technetium-tc-99m-exametazime and Reflex-Sympathetic-Dystrophy

The differential diagnosis between complex regional pain syndrome (CRPS) and postoperative infection is sometimes difficult. We discuss such a case following surgical release of a trigger finger. Because of lack of an accurate diagnosis, the patient was subjected to more and more costly investigations and was operated one more (and unnecessary) time. As white blood cell scintigraphy ((99m)technetium hexamethylpropyleneamineoxime leukocyte [(99m)Tc HMPAO leu]) proved negative, it allowed us to identify with high specificity, a non infectious cause for the problem, and to stop over-investigation and inflation of the costs of treatment. However, the use of white blood cell scintigraphy should remain exceptional, because of its complexity and expense.

Topics: Bacterial Infections; Diagnosis, Differential; Female; Hand; Humans; Leukocytes; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Reflex Sympathetic Dystrophy; Sensitivity and Specificity; Surgical Wound Infection; Technetium Tc 99m Exametazime; Thumb

Analyzing changes in regional cerebral blood flow (rCBF) with SPECT in complex regional pain syndrome type 1 (CRPS 1), formerly known as reflex sympathetic dystrophy, is an optimal method for evaluating effective pain relief. We attempted to investigate the correlation of changes in rCBF with pain relief during treatments of sympathetic blockade and multimodal epidural pain control.. We describe a patient with severe CRPS 1 in whom conventional treatment failed to relieve the pain. Combined repeated lumbar sympathetic blocks and long-term epidural morphine, bupivacaine, and ketamine administration provided satisfactory pain relief and functional activity recovery. Six normal control subjects having one Tc-99m HMPAO scan each and the patient with CRPS having 3 Tc-99m HMPAO scans (once before treatment and twice at 4 months and 6 months after treatment, respectively). The patient with CRPS showed lower rCBF than normal controls in the left thalamus and higher rCBF than normal controls in the right parietal lobe and left frontal lobe. After subsequent treatment, the subtraction images showed increased rCBF in the left thalamus and decreased rCBF in the right parietal and left frontal lobes.. Tc-99m HMPAO SPECT showed a relationship of rCBF in the thalamus, parietal lobe, and frontal lobe with pain relief. rCBF alterations may provide an indicator for the quality of pain management for neuropathic pains. Subtraction analysis between pre- and posttreatment, by using statistical parametric mapping (version 2), can be used as an objective indicator for the effectiveness of therapy.

Topics: Adult; Brain; Cerebrovascular Circulation; Humans; Male; Pain Measurement; Prognosis; Radiopharmaceuticals; Reflex Sympathetic Dystrophy; Statistics as Topic; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Treatment Outcome

The pathophysiology of Complex Regional Pain Syndrome type I (CRPS I) is unclear. An inflammatory reaction may cause the syndrome in which leukocytes may play an important role.. In this pilot study of six patients with acute warm CRPS I, we performed radiolabeled autologous leukocyte scans of both hands, in order to assess leukocyte accumulation. Comparison was made with the unaffected limb, and with three control patients with a Colles fracture without CRPS I.. Images of the CRPS I patients obtained 4 h after leukocyte injection provided the clearest results. At 4 h post-injection, there was clear, asymmetrical leukocyte accumulation in the affected extremity with a mean ratio of 1.49+/-0.19. In control patients, no asymmetry was observed between hands (mean ratio 1.09+/-0.06), indicating the absence of specific leukocyte accumulation. There was a statistically significant difference between CRPS I and control subjects 4 h post injection (p=0.012).. We found a significantly increased accumulation of leukocytes in patients with CRPS I. This is the first study to show a possible role for leukocytes in the pathophysiology of acute CRPS I.

Topics: Adult; Aged; Colles' Fracture; Female; Hand; Humans; Leukocyte Transfusion; Leukocytes; Male; Middle Aged; Pilot Projects; Radionuclide Imaging; Radiopharmaceuticals; Reflex Sympathetic Dystrophy; Technetium Tc 99m Exametazime; Time Factors