Reflex sympathetic dystrophy of the hand: an excessive inflammatory response?
In 23 patients with reflex sympathetic dystrophy (RSD) of the hand, scintigraphy with indium-111 labeled human non-specific polyclonal immunoglobulin G (In-111-IgG) was performed to investigate whether inflammatory characteristics are present in RSD. Both blood flow and accumulation over 48 h were assessed. Nineteen patients had increased flow to the affected hand, and 3 had decreased flow. One patient had bilateral RSD. Exercise provoked aggravation of complaints and signs in all patients. The affected/non-affected hand ratio (target-to-background, T/B) immediately before and after exercise did not change significantly. The T/B ratios 48 h after In-111-IgG injection were significantly higher in patients with RSD less than 5 months than in patients with RSD existing 5 months or longer. The T/B ratios 24 and 48 h after In-111-IgG injection were not correlated with the flow T/B ratios. In fact, 2 of the 3 patients with a decreased flow showed excess accumulation on the late images. Significantly more patients with early RSD, existing less than 5 months, had a positive In-111-IgG scintigraphy (14 of 17) than the patients with late RSD (1 of 6). Increased vascular permeability for macromolecules, an important characteristic of inflammation, appears to play a role in the development of RSD. This phenomenon is not flow-dependent.
Oyen
Wim J G
WJG
Department of Nuclear Medicine, University Hospital Nijmegen, NijmegenNetherlands Department of Surgery, University Hospital Nijmegen, NijmegenNetherlands Department of Internal Medicine, University Hospital Nijmegen, NijmegenNetherlands.
Arntz
Ivo E
IE
Claessens
Roland A M J
RAMJ
Van der Meer
Jos W M
JWM
Corstens
Frans H M
FHM
Goris
Jan A R
JAR
D000328:Adult; D000368:Aged; D005260:Female; D015902:Gamma Cameras; D006225:Hand / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007205:Indium Radioisotopes; D007249:Inflammation / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D012019:Reflex Sympathetic Dystrophy / Q000000981:diagnostic imaging / Q000503:physiopathology*
D007205:Indium Radioisotopes