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Quantitative [18F]-Naf-PET-MRI Analysis for the Evaluation of Dynamic Bone Turnover in a Patient with Facetogenic Low Back Pain
Published on: August 8, 2019
[ 18 F]fluorodeoxyglucose PET/MRI for nononcological musculoskeletal indications: reference uptake values in the
Jacob M Mostert1, Edwin H G Oei1, Denise W J van Beekveld1
1Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Objective:
To assess normal [ 18 F]fluorodeoxyglucose ([ 18 F]FDG) uptake values in lumbar spine structures on PET/MRI in patients without low back pain.
Methods:
Asymptomatic adults receiving whole-body FDG PET/MRI for nononcological indications were prospectively included. Spinal structures of interest were manually annotated at each lumbar level. Maximum standardized uptake value (SUV max ) and mean SUV (SUV mean ) values were extracted from ordered subset expectation maximization, block sequential regularized expectation maximization (BSREM) β450, and BSREM β300 images. The distributions of SUV max and SUV mean values were evaluated across spinal levels and structures. We also evaluated normalization of SUV metrics with the liver and subcutaneous fat uptake values, and correlations between SUV metrics and BMI, age, and blood glucose level.
Results:
Twenty-two patients were included for analysis. Average SUV max on OSEM reconstructions was 2.99 (SD: 0.69) for the vertebral body and 1.95 (SD: 0.54) for the intervertebral disc. In the nervous system, SUV max for articular, peri-articular, and ligamentous structures was lower, ranging between 1.26 and 1.62. Uptake values were significantly lower on BSREM β450 and higher on BSREM β300. There was a positive correlation between uptake values and BMI, but no correlation was found with age or blood glucose level.
Conclusion:
Normal uptake values in the lumbar spine on [ 18 F]FDG PET/MRI in asymptomatic adults were assessed. The uptake values reported in this study could serve as a reference for the identification of abnormalities in patients with chronic low back pain, but the applied PET reconstruction method and patient BMI should be taken into account.
Insights
This study establishes normal [18F]fluorodeoxyglucose (FDG) uptake values in the lumbar spine for asymptomatic adults using PET/MRI. These findings provide crucial reference ranges for identifying low back pain abnormalities, considering patient BMI and reconstruction methods.
Area of Science:
- Nuclear Medicine
- Radiology
- Spine Imaging
Background:
- Low back pain is a prevalent condition often requiring advanced imaging.
- Positron Emission Tomography/Magnetic Resonance Imaging (PET/MRI) with [18F]fluorodeoxyglucose ([18F]FDG) is increasingly used for comprehensive body imaging.
- Establishing normal physiological uptake values is essential for accurate interpretation of pathological findings.
Purpose of the Study:
- To determine normal [18F]FDG uptake values in lumbar spine structures using PET/MRI in individuals without low back pain.
- To provide reference ranges for [18F]FDG uptake in the lumbar spine for asymptomatic adults.
- To investigate the influence of PET reconstruction methods and patient characteristics on uptake values.
Main Methods:
- Prospective inclusion of asymptomatic adults undergoing whole-body [18F]FDG PET/MRI for nononcological reasons.
- Manual annotation of lumbar spine structures (vertebral body, intervertebral disc, nervous system, articular, peri-articular, and ligamentous structures).
- Extraction of maximum standardized uptake value (SUVmax) and mean SUV (SUVmean) using OSEM and BSREM reconstruction algorithms; correlation analysis with BMI, age, and glucose levels.
Main Results:
- Average SUVmax values were 2.99 for vertebral bodies and 1.95 for intervertebral discs (OSEM).
- Uptake in nervous system and ligamentous structures was lower (SUVmax 1.26-1.62).
- Uptake values varied significantly between BSREM reconstructions and showed a positive correlation with BMI.
Conclusions:
- This study provides normative [18F]FDG uptake values for lumbar spine structures in asymptomatic adults on PET/MRI.
- These reference values can aid in the detection of abnormalities in patients with chronic low back pain.
- Consideration of the PET reconstruction method and patient's BMI is recommended for accurate interpretation.
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