technetium-tc-99m-medronate and Complex-Regional-Pain-Syndromes

In this report, we present a case of complex regional pain syndrome in a 55-y-old woman in whom the diagnosis was made on the basis of the bone scan findings. We also discuss the typical and atypical scintigraphic presentations of this entity, including pathophysiology and management.

Topics: Complex Regional Pain Syndromes; Diagnosis, Differential; Female; Hand Bones; Humans; Middle Aged; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Wrist Joint

Three-phase bone scintigraphy (TPBS) is an objective diagnostic test for complex regional pain syndrome (CRPS). The diagnostic importance of an increased uptake on the delayed phase has been proven in early CRPS, but that of the vascular and blood pool phases has not. The purpose of this study is to improve the diagnostic strength of the very acute stage of CRPS after stroke through a combined quantitative evaluation of each TPBS phase.. Quantitative TPBS analysis was performed in 26 post-stroke hemiplegic patients with very acute stage of CRPS and in 12 controls with no CRPS after brain lesion. Regions of interest (hands without fingers--carpal bones, metacarpal bones and metacarpopharyngeal joints) were selected and the count ratios of the affected to unaffected sides were calculated.. The maximum values of control in each phase were used as the criteria of positive findings of each TPBS phase. Eleven patients in the vascular phase, 13 in the blood pool phase and 17 in the delayed phase had a higher assumption than the maximum values and a sensitivity of 42.3%, 50% and 65.4%, respectively. Twenty-one of 26 patients were interpreted as abnormal when at least one phase showed a positive finding. As a result, increased sensitivity of 80.8% and identical specificity of 100% were achieved.. These findings suggest that the combination of quantitative evaluation of each TPBS phase can improve the diagnostic strength of the very acute stage of CRPS after stroke.

Topics: Acute Disease; Arthralgia; Bone and Bones; Complex Regional Pain Syndromes; Female; Humans; Image Interpretation, Computer-Assisted; Male; Middle Aged; Outcome Assessment, Health Care; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Stroke; Technetium Tc 99m Medronate

The efficacy of ketamine in relieving complex regional pain syndrome (CRPS) lacks predictive factors. The value of three-phase bone scintigraphy (TPBS) was assessed for this purpose.. TPBS was performed in 105 patients with unilateral, focal CRPS of type 1 before 5 days of ketamine infusions. Tracer uptake was measured in the region of interest concerned by CRPS and the contralateral homologous region. For the 3 scintigraphic phases (vascular, tissular, and bone phases), an asymmetry ratio of fixation was calculated between the affected and the unaffected sides (vascular phase [VPr], tissular phase [TPr], and bone phase [BPr]). Ketamine efficacy was assessed on pain intensity scores.. Ketamine-induced pain relief did not correlate with VPr, TPr, and BPr, but with the ratios of these ratios: BPr/TPr (r=0.32, P=0.009), BPr/VPr (r=0.34, P=0.005), and TPr/VPr (r=0.23, P=0.02). The optimum cut-off value for predicting the response to ketamine therapy was >1.125 for BPr/TPr, >1.075 for BPr/VPr, and >0.935 for TPr/VPr. The combination of increased values of BPr/TPr, BPr/VPr, and TPr/VPr was highly significantly associated with ketamine therapy outcome.. The relative hyperfixation of the radioactive tracer in the limb region concerned by CRPS in phases 2 and 3 versus phase 1 of TPBS correlated positively to the analgesic efficacy of ketamine. This study shows for the first time the potential predictive value of TPBS regarding ketamine therapy outcome. In addition, these results suggest that the analgesic action of ketamine is not restricted to "central" mechanisms, but may also involve "peripheral" mechanisms related to tissue inflammation and bone remodeling.

Topics: Adult; Aged; Aged, 80 and over; Analgesics; Bone and Bones; Complex Regional Pain Syndromes; Female; Humans; Ketamine; Male; Middle Aged; Prognosis; Prospective Studies; Radiopharmaceuticals; Technetium Tc 99m Medronate

The authors describe a complex regional pain syndrome (CRPS) and discuss its type according to the presence or absence of nerve injury. A patient underwent thromboendarterectomy of the right popliteal artery. Subsequently, right lower limb reflex sympathetic dystrophy developed, which was confirmed by scintigraphy and responded well to calcitonin treatment. Typing according to the new classification of CRPS type I or II with possible nerve injury is discussed, and a short review of the literature is included.

Topics: Aged; Causalgia; Complex Regional Pain Syndromes; Diagnosis, Differential; Endarterectomy; Foot; Humans; Male; Popliteal Artery; Radionuclide Imaging; Radiopharmaceuticals; Reflex Sympathetic Dystrophy; Technetium Tc 99m Medronate; Vascular Diseases; Whole-Body Counting