Ann Rehabil Med.  2012 Dec;36(6):745-755.

Usefulness of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Management of Cervical Dystonia

• Lee HB
• An YS
• Lee HY
• Hwang JH
• Lee HJ
• Jeong KY
• Kim JW
• Yim SY

Abstract

OBJECTIVE
To evaluate the usefulness of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the management of cervical dystonia (CD) with botulinum toxin type A (BoNT-A) injection. METHOD: Thirty two subjects with CD were included. A BoNT-A injection was provided either by clinically targeting method (group 1) or by 18F-FDG PET/CT-assisted, clinically targeting method (group 2). In group 2, selection of target muscles and dosage of BoNT-A were determined according to the increased 18F-FDG uptake, in addition to physical examination and functional anatomy. The outcomes of BoNT-A injection was compared between the two groups, in terms of the number of subjects who had reinjection before and after 6 months, the number of reinjections, the interval of reinjections, the duration to the minimal Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), the number of adverse events, the reduction rate of TWSTRS at 1-3 months and 3-6 months after injection, and the probability of reinjection-free living.
RESULTS
The number of subjects who had reinjection within 6 months was significantly lower in group 2 than in group 1 (10 in group 1 vs. 3 in group 2). The reduction rate of TWSTRS after 3-6 months (37.8+/-15.7% of group 1 vs. 63.3+/-28.0% of group 2) and the probability of reinjection-free living were significantly higher in group 2 than in group 1.
CONCLUSION
These findings suggest that 18F-FDG PET/CT study could be useful in management of CD in terms of the identification of dystonic muscles if there is an increase in the 18F-FDG uptake in the cervical muscle of the images.

Keyword

Cervical dystonia; 18F-Fluorodeoxyglucose; Positron emission tomography; Botulinum toxin

MeSH Terms

Botulinum Toxins
Botulinum Toxins, Type A
Electrons
Fluorodeoxyglucose F18
Muscles
Physical Examination
Positron-Emission Tomography
Torticollis
Botulinum Toxins
Botulinum Toxins, Type A
Fluorodeoxyglucose F18

Figure

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  Fig. 1 The picture showing the clinically targeting group or 18F-FDG PET/CT-assisted, clinically targeting group in chronologic order.

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  Fig. 2 The 18F-FDG PET/CT images of 2 independent subjects with left torticollis. 1. A 20-year-old man with cervical dystonia whose main symptom was left torticollis (A-D). The 18F-FDG uptake is increased at the anterior and posterior neck muscles on the left side at the level of the C2 vertebral body. The hot uptake of 18F-FDG was seen in the left LC/Lc (black arrow head), left SPC (thick black arrow) and left SSC (thin black arrow) (B-D). 2. A 38-year-old man with cervical dystonia whose main symptom was left torticollis (E-H). The 18F-FDG uptake is increased at the anterior and posterior neck muscles at the levels of foramen magnum (FM; E), C2 vertebral body (F) and C3 vertebral body (G). The hot uptake of 18F-FDG was seen in the right OCS (thick white arrow), left LC (black arrow head) and left SPC (thick black arrow) (E). Increased 18F-FDG uptake was also seen in the right SCM (white arrow head), left LC (black arrow head), left SPC (thick black arrow) and left RCPM (thin black arrow) (F). The hot uptake of 18F-FDG was showed in the right SCM (white arrow head), right uTz (thin white arrow), left LC (black arrow head) and left SPC (thick black arrow) (G). LC: Longus capitis, Lc: Longus colli, SPC: Splenius capitis, SSC: Semispinalis capitis, OCS: Obliquus capitis superior, SCM: Sternocleidomastoid, RCPM: Rectus capitis posterior major, uTz: Upper trapezius.

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  Fig. 3 The Kaplan-Meier plot showing the probability of reinjection-free living after BoNT-A injection in clinically targeting group (group 1) and the 18F-FDG PET/CT-assisted, clinically targeting group (group 2). The probability of reinjection-free living is 0.8 in group 2, while the rate is 0.19 in group 1 when the duration of follow up is one year (365 days). The duration of follow-up for group 1 was 144 days (95% confidence interval: 134.2-153.8) when the reinjection-free living rate had come to 50%.

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