title: Sensitivity and specificity of 3-phase bone scintigraphy in the diagnosis of complex regional pain syndrome of the upper extremity.
abstract: OBJECTIVE
  Joint and bone alterations are seldom mentioned in the diagnostic criteria for complex regional pain syndrome (CRPS) even though they are important for long-term outcome. Altered periarticular bone metabolism can be detected by 3-phase bone scintigraphy (TPBS). Although frequently examining the diagnostic efficacy of TPBS is debatable.
  
  
  METHODS
  In all, 78 TPBS (45 CRPS/33 control group) were evaluated qualitatively and quantitatively. Sensitivity and specificity of the qualitative blinded reviewer analysis (n=57) compared with quantitative region of interest (ROI)-based analysis over the metacarpophalangeal, proximal, and distal interphalangeal joints (n=74) were evaluated. Patients' sex, age, duration of CRPS, inciting event, extent of joint alteration, and handedness were included as covariables.
  
  
  RESULTS
  Qualitative blinded reviewer TPBS analysis had a high specificity (83%-100%). However, sensitivity was 31% to 50%. Interrater reliability was moderate (kappa score 0.56). Using the ROI-based evaluation, the highest sensitivity (69%) and specificity (75%) (ROI score > or =1.32) was shown for phase 3, whereas sensitivity of phases 1 and 2 rapidly declined to 50%. Duration of CRPS until TPBS was the only variable with significant impact on ROI scores of phase 3 (F=23.7; P=0.000; R=0.42). ROI scores declined with increasing duration of CRPS.
  
  
  CONCLUSIONS
  In conclusion, TPBS is a highly specific tool for diagnosing CRPS of the upper limb. ROI evaluation of phase 3 within the first 5 months after onset of CRPS is an appropriate additional diagnostic tool to confirm or exclude CRPS of the upper extremity.
authors.affiliation: Departments of Pain Management daggerDiagnostic Radiology, Interventional Radiology and Nuclear Medicine, BG-Kliniken Bergmannsheil Bochum, Ruhr-University Bochum, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Wüppenhorst
authors.forename: Christoph
authors.initials: C
authors.lastname: Maier
authors.forename: Jule
authors.initials: J
authors.lastname: Frettlöh
authors.forename: Werner
authors.initials: W
authors.lastname: Pennekamp
authors.forename: Volkmar
authors.initials: V
authors.lastname: Nicolas
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D020918:Complex Regional Pain Syndromes / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging / Q000379:methods; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013669:Technetium Tc 99m Medronate; D034941:Upper Extremity / Q000000981:diagnostic imaging; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate