Chonnam Med J.  2013 Apr;49(1):38-42. 10.4068/cmj.2013.49.1.38.

Changes in 18F-Fluorodeoxyglucose Uptake in the Spinal Cord in a Healthy Population on Serial Positron Emission Tomography/Computed Tomography

  • 1Department of Nuclear Medicine, Chosun University Hospital, School of Medicine, Chosun University, Gwangju, Korea.
  • 2Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Korea.
  • 3Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea.
  • 4Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.


We aimed to determine the changes in 18F-fluorodeoxyglucose (FDG) uptake in the spinal cord on two serial positron emission tomography/computed tomography (PET/CT) scans in a healthy population. We retrospectively enrolled healthy people who underwent PET/CT twice for cancer screening. We excluded those who had degenerative vertebral disease, neurologic disease, or a history of a vertebral operation. The standardized uptake value (SUVmax) of the spinal cord of each mid-vertebral body was obtained by drawing a region of interest on an axial image of PET/CT. For analysis, the cord-to-background ratio (CTB) was used (CTB=SUVmax of each level/SUVmax of L5 level). Differences in pattern, sex, age, and intervals of the two serial PET/CT scans were analyzed. A total of 60 PET/CT images of 30 people were analyzed. The mean interval between the two PET/CT imaging studies was 2.80+/-0.94 years. On the follow-up PET/CT, significant change was shown only at the level of the C6 and T10 vertebrae (p<0.005). Mean CTB showed a decreasing pattern from cervical to lumbar vertebrae. There were two peaks at the lower cervical level (C4-6) and at the lower thoracic level (T12). Neither sex nor age significantly affected CTB. The FDG uptake of the spinal cord changed significantly on follow-up PET/CT only at the level of the C6 and T10 vertebrae. This finding is valuable as a baseline reference in the follow-up of metabolic changes in the spinal cord.


Spinal cord; Fluorodeoxyglucose F18; Positron-emission tomography and computed tomography

MeSH Terms

Early Detection of Cancer
Fluorodeoxyglucose F18
Follow-Up Studies
Lumbar Vertebrae
Positron-Emission Tomography and Computed Tomography
Retrospective Studies
Spinal Cord
Fluorodeoxyglucose F18


  • FIG. 1 Demonstration of a drawing of the region-of-interest for FDG uptake in the spinal cord at each vertebral body level. (A) Fused PET/CT image in sagittal view. (B) Sagittal PET image. (C) Sagittal CT image. (D) Axial view of fused PET/CT image at the level of the yellow cross mark of the image. (E) Axial view of the CT image at the same level as in D. First, we placed a cursor at the level of the specific vertebra (at the middle height of the vertebral body). Then, Advanced Workstation 3.4 automatically showed axial views of each PET, CT, and fusion PET/CT images at the same level. Using the fused image, we drew the region-of-interest (ROI) in the spinal canal. The SUVmax of the ROI was obtained. We repeated the same process at all vertebral levels in every subject.

  • FIG. 2 Changes of mean 18F-FDG uptake in the spinal cord of 30 healthy people between the first and follow-up PET/CT. FDG uptake is shown as the cord-to-background ratio (CTB, cord SUVmax to L5 SUVmax). The graph shows the mean CTB of each vertebral level of the spinal cord of 30 healthy people (white circle mark). It shows a decreasing pattern along the spinal cord from the cervical to lumbar vertebrae. There are two peaks at the lower cervical level (C4-7) and at the lower thoracic level (T12). The follow-up FDG PET/CT (rectangular mark) was done after more than a year (2.80±0.94 years). The cervical peak was not prominent in the follow-up PET/CT. Moreover, the mean CTB of each level was lower in the second PET. However, the Wilcoxon signed rank test showed that there was no significant change in FDG uptake in the spinal cord at each vertebral level between the first and second PET/CT with the significance level of p<0.001 (Also see Table 1). Note: Error bars represent the 9% confidence interval (CI) of each mean value.


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