PET/CT imaging of spinal inflammation and microcalcification in patients with low back pain: A pilot study on the quantification by artificial intelligence-based segmentation

• Background Current imaging modalities are often incapable of identifying nociceptive sources of low back pain (LBP). We aimed to characterize these by means of positron emission tomography/computed tomography (PET/CT) of the lumbar spine region applying tracers F-18-fluorodeoxyglucose (FDG) and F-18-sodium fluoride (NaF) targeting inflammation and active microcalcification, respectively. Methods Using artificial intelligence (AI)-based quantification, we compared PET findings in two sex- and age-matched groups, a case group of seven males and five females, mean age 45 +/- 14 years, with ongoing LBP and a similar control group of 12 pain-free individuals. PET/CT scans were segmented into three distinct volumes of interest (VOIs): lumbar vertebral bodies, facet joints and intervertebral discs. Maximum, mean and total standardized uptake values (SUVmax, SUVmean and SUVtotal) for FDG and NaF uptake in the 3 VOIs were measured and compared between groups. Holm-Bonferroni correction was applied to adjust for multiple testing. Results FDG uptake was slightly higher in most locations of the LBP group including higher SUVmean in the intervertebral discs (0.96 +/- 0.34 vs. 0.69 +/- 0.15). All NaF uptake values were higher in cases, including higher SUVmax in the intervertebral discs (11.63 +/- 3.29 vs. 9.45 +/- 1.32) and facet joints (14.98 +/- 6.55 vs. 10.60 +/- 2.97). Conclusion Observed intergroup differences suggest acute inflammation and microcalcification as possible nociceptive causes of LBP. AI-based quantification of relevant lumbar VOIs in PET/CT scans of LBP patients and controls appears to be feasible. These promising, early findings warrant further investigation and confirmation.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Radiologi och bildbehandling (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Radiology, Nuclear Medicine and Medical Imaging (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Medicinsk bioteknologi -- Biomedicinsk laboratorievetenskap/teknologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Medical Biotechnology -- Biomedical Laboratory Science/Technology (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Ortopedi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Orthopaedics (hsv//eng)

Nyckelord

fluorodeoxyglucose

low back pain

lumbar vertebrae

positron emission

tomography

sodium fluoride

facet joint osteoarthritis

atherosclerotic plaque

vascular

calcification

disc degeneration

features

Physiology

fluorodeoxyglucose

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