Nucl Med Mol Imaging.  2023 Oct;57(5):247-250. 10.1007/s13139-023-00797-3.

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

• Su C
• Huang G
• Chang W
• Wang C
• Chen C
• Hsu Y

• KMID: 2547014
• DOI: http://doi.org/10.1007/s13139-023-00797-3

Abstract

Magnetic resonance imaging (MRI) is the most popular imaging modality for investigating intervertebral disc herniation. However, it has a high chance for identifying incidental findings that are morphologically or structurally abnormal but not responsible for patients’ symptoms. Although a previous study suggested that ¹⁸F-fluorodeoxyglucose ( ¹⁸F-FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) may help identify neuroinflammation in lumbar radiculopathy, there is currently no direct evidence obtained from surgery. Here, we describe the case of a 32-year-old man with low back pain and right leg paresthesia for 7 months. MRI demonstrated disc herniation at the L3-L4, L4-L5 and L5-S1 levels, causing bilateral L5 and left S1 root compression. ¹⁸F-FDG PET/MRI demonstrated increased ¹⁸F-FDG uptake at the right L5 root, which was compatible with the patient’s symptoms. Transforaminal percutaneous endoscopic lumbar discectomy (PELD) was performed. Intraoperative images revealed a swollen nerve root at the right L5 after removal of the herniated disc. After surgery, the patient experienced immediate pain relief and had no recurrence at the 6-month follow-up. When performing PELD in patients with multilevel radiculopathy identified on MRI, the use of ¹⁸F-FDG PET/MRI can help in accurate localization of the symptomatic roots and minimize surgical incision and soft-tissue injury.

Keyword

¹⁸F-FDG PET-MRI; Lumbar radiculopathy; Percutaneous endoscopic lumbar discectomy; PELD