Aarnio Mikko, Appel Lieuwe, Fredrikson Mats, Gordh Torsten, Wolf Olof, Sörensen Jens, Thulin Måns, Peterson Magnus, Linnman Clas
Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University Hospital, Sweden.
PET Centre, Department of Medical Imaging, Uppsala University Hospital, Sweden; Section of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Sweden.
Scand J Pain. 2017 Oct;17:418-424. doi: 10.1016/j.sjpain.2017.10.008. Epub 2017 Nov 8.
Positron emission tomography (PET) with the radioligand [C]-D-deprenyl has shown increased signal at location of pain in patients with rheumatoid arthritis and chronic whiplash injury. The binding site of [C]-D-deprenyl in peripheral tissues is suggested to be mitochondrial monoamine oxidase in cells engaged in post-traumatic inflammation and tissue repair processes. The association between [C]-D-deprenyl uptake and the transition from acute to chronic pain remain unknown. Further imaging studies of musculoskeletal pain at the molecular level would benefit from establishing a clinical model in a common and well-defined injury in otherwise healthy and drug-naïve subjects. The aim of this study was to investigate if [C]-D-deprenyl uptake would be acutely elevated in unilateral ankle sprain and if tracer uptake would be reduced as a function of healing, and correlated with pain localizations and pain experience.
Eight otherwise healthy patients with unilateral ankle sprain were recruited at the emergency department. All underwent [C]-D-deprenyl PET/CT in the acute phase, at one month and 6-14 months after injury.
Acute [C]-D-deprenyl uptake at the injury site was a factor of 10.7 (range 2.9-37.3) higher than the intact ankle. During healing, [C]-D-deprenyl uptake decreased, but did not normalize until after 11 months. Patients experiencing persistent pain had prolonged [C]-D-deprenyl uptake in painful locations.
The data provide further support that [C]-D-deprenyl PET can visualize, quantify and follow processes in peripheral tissue that may relate to soft tissue injuries, inflammation and associated nociceptive signaling. Such an objective correlate would represent a progress in pain research, as well as in clinical pain diagnostics and management.
使用放射性配体[C]-D-司来吉兰的正电子发射断层扫描（PET）显示，类风湿性关节炎和慢性挥鞭样损伤患者疼痛部位的信号增强。[C]-D-司来吉兰在外周组织中的结合位点被认为是参与创伤后炎症和组织修复过程的细胞中的线粒体单胺氧化酶。[C]-D-司来吉兰摄取与从急性疼痛向慢性疼痛转变之间的关联尚不清楚。在分子水平上对肌肉骨骼疼痛进行进一步的影像学研究将受益于在健康且未使用过药物的受试者中建立一种常见且明确损伤的临床模型。本研究的目的是调查[C]-D-司来吉兰摄取在单侧踝关节扭伤时是否会急性升高，以及示踪剂摄取是否会随着愈合而降低，并与疼痛部位和疼痛体验相关。
在急诊科招募了8名单侧踝关节扭伤的健康患者。所有患者在急性期、受伤后1个月以及6 - 14个月均接受了[C]-D-司来吉兰PET/CT检查。
损伤部位的急性[C]-D-司来吉兰摄取比未受伤的踝关节高10.7倍（范围为2.9 - 37.3）。在愈合过程中，[C]-D-司来吉兰摄取降低，但直到11个月后才恢复正常。经历持续性疼痛的患者在疼痛部位的[C]-D-司来吉兰摄取时间延长。
这些数据进一步支持了[C]-D-司来吉兰PET能够可视化并量化外周组织中与软组织损伤、炎症及相关伤害性信号传导有关的过程。这样一种客观关联将代表疼痛研究以及临床疼痛诊断和管理方面的进展。
