Reflex sympathetic dystrophy in the foot: clinical and scintigraphic criteria.
To establish strict clinical criteria for reflex sympathetic dystrophy (RSD) of the foot and to characterize any associated scintigraphic pattern, the authors performed three-phase radionuclide bone scanning in 51 patients prospectively referred because RSD was a diagnostic consideration. To establish sensitivity and specificity data, the cases of an additional 100 consecutive patients referred for a variety of foot problems were retrospectively reviewed. The authors defined RSD of the foot as a pain syndrome characterized by diffuse nonanatomic, often unrelenting pain; autonomic-vasomotor signs including warm or cool skin temperatures and moist-sweaty or dry-scaly skin; and a positive response to a lumbar sympathetic block. Patients with RSD have a characteristic delayed bone-scan pattern consisting of diffuse increased tracer throughout the foot, with juxta-articular accentuation of tracer uptake. Overall, sensitivity in this study was 100%; specificity, 80%; positive predictive value, 54%; and negative predictive value, 100%. False-positive images were obtained in patients with infection, diabetes, and chronic pain. Specificity was 66% in the subgroup of patients who underwent sympathetic block, with a positive-predictive value of 88%. There were no differences in scan pattern related to duration of symptoms prior to imaging.
Holder
L E
LE
Department of Radiology and Nuclear Medicine, Baltimore, MD 21218-2895.
Cole
L A
LA
Myerson
M S
MS
D000328:Adult; D000368:Aged; D001842:Bone and Bones / Q000000981:diagnostic imaging; D005189:False Positive Reactions; D005260:Female; D005534:Foot Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011875:Radionuclide Angiography; D012019:Reflex Sympathetic Dystrophy / Q000000981:diagnostic imaging* / Q000453:epidemiology; D012189:Retrospective Studies; D013669:Technetium Tc 99m Medronate
D013669:Technetium Tc 99m Medronate