Three-phase bone scan and dynamic vascular scintigraphy in algoneurodystrophy of the upper extremity

Algoneurodystrophy (AND) is a complex disorder with a wide spectrum of clinical presentations. Patients referred for a work-up of unilateral upper extremity AND were reviewed, and 50 patients were enrolled with sufficient documentation on history, causal event, clinical stage, and final outcome. There were 27 females, 23 males, mean age 44 years. The affected area was: shoulder 5, arm 3, elbow 3, wrist 26 and hand 13. Main precipitating events were fracture, contusion, or prior surgery. Three-phase bone scintigraphy was performed followed by a 2-phase vascular scintigraphy on another day. Typical periarticular uptake on the delayed bone scan was used to diagnose AND. Staging was done with the dynamic phase of the vascular scan. The clinicians diagnosed 30 patients positive for AND, 14 negative, and 6 equivocal. Bone scintigraphy yielded 25 positive, 20 negative, and 5 equivocal scans, i.e. sensitivity 73% and specificity 86%. Of the positive bone scans, 21 had all 3 phases positive, and 16 were concordant on vascular scintigraphy. The remaining 5 vascular scans classified 3 patients in transition (stage I-->II) and 2 in stage II. In other words, in 24% of patients vascular scintigraphy indicated restaging.

dynamic bone scintigraphy is an accurate method to diagnose AND. Vascular scintigraphy changed AND stage in one quarter of the patients. Therefore, a combination of both studies is indicated in the work-up and treatment monitoring of AND.