The Value of Three Phase Bone Scan in Diagnosing Reflex Sympathetic Dystrophy in Hemiplegia

ABSTRACT

The purpose of this study is to determine the usefulness of the three-phase bone scan(TBS) in the diagnosis of reflex sympathetic dystrophy(RSD) and to evaluate the differences of TBS findings with the clinical stages of RSD. Twenty-four hemiplegic patients were assessed prospectively for radionuclide and clinical features of RSD. 5 cases of stage II RSD patients also had TBS. The results of TBS showed a high diagnostic sensitivity for the stage I RSD within three months of stroke onset. If the "positive TBS" was defined as increased radioisotope uptake in all three phase images, it showed 83.3% of sensitivity and 91.7% of specificity. If the "positive TBS" was defined as increased radioisotope only in delayed image, it showed 100% sensitivity and 66.7% specificity, There was no significant difference in TBS findings with the clinical stages of RSD. Considering difficulties in the clinical diagnosis as various features of the symptoms of RSD are often present for other reasons and increased radioisotope uptake of the delayed image can be present also in other conditions such as disuse and immobilization, TBS may be a useful diagnostic tool for RSD during early rehabilitation if "positive TBS" is defined as increased radioisotope uptake in all three images. Increased radioisotope uptake of the delayed image in patients who have no clinical RSD does not seem to be a predictor of the subsequent development of RSD.