Virginie Kreutzinger, Katharina Ziegeler, Cynthia T Chin, Misung Han, Emma Bahroos, Daehyun Yoon, Thomas M Link, Sharmila Majumdar
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An MSK radiologist rated endplates changes using Modic classification and a relative scale: none; only edema; edema > fat; edema=fat; edema< fat; only fat. Radiotracer uptake (SUVmax) in endplate-adjacent bone was measured using ROIs. VAS scores (0-10) for back pain were recorded before imaging. Generalized estimating equations assessed associations between pain and radiotracer uptake as outcomes and radiologic findings as predictors, adjusted for age, sex, and BMI.</p><p><strong>Results: </strong>The study included 220 endplates from 22 patients (110 per arm). Overall, pain was positively associated with edematous lesions (beta 0.21, p = 0.024), but not with fatty changes (beta 0.10, p = 0.567). In the [18F]NaF arm, tracer uptake was associated with edematous lesions (beta 1.79, p = 0.001) and with pain (beta 0.18, p = 0.007). In the [18F]FDG arm, tracer uptake was negatively associated with edematous lesions (beta -0.11, p = 0.013) and showed no significant association with pain (beta -1.50, p = 0.064).</p><p><strong>Conclusion: </strong>Our study shows that [18F]NaF-PET-MRI detected bone-remodeling is more closely linked to painful vertebral end-plate degeneration than inflammatory [18F]FDG signal.</p>","PeriodicalId":19744,"journal":{"name":"Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.0000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490939/pdf/","citationCount":"0","resultStr":"{\"title\":\"Bone Remodeling, Not Inflammation, as the Predominant Pathology in Modic Type 1 Lesions of the Lumbar Spine.\",\"authors\":\"Virginie Kreutzinger, Katharina Ziegeler, Cynthia T Chin, Misung Han, Emma Bahroos, Daehyun Yoon, Thomas M Link, Sharmila Majumdar\",\"doi\":\"10.1093/pm/pnaf085\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Lesions of the vertebral endplates (Modic changes) are associated with low back pain (LBP), and different pathological processes, including inflammation, have been proposed as causative. This study aimed to explore the relationship between [18F]FDG uptake (inflammation) and [18F]NaF uptake (bone remodeling) and patient-reported back pain as well as conventional MRI detected endplate changes.</p><p><strong>Methods: </strong>Participants were selected from an IRB-approved study, creating two arms: [18F]NaF (n = 11) and [18F]FDG (n = 11). Scans were performed on a 3.0T PET-MRI scanner. An MSK radiologist rated endplates changes using Modic classification and a relative scale: none; only edema; edema > fat; edema=fat; edema< fat; only fat. Radiotracer uptake (SUVmax) in endplate-adjacent bone was measured using ROIs. VAS scores (0-10) for back pain were recorded before imaging. Generalized estimating equations assessed associations between pain and radiotracer uptake as outcomes and radiologic findings as predictors, adjusted for age, sex, and BMI.</p><p><strong>Results: </strong>The study included 220 endplates from 22 patients (110 per arm). 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引用次数: 0
摘要
目的:椎体终板病变(Modic changes)与腰痛(LBP)有关,包括炎症在内的不同病理过程被认为是病因。本研究旨在探讨[18F]FDG摄取(炎症)和[18F]NaF摄取(骨重塑)与患者报告的背部疼痛以及常规MRI检测到的终板变化之间的关系。方法:参与者从irb批准的研究中选择,形成两组:[18F]NaF (n = 11)和[18F]FDG (n = 11)。在3.0T PET-MRI扫描仪上进行扫描。MSK放射科医生使用Modic分类和相对量表评定终板变化:无;只有水肿;水肿>脂肪;水肿=脂肪;水肿<脂肪;只有脂肪。利用roi测量终板邻近骨的放射性示踪剂摄取(SUVmax)。成像前记录背部疼痛的VAS评分(0-10分)。广义估计方程评估了疼痛和放射性示踪剂摄取作为结果之间的关联,并根据年龄、性别和BMI进行了调整。结果:该研究包括22例患者的220个终板(每组110个)。总体而言,疼痛与水肿病变呈正相关(β 0.21, p = 0.024),但与脂肪变化无关(β 0.10, p = 0.567)。在[18F]NaF组中,示踪剂摄取与水肿病变(β 1.79, p = 0.001)和疼痛(β 0.18, p = 0.007)相关。在[18F]FDG组中,示踪剂摄取与水肿病变呈负相关(β -0.11, p = 0.013),与疼痛无显著相关性(β -1.50, p = 0.064)。结论:我们的研究表明[18F] naff - pet - mri检测到的骨重塑与疼痛的椎体终板退变的关系比炎性的[18F]FDG信号更密切。
Bone Remodeling, Not Inflammation, as the Predominant Pathology in Modic Type 1 Lesions of the Lumbar Spine.
Purpose: Lesions of the vertebral endplates (Modic changes) are associated with low back pain (LBP), and different pathological processes, including inflammation, have been proposed as causative. This study aimed to explore the relationship between [18F]FDG uptake (inflammation) and [18F]NaF uptake (bone remodeling) and patient-reported back pain as well as conventional MRI detected endplate changes.
Methods: Participants were selected from an IRB-approved study, creating two arms: [18F]NaF (n = 11) and [18F]FDG (n = 11). Scans were performed on a 3.0T PET-MRI scanner. An MSK radiologist rated endplates changes using Modic classification and a relative scale: none; only edema; edema > fat; edema=fat; edema< fat; only fat. Radiotracer uptake (SUVmax) in endplate-adjacent bone was measured using ROIs. VAS scores (0-10) for back pain were recorded before imaging. Generalized estimating equations assessed associations between pain and radiotracer uptake as outcomes and radiologic findings as predictors, adjusted for age, sex, and BMI.
Results: The study included 220 endplates from 22 patients (110 per arm). Overall, pain was positively associated with edematous lesions (beta 0.21, p = 0.024), but not with fatty changes (beta 0.10, p = 0.567). In the [18F]NaF arm, tracer uptake was associated with edematous lesions (beta 1.79, p = 0.001) and with pain (beta 0.18, p = 0.007). In the [18F]FDG arm, tracer uptake was negatively associated with edematous lesions (beta -0.11, p = 0.013) and showed no significant association with pain (beta -1.50, p = 0.064).
Conclusion: Our study shows that [18F]NaF-PET-MRI detected bone-remodeling is more closely linked to painful vertebral end-plate degeneration than inflammatory [18F]FDG signal.
期刊介绍:
Pain Medicine is a multi-disciplinary journal dedicated to pain clinicians, educators and researchers with an interest in pain from various medical specialties such as pain medicine, anaesthesiology, family practice, internal medicine, neurology, neurological surgery, orthopaedic spine surgery, psychiatry, and rehabilitation medicine as well as related health disciplines such as psychology, neuroscience, nursing, nurse practitioner, physical therapy, and integrative health.