Annals of Rehabilitation Medicine

"Three-phase bone scintigraphy"

Original Articles

The Comparative Analysis between Digital Infrared Thermography Imaging and Three-phase Bone Scintigraphy in the Post-hemiplegic Complex Regional Pain Syndrome.: Lee, Chang Ho , Hyun, Jung Keun , Lee, Seong Jae , Jeon, Jae Yong; J Korean Acad Rehabil Med 2006;30(2):122-127.

Abstract
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Objective
To evaluate the benefit of digital infrared thermography imaging (DITI) and three-phase bone scintigraphy (TPBS) for detecting the post-hemiplegic complex regional pain syndrome (CRPS). Method: DITI and TPBS were done in 26 patients with post-hemiplegic CRPS clinically and 14 hemiplegic patients without CRPS as controls. Positive findings were interpreted when the affected hands were 1.0^oC higher than those of unaffected hands in DITI system and pathological uptake in the regions of interest (hands without fingers-carpal bones, metacarpal bones and metacarpopharyngeal joints) in de-layed phase of the TPBS. Results: The sensitivities of DITI and TPBS to detect CRPS were the same to each other as 46.2%, and specificities were 85.7% and 100% respectively. Nineteen of 26 patients (sensitivity=73.1%) were interpreted as abnormal when at least one test showed a positive finding. As a result, an increased diagnostic strength was achieved.Conclusion: These findings suggest that the combination of TPBS and DITI can improve the diagnostic strength of post- hemiplegic CRPS. (J Korean Acad Rehab Med 2006; 30: 122-127)

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Therapeutic Effect of Oral Corticosteroids in Post-Stroke Reflex Sympathetic Dystrophy: Semiquantitative evaluation of three-phase bone scintigraphy.: Sung, Duk Hyun , Lee, Kang Woo , Kim, Byung Tae , Kwon, Jeong Yi , Kim, Jong Moon; J Korean Acad Rehabil Med 1997;21(5):851-859.

Abstract
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In 12 Reflex Sympathetic Dystrophy(RSD) patients(13 cases) after the acute stroke, Three- phase Bone Scintigraphy(TBS) was performed to evaluate whether the amount of radioisotope reflects the disease activity of RSD. The diagnosis of RSD was based on Kozin's criteria(definite or probable group) and scintigraphic findings(increased radioisotope uptake in all three phases). Initial TBS was performed within 10 days after the onset of clinical symptoms and it was followed up within 5days after the short term steroids therapy. Before and after the steroids therapy, patients were evaluated with respect to pain, swelling and allodynia. Radioisotope uptake of ROI(Regions Of Interest) of all three images was calculated semiquantitatively in initial and follow up scintigraphy.

Pain, swelling and allodynia of the affected hand were improved in all patients after short-term oral corticosteroids therapy. Radioisotope uptake in blood flow image(11 patients, 12 cases) and blood pool image(11 patients, 12 cases) were decreased(p＜0.05), but radioisotope uptake in delayed image was not decreased(p＞0.05).

We concluded that radioisotope uptake in blood flow and blood pool images could reflect disease activity of RSD. It was suggested that decreased capillary vascular permeability by corticosteroids resulted in decreased blood flow and blood pool. The semiquantitative evaluation of TBS may be useful for monitoring the response to therapeutic intervention.

The role of inflammatory mediators in RSD and pharmacologic effect of corticosteroids were also discussed.