Diagnostic approach to reflex sympathetic dystrophy after fracture: radiography or bone scintigraphy?
The aim of this paper was to compare the value of bone scintigraphy and radiography in the early diagnosis of post-fracture reflex sympathetic dystrophy (RSD). Thirty-seven adult patients with post-fracture RSD (28 in the first and nine in the second clinical stage of RSD), as well as seven patients with fracture but without RSD (control group), were investigated by radiography and bone scintigraphy. All of them were immobilized (duration of immobilization: 4-22 weeks). In 21 persons three phase bone scintigraphy was performed. The best distinction between the control group and the RSD patients was achieved by delayed bone scintigrams. The sensitivity (97%), positive predictive value (97%) and accuracy (95%) of delayed bone scintigraphy were very high compared to the values for radiography, which were 73%, 90% and 70% respectively. Bone scintigraphy also displayed higher specificity (86%) and negative predictive value (86%) than radiography (57% and 29% respectively). In the first clinical stage the difference between the accuracy of bone scintigraphy (97%) and radiography (63%) was greater than for the whole group. In the second stage of RSD the accuracy of bone scintigraphy (86%) and radiography (81%) was similar. Three-phase bone scintigraphy is not necessary for the diagnosis of post-fracture RSD: it is sufficient to perform delayed bone scintigraphy. It is concluded that bone scintigraphy is to be preferred to radiography for the early diagnosis of post-fracture RSD in the first clinical stage. In the second stage the diagnostic capabilities of bone scintigraphy and radiography are more comparable.
Clinical Center of Serbia, Belgrade, Yugoslavia.
M
M
Todorović-Tirnanić
V
V
Obradović
R
R
Han
B
B
Goldner
D
D
Stanković
D
D
Sekulić
T
T
Lazić
B
B
Djordjević
D000328:Adult; D000368:Aged; D001134:Arm Injuries / Q000150:complications*; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D004164:Diphosphonates; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D007869:Leg Injuries / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011237:Predictive Value of Tests; D011859:Radiography; D011877:Radionuclide Imaging; D012019:Reflex Sympathetic Dystrophy / Q000000981:diagnostic imaging* / Q000209:etiology; D012680:Sensitivity and Specificity
D004164:Diphosphonates; D015609:Organotechnetium Compounds; C033905:technetium Tc 99m 1,1-diphosphonopropane-2,3-dicarboxylic acid