Burmeister Lara S, Witkam Richard L, Vissers Kris C P, Gotthardt Martin, Henssen Dylan J H A
Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, The Netherlands.
Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
EJNMMI Rep. 2025 Aug 25;9(1):30. doi: 10.1186/s41824-025-00266-4.
Persistent postoperative low back pain, including persistent spinal pain syndrome type 2 (PSPS-T2), is a global healthcare challenge that lacks objective phenotypic diagnostic criteria or validated biomarkers. Molecular imaging techniques (nuclear medicine) could aid in establishing more objective phenotypical parameters as they are able to visualize biological processes underlying several diseases even before anatomical changes are present. This review aims to provide an overview of the of molecular imaging for the diagnosis of PSPS-T2.
An extensive search of PubMed and Embase was conducted to identify relevant studies that comprise imaging techniques using a radiopharmaceutical substance. Evidence reveals that these techniques can provide valuable insights into the underlying pathologies and mechanisms of PSPS-T2 by detecting pain generators that would have otherwise gone unnoticed. Moreover, the meta-analysis showed a pooled sensitivity of 90.3% (95% CI: 53–100%) and a specificity of 89.1% (95% CI: 31–100%) for [F]NaF PET-CT, and a pooled sensitivity of 61.5% (95% CI: 7–93%) and specificity of 96% (95% CI: 21–100%) for diphosphonates SPECT-CT.
These findings suggest a potential utility in identifying those who are likely to benefit from surgical re-intervention. This illustrates the potential of molecular imaging in establishing a personalized-medicine approach. However, the retrospective design and the limited sample sizes are among the limitations of the included studies and further research is needed to unravel the potential of molecular imaging techniques as a tool to detect phenotypical biomarkers and to optimize patient care in patients with persistent postoperative low back pain, including PSPS-T2.
术后持续性下腰痛，包括2型持续性脊柱疼痛综合征（PSPS-T2），是一项全球性的医疗挑战，缺乏客观的表型诊断标准或经过验证的生物标志物。分子成像技术（核医学）能够在解剖学变化出现之前可视化多种疾病的生物学过程，有助于建立更客观的表型参数。本综述旨在概述分子成像在PSPS-T2诊断中的应用。
对PubMed和Embase进行了广泛检索，以识别使用放射性药物的成像技术相关研究。证据表明，这些技术可通过检测原本会被忽视的疼痛源，为PSPS-T2的潜在病理和机制提供有价值的见解。此外，荟萃分析显示，[F]NaF PET-CT的合并敏感性为90.3%（95%CI：53-100%），特异性为89.1%（95%CI：31-100%）；双膦酸盐SPECT-CT的合并敏感性为61.5%（95%CI：7-93%），特异性为96%（95%CI：21-100%）。
这些发现表明在识别可能从手术再次干预中获益的患者方面具有潜在效用。这说明了分子成像在建立个性化医疗方法方面的潜力。然而，纳入研究的回顾性设计和样本量有限是其局限性，需要进一步研究以揭示分子成像技术作为检测表型生物标志物和优化包括PSPS-T2在内的术后持续性下腰痛患者护理工具的潜力。
