Diagnostic Performance of Three-Phase Bone Scintigraphy and Digital Infrared Thermography Imaging for Chronic Post-Traumatic Complex Regional Pain Syndrome.

Miju Cheon,Kyung Hee Do,Jang Yoo,Hyo Jung Kang,Eul Joo Han,Hee Seung Yang

doi:10.3390/diagnostics11081459

Miju Cheon, Kyung Hee Do + Show 4 more

Open Access

https://doi.org/10.3390/diagnostics11081459

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Journal: Diagnostics (Basel, Switzerland)	Publication Date: Aug 12, 2021
Citations: 7	License type: CC BY 4.0

Affiliation: Seoul Veterans Hospital

Abstract

This study aimed to evaluate the diagnostic performance of three-phase bone scintigraphy (TPBS) and digital infrared thermography imaging (DITI) in the chronic post-traumatic CRPS and propose new imaging diagnostic criteria that combine the two tests. We retrospectively enrolled 44 patients with suspected symptoms of CRPS from various injuries during obligatory military service. We analyzed the following findings: (1) uptake pattern on TPBS, (2) uptake ratios of affected and unaffected sides in each phase of TPBS, (3) difference in body skin temperature on DITI. New criteria combining the above findings were also evaluated. Eighteen patients were finally defined as CRPS according to the Budapest criteria. Uptake pattern and uptake ratio in blood pool phase on the TPBS were significantly different between CRPS and non-CRPS groups (both p < 0.05). The DITI could not discriminate significantly between the groups (p = 0.334). The diagnostic criteria considering both the pattern analysis and quantitative analysis in TPBS exhibited the highest positive likelihood ratio. On the other hand, the diagnostic criteria combining DITI and TPBS showed the lowest negative likelihood ratio value. TPBS can be useful in diagnosing chronic post-traumatic CRPS. Moreover, we can suggest that different diagnostic criteria be applied depending on the purpose.

Highlights

Complex regional pain syndrome (CPRS) is clinically a disease in which symptoms such as diffuse pain, hypersensitivity, edema, and decreased autonomic and motor functions are present in the affected limb [1]
The current study aimed to evaluate the diagnostic performance of three-phase bone scintigraphy (TPBS) and digital infrared thermography imaging (DITI) in the chronic post-traumatic CRPS and propose new imaging diagnostic criteria that combine the two tests
Patients who did not undergo both TPBS and DITI, patients with less than one year after symptom onset, and patients with bilateral pain in their extremities were excluded from the study

Summary

Introduction

Complex regional pain syndrome (CPRS) is clinically a disease in which symptoms such as diffuse pain, hypersensitivity, edema, and decreased autonomic and motor functions are present in the affected limb [1]. It can be caused by trauma, fractures, nerve damage of limbs, brain lesions including strokes, brain tumors, traumatic brain injury, spinal cord injury, myocardial infarction, and unspecified causes [2]. The diagnosis of chronic CRPS is frequently difficult because there are no unique and characteristic features that distinguish CRPS from similar conditions [4,7]. Some medications, physical therapy, occupational therapy, procedures such as sympathetic nerve blocks or neuromodulation can control the pain and improve the patient’s quality of life, so accurate

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