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The Value of 18F-FDG PET/MRI in Detecting Lumbar Radiculopathy for Selective Percutaneous Endoscopic Discectomy: a

Chih-Ying Su1,2, Guo-Shu Huang1,3, Wei-Chou Chang1

  • 1Department 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.

Nuclear Medicine and Molecular Imaging
|September 18, 2023
PubMed

Insights

Positron emission tomography/magnetic resonance imaging (PET/MRI) using 18F-FDG can pinpoint symptomatic nerve roots in patients with lumbar radiculopathy, improving surgical accuracy. This technique aids in precise localization, minimizing invasive procedures and tissue damage.

Area of Science:

  • Neurology
  • Radiology
  • Surgical Innovation

Background:

  • Magnetic resonance imaging (MRI) is standard for diagnosing intervertebral disc herniation but often reveals incidental findings.
  • Identifying the specific symptomatic nerve root in cases of multilevel disc herniation can be challenging.
  • Previous research suggested 18F-FDG PET/MRI's potential in detecting neuroinflammation in lumbar radiculopathy, but surgical correlation was lacking.

Observation:

  • A 32-year-old male presented with chronic low back pain and right leg paresthesia.
  • MRI indicated multilevel disc herniations (L3-L4, L4-L5, L5-S1) compressing bilateral L5 and left S1 nerve roots.
  • 18F-FDG PET/MRI revealed increased tracer uptake at the right L5 root, correlating with the patient's symptoms.

Findings:

  • The patient underwent transforaminal percutaneous endoscopic lumbar discectomy (PELD).
  • Intraoperative imaging confirmed nerve root swelling at the right L5.
  • Post-surgery, the patient reported immediate pain relief and remained symptom-free at 6-month follow-up.

Implications:

  • 18F-FDG PET/MRI can accurately localize symptomatic nerve roots in multilevel lumbar radiculopathy.
  • This imaging modality can guide minimally invasive surgical interventions like PELD.
  • Improved localization may reduce surgical invasiveness, minimize soft-tissue injury, and enhance patient outcomes.
Keywords:
18F-FDG PET-MRILumbar radiculopathyPELDPercutaneous endoscopic lumbar discectomy

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