Quantitative Measurement of Three Phase Bone Scintigraphy in Stroke Patients with Complex Regional Pain Syndrome

OBJECTIVE: To evaluate usefulness of quantitative measurement of three phase bone scintigraphy in assessing the complex regional pain syndrome (CRPS) after stroke using reference value in healthy adults. METHOD: Twenty nine stroke patients with CRPS and 15 stroke patients without CRPS underwent three phase bone scintigraphy (TPBS). Uptake ratio was calculated by isotope count of affected side divided in isotope count of unaffected side in each phase. Reference value was obtained in 13 healthy adults. The sensitivity and specificity of quantitative measurement of TPBS was assessed. RESULTS: In the all phases of hand, uptake ratios of the CRPS group were significantly higher than non-CRPS group (p<0.05). There was no significant difference in the delayed phase of shoulder between the CRPS group and the non- CRPS group. In the delayed phase of hand, sensitivity and specificity of quantitative measurement of TPBS were 82.8% and 86.7%, whereas those of qualitative interpretation by nuclear physician were 65.5% and 66.7%, respectively. CONCLUSION: Quantitative measurement of TPBS was more sensitive and more specific than qualitative interpretation by nuclear physician in assessing the CRPS after stroke. Quantitative measurement of TPBS may be helpful in detecting CRPS after stroke.

Validation of Clinical Dysphagia Scale: Based on Videofluoroscopic Swallowing Study

OBJECTIVE: Dysphagia is one of the important determinants of the prognosis for various diseases. Clinical dysphagia scale (CDS) was developed to screen dysphagia after stroke. We aimed to reevaluate this scale with comparison to the videofluoroscopic swallowing study (VFSS) findings. METHOD: Retrospective chart reviews were completed on 677 dysphagic patients undergoing the VFSS from July 2000 to January 2004. CDS was evaluated by a physiatrist before the VFSS. Functional dysphagia scale, new VFSS scale, and American Speech-Language-Hearing Association National Outcome Measurement System swallowing scale (ASHA NOMS scale) were evaluated based on the VFSS. The correlations between CDS and these VFSS scales were studied. In 118 patients, followed up for more than 6 months, the initial CDS were analysed with the follow-up VFSS findings. RESULTS: CDS was correlated with the VFSS findings and also correlated in disease groups other than stroke (p<0.05). CDS was different significantly between the aspiration, penetration, and normal group classified on the simultaneous VFSS but not on the VFSS after more than 6 months (p= 0.102). CONCLUSION: We confirmed that CDS was a quantitative clinical tool responding the VFSS findings well and was adoptable to any dysphagic patients irrespective of the causal disorders.

Shoulder Uptake in the Bone Scintigraphy in Patients with Hemiplegic Reflex Sympathetic Dystrophy Syndrome / 대한핵의학회잡지

PURPOSE: Increased uptake of wrist and hand joints in three phase bone scintigraphy (TPBS) have been used in the detection of reflex sympathetic dystrophy syndrome (RSDS). TPBS frequently shows increased shoulder uptake in the hemiplegic RSDS patients. We investigated the significance of the shoulder uptake in the detection of these patients. MATERIALS AND METHODS: Twenty three patients who had hemiplegia due to brain stroke and diagnosed as RSD were enrolled in this study (M: F=16: 7, R: L=11: 12). The mean age was 63 +/- 10 yrs. Ten normal volunteer (mean age: 60 +/- 5, M: F=1: 9) data was used as control group. TPBS was performed 59 +/- 32 days after stoke (acute stage). We obtained the count ratios of bilateral hands by drawing a region of interest (ROI) in three phase images and compared to the count ratios of shoulders in the delayed image. Hand ROI included an ipsilateral wrist. Sensitivity of detecting the affected limb was defined using the right/left count ratio of normal control. RESULTS: Sensitivities using count ratios of hand blood flow, blood pool and delayed image were 45%, 76% and 78%, respectively. Sensitivity of shoulder count ratio was 74%. Log of right/left counts of hand delayed image and that of shoulder delayed image were correlated well with statistical significance (Spearman's R=0.824, p< 0.001). CONCLUSION: Shoulder uptake showed good correlation with hand uptake in the delayed image of TPBS. Shoulder uptake maybe helpful in the diagnosis of reflex sympathetic dystrophy syndrome in patients with hemiplegia.