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Published on: August 8, 2019
Beyond Anatomy: Fat-Suppressed MR and Molecular Imaging of Spinal Pain Generators
Vance T Lehman1, Christin A Tiegs-Heiden1, Stephen M Broski1
1Department of Radiology, Mayo Clinic, 200 1st Street SouthWest, Rochester, MN 55905, USA.
Abstract:
Spine pain is highly prevalent and costly, but evaluation with clinical features and anatomic imaging remain limited. Fat-suppressed MR imaging and molecular imaging (MI) may help identify inflammatory, lesional, and malignant causes. Numerous MI agents are available, each with advantages and disadvantages. Herein, FDG PET, prostate-specific membrane antigen (PSMA), bone radiotracers, and others are highlighted. No specific pain MI agents have been identified, but mechanisms of key agents are shown in video format, and the mechanism of PSMA as a theranostic agent is displayed. A multidisciplinary approach is needed to master this topic.
Insights
Molecular imaging (MI) aids in evaluating spine pain causes like inflammation or malignancy when traditional methods fall short. While no specific pain MI agents exist, various tracers like FDG PET and PSMA show promise.
Area of Science:
- Radiology and Nuclear Medicine
- Spine Imaging
- Molecular Diagnostics
Background:
- Spine pain presents a significant public health challenge due to its high prevalence and associated costs.
- Current diagnostic approaches using clinical features and standard anatomic imaging have limitations in identifying underlying causes.
- Advanced imaging techniques like fat-suppressed MR imaging and molecular imaging (MI) offer potential solutions.
Purpose of the Study:
- To review the role of molecular imaging in diagnosing the causes of spine pain.
- To highlight various available MI agents and their mechanisms.
- To emphasize the need for a multidisciplinary approach in interpreting MI for spine conditions.
Main Methods:
- Review of existing literature on molecular imaging agents for spine pain evaluation.
- Discussion of specific MI modalities including FDG PET, prostate-specific membrane antigen (PSMA) PET, and bone radiotracers.
- Inclusion of visual aids (videos) to explain the mechanisms of key imaging agents.
Main Results:
- Fat-suppressed MR imaging and MI can identify inflammatory, lesional, and malignant causes of spine pain.
- A range of MI agents are available, each with distinct advantages and disadvantages.
- No specific MI agents exclusively for spine pain have been identified to date.
- The mechanism of PSMA as a theranostic agent is presented.
Conclusions:
- Molecular imaging, despite lacking specific agents for pain, offers valuable insights into the etiology of spine pain.
- Understanding the mechanisms of various MI agents is crucial for effective clinical application.
- A collaborative, multidisciplinary approach is essential for mastering the interpretation and application of MI in spine pain management.
