대한핵의학회지 (1967년~2009년)
Nucl Med Mol Imaging 2008;42(1)044~051
원저 : 외상 후 복합부위통증증후군 환자에서 시행한 삼상 뼈 스캔의 판독 신뢰도에 관한 연구
(Study for Reliability of Interpretation of the Three Phase Bone Scintigraphy in Patients with Post-traumatic Complex Regional Pain Syndrome)
Author 박정미1, 김선정2, 정승현3, 이용택4,
Jung Mi Park, M.D.1, Seon Jung Kim, M.D.2, Seung Hyun Chung, M.D.3, and Yong-Taek Lee, M.D.4
Affiliation 순천향대학교 부천병원 핵의학과1, 일산보험공단병원 핵의학과2, 국립암센터 재활의학과3, 성균관의과대학교 강북삼성병원 재활의학과4
1Department of Nuclear Medicine, Bucheon Hospital Soonchunhyang University College of Medicine, Bucheon, Korea, 2Department of Nuclear Medicine, National Health Insurance Corporation Ilsan Hospital, Koyang, Korea, 3Department of Rehabilitation Medicine, N
Abstract

Purpose: We performed this study to evaluate reliability on interpretation of three phase bone scintigraphy (TPBS) in patients with post-traumatic complex regional pain syndrome (PT-CRPS). Methods: Based on International Association for the Study of Pain guideline in 1994, 34 patients with PT-CRPS were selected for this study. Two nuclear medicine physicians evaluated identical TPBS according to the uptake pattern, extent and intensity of the lesion, and their agreements (kappa values) were analysed. The final diagnosis based on arbitrary criteria of each physician were compared with those obtained by the criteria for PT-CRPS established in this study, which are hyperactivity on all phases (criteria 1), hyperactivity of whole joints on delayed phase (criteria 2), and hyperactivity of either whole or focal joints on delayed phase (criteria 3). Results: Intra-observer agreements were good for uptake pattern, intensity, and extent on TPBS. Inter-observer agreements were also good, except extent on blood pool phase (0.55). The inter-observer agreements on final diagnosis improved when criteria 1-3 were applied (0.77-0.88), compared to when physician's own criteria were used (0.63). Those also improved from 0.29 to 0.47-0.82 for acute stage, and from 0.37 to 1.0 for chronic stage. The sensitivities of chronic stage were relatively lower to those of acute stage. Conclusions: Inter-observer’s variations in diagnosis of the patients with PT-CRPS using TPBS were observed. These results were attributed to different criteria set by observers. In order to improve agreement on interpretation of TPBS, common positive criteria should be established, especially considering uptake pattern and clinical stages. (Nucl Med Mol Imaging 2008;42(1):44-51)

Keyword Tc-99m deoxypyridinoline (DPD), three phase bone scintigraphy, post-traumatic complex regional pain syndrome
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