Weng Yu-Shiou, Tang Chi-Tun, Chang Wei-Chou, Huang Guo-Shu, Chiu Chuang-Hsin, Chiang Shih-Wei, Lee Chia-Wei, Hsu Yi-Chih
Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Rd., Neihu 114, Taipei, Taiwan, Republic of China.
Department of Neurosurgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
Jpn J Radiol. 2025 Mar;43(3):509-519. doi: 10.1007/s11604-024-01679-0. Epub 2024 Oct 15.
Given increasing research suggesting the utility of positron emission tomography/magnetic resonance imaging (PET/MRI) in identifying the pain generator of low back pain, our study aims to assess its effectiveness in evaluating the source of pain in patients with failed back surgery syndrome (FBSS) by comparing the performance of fluorine-18-labeled fluorodeoxyglucose (F-FDG) PET/MRI with conventional MRI.
We retrospectively analyzed data from patients with FBSS who underwent F-FDG PET and MRI of the lumbar vertebrae and lower extremities for undetermined sources of pain. We assessed 1) The diagnostic reliability and efficacy of MRI and F-FDG PET/MRI according to correct differential diagnosis, affected level, and affected side of the pain source compared to the findings of selective root or peripheral nerve block or revision lumbar spine surgery; and 2) The association between standardized uptake value (SUV) and standardized uptake value ratio (SUVR) threshold and accuracy of the suspected pathology on F-FDG PET/MRI.
Among 30 included patients, the diagnostic accuracy of pain source recognition was higher for F-FDG PET/MRI than for MRI alone (1.0 vs. 0.4 in spinal disease and 0.8 vs. 0 in lower extremity disease, both p < 0.05). SUVR values of 1.4-1.5 showed the highest accuracy (0.93), higher than the accuracy obtained using the SUV threshold (0.87).
F-FDG PET/MRI added value to MRI alone in detecting of hypermetabolic activity associated with pain from spinal and non-spinal sources.
鉴于越来越多的研究表明正电子发射断层扫描/磁共振成像（PET/MRI）在识别腰痛疼痛源方面的效用，我们的研究旨在通过比较氟-18标记的氟脱氧葡萄糖（F-FDG）PET/MRI与传统MRI的性能，评估其在评估腰椎手术失败综合征（FBSS）患者疼痛来源方面的有效性。
我们回顾性分析了因疼痛源不明而接受腰椎和下肢F-FDG PET及MRI检查的FBSS患者的数据。我们评估了：1）与选择性神经根或周围神经阻滞或腰椎翻修手术的结果相比，根据疼痛源的正确鉴别诊断、受累水平和受累侧，评估MRI和F-FDG PET/MRI的诊断可靠性和有效性；2）标准化摄取值（SUV）和标准化摄取值比（SUVR）阈值与F-FDG PET/MRI上可疑病变准确性之间的关联。
在纳入的30例患者中，F-FDG PET/MRI对疼痛源识别的诊断准确性高于单独的MRI（脊柱疾病中分别为1.0和0.4，下肢疾病中分别为0.8和0，均p<0.05）。SUVR值为1.4-1.5时显示出最高的准确性（0.93），高于使用SUV阈值获得的准确性（0.87）。
F-FDG PET/MRI在检测与脊柱和非脊柱来源疼痛相关的高代谢活动方面，比单独的MRI更具价值。
