Su Chih-Ying, Huang Guo-Shu, Chang Wei-Chou, Wang Chih-Chien, Chen Chun-Wen, Hsu Yi-Chih
Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-kung Rd., Neihu Dist, 114 Taipei, Taiwan, Republic of China.
Department of Radiology, Taichung Armed Forces General Hospital, Taichung, Taiwan, Republic of China.
Nucl Med Mol Imaging. 2023 Oct;57(5):247-250. doi: 10.1007/s13139-023-00797-3. Epub 2023 Mar 29.
Magnetic resonance imaging (MRI) is the most popular imaging modality for investigating intervertebral disc herniation. However, it has a high chance for identifying incidental findings that are morphologically or structurally abnormal but not responsible for patients' symptoms. Although a previous study suggested that F-fluorodeoxyglucose (F-FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) may help identify neuroinflammation in lumbar radiculopathy, there is currently no direct evidence obtained from surgery. Here, we describe the case of a 32-year-old man with low back pain and right leg paresthesia for 7 months. MRI demonstrated disc herniation at the L3-L4, L4-L5 and L5-S1 levels, causing bilateral L5 and left S1 root compression. F-FDG PET/MRI demonstrated increased F-FDG uptake at the right L5 root, which was compatible with the patient's symptoms. Transforaminal percutaneous endoscopic lumbar discectomy (PELD) was performed. Intraoperative images revealed a swollen nerve root at the right L5 after removal of the herniated disc. After surgery, the patient experienced immediate pain relief and had no recurrence at the 6-month follow-up. When performing PELD in patients with multilevel radiculopathy identified on MRI, the use of F-FDG PET/MRI can help in accurate localization of the symptomatic roots and minimize surgical incision and soft-tissue injury.
磁共振成像（MRI）是用于研究椎间盘突出症最常用的成像方式。然而，它很有可能识别出形态或结构异常但与患者症状无关的偶然发现。尽管先前的一项研究表明，氟脱氧葡萄糖（F-FDG）正电子发射断层扫描/磁共振成像（PET/MRI）可能有助于识别腰椎神经根病中的神经炎症，但目前尚无来自手术的直接证据。在此，我们描述了一名32岁男性的病例，该患者有7个月的腰痛和右腿感觉异常。MRI显示L3-L4、L4-L5和L5-S1水平存在椎间盘突出，导致双侧L5和左侧S1神经根受压。F-FDG PET/MRI显示右侧L5神经根处F-FDG摄取增加，这与患者的症状相符。进行了经椎间孔经皮内镜下腰椎间盘切除术（PELD）。术中图像显示在切除突出椎间盘后右侧L5神经根肿胀。术后，患者立即疼痛缓解，6个月随访时无复发。在对MRI显示有多节段神经根病的患者进行PELD时，使用F-FDG PET/MRI有助于准确定位有症状的神经根，并最大限度地减少手术切口和软组织损伤。
