title: Alterations of the three-phase bone scan after sympathectomy.
abstract: OBJECTIVE
  To evaluate alterations of the three-phase bone scan (TPBS) in patients with the clinical diagnosis of reflex sympathetic dystrophy (RSD) before and after surgical or chemical sympathectomy.
  
  
  METHODS
  The TPBS was done after i.v. administration of 99technetium dimethylphosphonate. Scans were read by one blinded and one nonblinded reviewer (as to site of symptoms and procedure), using a visual grading system devised in our institution. Since there were no statistically significant differences between the two examiners' scores for blood flow, pool, and delayed phases, all scores were averaged and used for comparison before and after sympathectomy.
  
  
  METHODS
  Ten women and four men with RSD were observed with 17 TPBSs before and 30 TPBSs after surgical (n = 6) or chemical (n = 8) sympathectomy.
  
  
  RESULTS
  All three phases of TPBS were significantly enhanced after sympathectomy in 11 of 14 patients in a pattern indistinguishable from that very commonly reported in florid RSD. The increased uptake occurred within 24 h after the procedure, normalized as early as 3 months in some scans, and remained abnormal in some patients in the 12-month follow-up period. In total, only 33% of all sympathectomies performed led to long-term symptom relief.
  
  
  CONCLUSIONS
  The data demonstrated that alterations in TPBS after sympathectomy are identical to those reported in early RSD and these alterations bear no relationship to the success of sympathectomy regarding pain relief. The mechanisms underlying alterations of TPBS as well as the potential mechanisms of sympathectomy failures are discussed.
authors.affiliation: Pain Investigation Unit, Toronto Hospital (Western Division), University of Toronto, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Mailis
authors.forename: H
authors.initials: H
authors.lastname: Meindok
authors.forename: M
authors.initials: M
authors.lastname: Papagapiou
authors.forename: D
authors.initials: D
authors.lastname: Pham
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011877:Radionuclide Imaging; D012019:Reflex Sympathetic Dystrophy / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D013562:Sympathectomy / Q000379:methods; D013563:Sympathectomy, Chemical; D013997:Time Factors; D016896:Treatment Outcome