Reflex sympathetic dystrophy in the hands: clinical and scintigraphic criteria

In an attempt to establish specific scintigraphic criteria for the reflex sympathetic dystrophy syndrome (RSD) as defined by a group of specialized hand surgeons, 145 consecutive patients, 23 of whom had clinical RSD, underwent three phase radionuclide bone scanning (TPBS). Specific patterns for positive radionuclide angiogram, blood pool, and delayed images were established. The delayed images were sensitive (96%), specific (97%), and had a valuable negative predictive value (99%). We concluded that TPBS could provide an objective marker for RSD, and it could also be used to exclude RSD in patients who had less specific signs and symptoms.     

Reflex sympathetic dystrophy syndrome. Contribution of magnetic resonance

An attempt was made to establish Magnetic Resonance Imaging (MRI) diagnostic criteria for the study of the reflex sympathetic dystrophy syndrome (RSDS). Five patients with hip and knee pain were studied. The radiographic pattern was "positive" only in two patients, while radionuclide studies showed increased activity in the painful joint in all; only in three cases Computed Tomography was performed. In all patients MRI demonstrates the lesions and defines their extension. MRI allows a differential diagnosis between RSDS and other bone lesions such as osteonecrosis and tumors. The relation between anatomopathological findings of RSDS and MRI features is discussed. MRI proved to be a reliable technique in showing and characterizing RSDS better than radiographic examination (often "negative" in early phases), and radionuclide study (a sensitive but not specific technique).     

MRI symptomology in reflex sympathetic dystrophy of the foot]

PURPOSE: To describe the MRI findings of reflex sympathetic dystrophy of the foot and ankle. METHODS: Retrospective study of 50 patients with reflex sympathetic dystrophy of the foot (5 with the cold form, and 45 with the warm form) diagnosed based on clinical and scintigraphic findings. All patients underwent MR imaging. The MRI findings were correlated with the clinical and scintigraphic findings. RESULTS: Patients with the cold form of reflex sympathetic dystrophy had no abnormality of signal at MR imaging. All patients with the warm from of reflex sympathetic dystrophy showed periarticular marrow edema at MR, typically involving more than one bone (mean of 4). Other findings were inconstant: soft tissue edema, joint effusion, and rarely, subchondral band of low T1W signal intensity of unclear etiology. CONCLUSION: MR imaging, including fat-suppressed T2W or STIR images and noncontrast T1W images, is helpful in patients with the warm or acute form of reflex sympathetic dystrophy of the foot. In patients with the cold form, MR imaging is helpful to exclude another underlying etiology for the symptoms and identify patients with the warm form of the process.     

Reflex sympathetic dystrophy syndrome secondary to organophosphate intoxication induced neuropathy

Reflex sympathetic dystrophy or Sudeck’ s atrophy is a syndrome that can usually be followed by a traumatic insult. This disorder is accompanied by signs and symptoms of vasomotor instability, trophic skin changes, and rapid development of bony demineralization. This report presents a case with reflex sympathetic dystrophy syndrome secondary to organophosphate intoxication induced neuropathy. The patient was threated with calcitonin well.     

Reflex sympathetic imbalance. Response to epidural blockade

Eleven patients (two male, nine female) were treated with epidural sympathetic blockade for reflex sympathetic imbalance, an incomplete manifestation of reflex sympathetic dystrophy. Each had developed severe pain, sensitivity, and disability disproportionate to associated trauma. One patient injured an ankle, and the remaining 10 patients one or both knees (12 knees). Seven patients had undergone previous surgery. All but one had a favorable response to initial blockade. This individual eventually failed treatment despite surgical sympathectomy. Seven have required readministration of a block for clinical relapse. Mean followup was 22 months (range, 10 to 41 months). Five underwent extensive psychological testing. All have required adjunctive forms of therapy including physical therapy, transcutaneous electrical nerve stimulation (TENS), antiinflammatory or other nonnarcotic agents. Recovery is typically prolonged, particularly if the diagnosis is delayed. Close attention to, and therefore prevention of, situations that trigger its recurrence is essential for successful rehabilitation.     

核素肺显像RM—PIOPED与PISA-PED评价标准用于急性肺栓塞诊断的比较研究

目的比较放射性核素肺显像的2种评价标准和临床肺栓塞危险度分层对诊断急性肺动脉血栓栓塞症（PTE）的一致性和效能。方法分析2005年10月至2007年7月共104例连续性临床疑诊急性PTE患者的放射性核素肺显像和临床情况,分别采用麦克马斯特（McMaster）临床危险度分层：核素肺显像修订版肺栓塞诊断前瞻陛研究（RM—PIOPED）评价标准、急性肺栓塞诊断前瞻性调查研究（PISA-PED）评价标准进行诊断。以汇总肺动脉增强CT扫描（CTPA）、肺动脉造影（PAA）、各实验室检查、临床病史及临床治疗反应讨论得出的最终诊断作为“标准诊断”,然后比较2种显像评价标准及McMaster临床危险度分层相互之间的一致性和诊断效能。采用Kappa分析比较2种评价方法之间的一致性;配对,检验比较2种评价方法之间的差异有无统计学意义。结果2种显像评价标准及McMaster临床危险度分层之间：PISA—PED评价标准与RM—PIOPED评价标准的一致性好（Kappa值为0．92,P〈0．05）;McMaster临床危险度分层与RM—PIOPED评价标准及PISA—PED评价标准的一致性差（Kappa值均为0．35,P均〉0．05）。104例患者中55例被诊断为急性PTE,占52．9％。McMaster临床危险度分层、RM—PIOPED评价标准及PISA—PED评价标准的灵敏度分别为69．1％（38／55）、90．9％（50／55）、92．7％（51／55）;特异性分别为73．5％（36／49）、73．5％（36／49）、75．5％（37／49）;准确性分别为71．2％（74／104）、82．7％（86／104）、84．6％（88／104）。对于该2种评价标准及McMaster临床危险度分层,特异性两两之间差异均无统计学意义（χ^2值分别为0．00,0．05,0．05,P均〉0．05）;RM-PIOPED评价标准的灵敏度与PISA—PED评价标准之间差异亦无统计学意义（χ^2=0．12,P〉0．05）;但McMaster临床危险度分层的灵敏度与2种评价标准之间?     

Unusual clinical presentation and scintigraphic pattern in myositis ossificans.

Myositis ossificans, or heterotopic bone formation, is a possible sequela of musculoskeletal trauma. Its radiographic and scintigraphic appearances have been well documented. Specifically, plain film radiographs usually show soft tissue calcification in the muscle groups adjacent to the trauma. The three-phase bone scan may demonstrate an area of nonspecific increased tracer uptake in all three phases. The authors present a case of radiographically demonstrated heterotopic bone formation in the leg of a retired football player.     

Juxta-articular erosions in reflex sympathetic dystrophy

Thirty-one patients with documented reflex sympathetic dystrophy syndrome (RSDS) were reviewed for their radiographic changes. Juxta-articular and metaphyseal bone loss was found in the majority of the patients. Juxta-articular bone loss closely resembling erosions seen in rheumatoid arthritis was found in all the patients. The significance of these findings is discussed.     

Comparison of scintigraphic diagnostic criteria in suspected pulmonary embolism

Various criteria have been proposed for the interpretation of ventilation and perfusion (V/Q) scintigrams in diagnosing pulmonary thromboembolism. The Biello criteria, with modifications, have been a standard for years but they differ from the criteria currently being used in the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) trial. We carried out a retrospective study in an attempt to establish if one or the other set of criteria is better. Between February 1985 and September 1987, 38 patients had a V/Q scan for suspected pulmonary embolism and subsequently underwent pulmonary angiography. The V/Q scans were reviewed by two observers using the modified Biello and the PIOPED criteria. Receiver-operated characteristic curves were constructed separately for each set of criteria. Statistical analysis revealed that neither set of criteria was significantly better than the other, but the PIOPED criteria were felt to be better defined and easier to use. This may have implications for the practical application of the criteria.     

99mTc-PEG liposomes for the scintigraphic detection of infection and inflammation: clinical evaluation.

Polyethyleneglycol (PEG) liposomes have been shown to be excellent vehicles for scintigraphic imaging of infection and inflammation in various experimental models. In this article we report on a series of patients with possible infectious and inflammatory disease in whom the performance of 99mTc-PEG liposomes was evaluated. The results of 99mTc-PEG liposome scintigraphy were directly compared with those of 111In-immunoglobulin G (IgG) scintigraphy. METHODS: Thirty-five patients (22 men, 13 women; mean age, 51 y; range, 20-76 y), suspected of having infectious or inflammatory disease, received 740 MBq 99mTc-PEG liposomes intravenously. Imaging was performed at 4 and 24 h after injection. Patients received 75 MBq 111In-IgG 24 h after administration of the liposomes. The scintigraphic results were compared and verified by culture, biopsy, surgery, and follow-up of at least 6 mo. RESULTS: Of the 16 proven infections and inflammations, 15 were detected by 99mTc-PEG liposome scintigraphy: soft-tissue infection (n = 3), septic arthritis (n = 3), autoimmune polyarthritis (n = 2), infected hip prosthesis (n = 1), infected osteosynthesis (n = 1), spondylodiscitis (n = 1), infected aortic prosthesis (n = 1), colitis (n = 1), abdominal abscess (n = 1), and pneumonia (n = 1). 99mTc-PEG liposome and 111In-IgG scintigraphy both missed 1 case of endocarditis. In addition, an 111In-IgG scan of a patient with mild soft-tissue infection was false-negative. Concordantly false-positive scans were recorded from 2 patients, both with uninfected pseudarthrosis and focal signs of sterile inflammation. During liposomal administration, 1 patient experienced flushing and chest tightness, which rapidly disappeared after lowering the infusion rate. No other adverse events were observed. CONCLUSION: This clinical evaluation of 99mTc-PEG liposomes shows that focal infection and inflammation can be adequately imaged with this new agent. The performance of 99mTc-PEG liposomes is at least as effective as that of 111In-IgG. With the simple and safe preparation and the physical and logistic advantages of a 99mTc label, 99mTc-PEG liposomes could be an attractive agent for infection or inflammation imaging.     

Abnormal bone scintigraphy and silent radiography in localized reflex sympathetic dystrophy syndrome.

Typical, definite forms of the reflex sympathetic dystrophy syndrome present no diagnostic problems, but the diagnosis of localized or very localized forms is very difficult. In the absence of characteristic roentgenographic evidence of acute, patchy, bony demineralization in the affected extremity, scintigraphy has proven to be a valuable examination. A retrospective analysis of 6 patients with a partial form of reflex sympathetic dystrophy with negative roentgenogram results who were evaluated by bone scintigraphy is presented. In the initial clinical stages, the predominant scintigraphic pattern was a very localized and intense hyperactivity in the internal femoral condyle and/or tibial plate of the affected joint on both blood pool and static images. The increased periarticular activity showed a marked decrease in association with remission of the clinical symptoms. In conclusion, bone scintigraphy was found to be a useful tool in the diagnosis and assessment of the therapeutic response genograms and increased periarticular radionuclide activity on scintigrams in the affected extremity are characteristic findings (Intenzo et al. 1989). Cases of reflex sympathetic dystrophy syndrome involving the hip (Lequesne and Mauger 1982) and the knee (Doury et al. 1987) have been reported, although the diagnosis at these sites is more difficult due to the absence of characteristic external signs. Localized or very localized forms of reflex sympathetic dystrophy (mainly involving the knee) with no radiological abnormalities throughout the course of the disease have been documented (Doury et al. 1979; Doury 1982). In these cases, bone scintigraphs proved to be a valuable examination to confirm the diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)