title: Diagnostic performance of three-phase bone scan for complex regional pain syndrome type 1 with optimally modified image criteria.
abstract: OBJECTIVE
  Although the three-phase bone scan (TBPS) is one of the widely used imaging studies for diagnosing complex regional pain syndrome type I (CRPS-1), there is some controversy regarding the TPBS image criteria for CRPS-1. In this study, we modified the image criteria using image pattern and quantitative analysis in the patients diagnosed using the most recent consensus clinical diagnostic criteria.
  
  
  METHODS
  The study included 140 patients with suspected CRPS-1 (CRPS-1, n = 79; non-CRPS, n = 61; mean age 39 ± 15 years) who underwent TPBS. The clinical diagnostic criteria for CRPS-1 revised by the Budapest consensus group were used for confirmative diagnosis. Patients were classified according to flow/pool and delayed uptake (DU) image patterns, and the time interval between the initiating event and TPBS (TIevent-scan). Quantitative analysis for lesion-to-contralateral ratio (LCR) was performed. Modified TPBS image criteria were created and evaluated for optimal diagnostic performance.
  
  
  RESULTS
  Both increased and decreased periarticular DU were significant image findings for CRPS-1 (CRPS-1 positive-rate = 73% in the increased DU group, 75% in the decreased DU group). The TIevent-scan did not differ significantly between the different image pattern groups. Quantitative analysis revealed an LCR of 1.43 was the optimal cutoff value for CRPS-1 and diagnostic performance was significantly improved in the increased DU group (area under the curve = 0.732). Given the modified image criteria, the sensitivity and specificity of TPBS for diagnosing CRPS-1 were 80% and 72%, respectively.
  
  
  CONCLUSIONS
  Optimally modified TPBS image criteria for CRPS-1 were suggested using image pattern and quantitative analysis. With the criteria, TPBS is an effective imaging study for CRPS-1 even with the most recent consensus clinical diagnostic criteria.
authors.affiliation: Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744 Korea ; Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology and College of Medicine/College of Pharmacy, Seoul National University, Seoul, Korea.
authors.forename: Hyun Woo
authors.initials: HW
authors.lastname: Kwon
authors.affiliation: Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744 Korea ; Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jin Chul
authors.initials: JC
authors.lastname: Paeng
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166 Gumi-Ro, Bundang-Gu, Seongnam, 463-707 Korea.
authors.forename: Francis Sahngun
authors.initials: FS
authors.lastname: Nahm
authors.affiliation: Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744 Korea.
authors.forename: Seog Gyun
authors.initials: SG
authors.lastname: Kim
authors.affiliation: Nuclear Medicine, Oncology and Radiotheraphy Institute, Pakistan Atomic Energy Commission, Islamabad, Pakistan.
authors.forename: Tanzeel
authors.initials: T
authors.lastname: Zehra
authors.affiliation: Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744 Korea.
authors.forename: So Won
authors.initials: SW
authors.lastname: Oh
authors.affiliation: Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744 Korea.
authors.forename: Hyo Sang
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744 Korea ; Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Keon Wook
authors.initials: KW
authors.lastname: Kang
authors.affiliation: Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744 Korea ; Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: June-Key
authors.initials: JK
authors.lastname: Chung
authors.affiliation: Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744 Korea ; Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Myung Chul
authors.initials: MC
authors.lastname: Lee
authors.affiliation: Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744 Korea ; Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Dong Soo
authors.initials: DS
authors.lastname: Lee
keywords: Complex regional pain syndrome type I; Diagnosis; Optimal criteria; Three-phase bone scan