nuklearmedizinische Studie.Unfallchirurgie 1988; 14: 238–246.

    PubMed  Google Scholar 

  23. O'Mara RE. Benign bone disease. In: Gottschalk A, Hoffer PB, Potchen EJ, eds. Diagnostic nuclear medicine, 2nd edn. Baltimore: Williams & Wilkins; 1988: 1033–1075.

    Google Scholar 

  24. Holder LE, Cole LA, Myerson MS. Reflex sympathetic dystrophy in the foot: clinical and scintigraphic criteria.Radiology 1992: 184: 531–535.

    PubMed  Google Scholar 

  25. Atkins RM, Tindale W, Bickerstaff D, Kanis JA. Quantitative bone scintigraphy in reflex sympathetic dystrophy.Br J Rheumatol 1993; 32: 41–45.

    PubMed  Google Scholar 

  26. Fialka V, Zifko I, Schneider B, Schurawitzki H. Long-term studies on reflex sympathetic dystrophy.Eur J Phys Med Rehabil 1992; 2: 58–62.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University Clinic of Nuclear Medicine, Waehringer Guertel 18-20, A-1090, Vienna, Austria

    T. Leitha, A. Staudenherz, M. Korpan & V. Fialka

Authors
  1. T. Leitha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Staudenherz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Korpan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V. Fialka
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leitha, T., Staudenherz, A., Korpan, M. et al. Pattern recognition in five-phase bone scintigraphy: diagnostic patterns of reflex sympathetic dystrophy in adults. Eur J Nucl Med 23, 256–262 (1996). https://doi.org/10.1007/BF00837623

Download citation

  • Received:

  • Revised:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00837623

Key words

Search

Navigation