Value of<sup>18</sup>F‐<scp>FDG PET</scp>/<scp>MRI</scp>for the outcome of<scp>CT</scp>‐guided facet block therapy in cervical facet syndrome: initial results

Sawicki, L; Schaarschmidt, Benedikt Michael; Heusch, Philipp; Buchbender, Christian; Rosenbaum-Krumme, Sandra; Umutlu, Lale; Eicker, Sven Oliver; Bockisch, Andreas; Antoch, Gerald; Floeth, Frank

doi:10.1111/1754-9485.12565

Cited by 16 publications

(11 citation statements)

References 26 publications

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“…54 69 Finally, a small retrospective study performed in 10 patients with chronic neck pain sought to determine whether positron emission tomography (PET)/MRI could be used to identify patients for therapeutic cervical MBB performed with high volumes of LA and steroid. 70 Increased 18F-fluoro-deoxyglucose uptake along with facet arthrosis was observed in six joints in six patients. These patients exhibited better pain relief 3 hours after the blocks, which persisted through 3-month follow-up.…”

Section: Mri Therapeutic Facet Injections and Radiofrequency Denervationmentioning

confidence: 89%

Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group

Cohen

Bhaskar

Bhatia

et al. 2020

Reg Anesth Pain Med

215

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BackgroundThe past two decades have witnessed a surge in the use of lumbar facet blocks and radiofrequency ablation (RFA) to treat low back pain (LBP), yet nearly all aspects of the procedures remain controversial.MethodsAfter approval by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, letters were sent to a dozen pain societies, as well as representatives from the US Departments of Veterans Affairs and Defense. A steering committee was convened to select preliminary questions, which were revised by the full committee. Questions were assigned to 4–5 person modules, who worked with the Subcommittee Lead and Committee Chair on preliminary versions, which were sent to the full committee. We used a modified Delphi method, whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chair, who incorporated the comments and sent out revised versions until consensus was reached.Results17 questions were selected for guideline development, with 100% consensus achieved by committee members on all topics. All societies except for one approved every recommendation, with one society dissenting on two questions (number of blocks and cut-off for a positive block before RFA), but approving the document. Specific questions that were addressed included the value of history and physical examination in selecting patients for blocks, the value of imaging in patient selection, whether conservative treatment should be used before injections, whether imaging is necessary for block performance, the diagnostic and prognostic value of medial branch blocks (MBB) and intra-articular (IA) injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for a prognostic block, how many blocks should be performed before RFA, how electrodes should be oriented, the evidence for larger lesions, whether stimulation should be used before RFA, ways to mitigate complications, if different standards should be applied to clinical practice and clinical trials and the evidence for repeating RFA (see table 12 for summary).ConclusionsLumbar medial branch RFA may provide benefit to well-selected individuals, with MBB being more predictive than IA injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of more false-negatives. Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice.

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Section: Mri Therapeutic Facet Injections and Radiofrequency Denervationmentioning

confidence: 89%

Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group

Cohen

Bhaskar

Bhatia

et al. 2020

Reg Anesth Pain Med

215

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“…The correlation of back pain and imaging findings was not otherwise reported, and clinically implicated facet joints were not determined. 6 Sawicki et al 14 reported that FDG-PET/MR imaging-directed cervical facet joint steroid injections were associated with improved clinical pain scores relative to clinically selected facet joints in patients without imaging findings positive for increased activity, though MBBs were not used and gadolinium was not administered. They also found that MR imaging T2 hyperintensity and FDG activity may be surrogates.…”

Section: Discussionmentioning

confidence: 99%

“…They also found that MR imaging T2 hyperintensity and FDG activity may be surrogates. 14 One prior study suggested that FDG-PET/MR imaging findings of the lumbar spine may help identify various causes of sciatica, including inflamed facet joints. 19 Limited evidence indicates that muscular or nerve FDG activity may be present in a painful lower extremity.…”

Section: Discussionmentioning

confidence: 99%

“…11 Such facet joint FDG activity has been described in a prevalence study, a study of the cervical spine, and a case report in the lumbar spine, 12 but there is little prospective information addressing lumbar facet joints. 13,14 The primary aim of this pilot study was to prospectively assess a standardized FDG-PET/MR imaging protocol with gadolinium in patients with suspected facetogenic axial low back pain. This includes assessment of the concordance of nonanatomic MR imaging FDG-PET and clinical findings on a patient and facet joint level.…”

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confidence: 99%

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Comparison of [¹⁸F] FDG-PET/MRI and Clinical Findings for Assessment of Suspected Lumbar Facet Joint Pain: A Prospective Study to Characterize Candidate Nonanatomic Imaging Biomarkers and Potential Impact on Management

Lehman¹,

Diehn²,

Broski³

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Prior retrospective studies have suggested that both T2 hyperintensity and gadolinium enhancement on fat-suppressed MR imaging are associated with lumbar facet joint pain, but prospective evaluation of FDG-PET/MR imaging with a standardized protocol and correlation to clinical findings are lacking. The primary aim was to prospectively assess a standardized FDG-PET/MRI protocol in patients with suspected facetogenic low back pain, with determination of the concordance of imaging and clinical findings. MATERIALS AND METHODS: Ten patients with clinically suspected facetogenic low back pain were prospectively recruited with a designation of specific facet joints implicated clinically. Subsequently, patients underwent an FDG-PET/MR imaging examination with gadolinium. Each facet joint was graded for perifacet signal change on MR imaging and FDG activity. The frequency and correlation of MR imaging, FDG-PET, and clinical findings were determined. RESULTS: FDG activity showed high concordance with high overall MR imaging scores (concordance correlation coefficient = 0.79). There was concordance of the clinical side of pain with the side of high overall MR imaging scores and increased FDG activity on 12/20 (60%) sides. Both a high overall MR imaging score (concordance correlation coefficient = 0.12) and FDG-PET findings positive for increased activity (concordance correlation coefficient = 0.10) had low concordance with the specific clinically implicated facet joints. Increased FDG activity or high MR imaging scores or both were present in only 10/29 (34%) facet joints that had been clinically selected for percutaneous intervention. Eleven (11%) facet joints that had not been selected for treatment demonstrated these imaging findings. CONCLUSIONS: There was low concordance of perifacet signal change and FDG activity with clinically implicated facet joints. This could indicate either the potential to change patient management or a lack of biomarker accuracy. Therefore, additional larger randomized studies with the use of comparative medial branch blocks would be useful to further investigate the clinical utility of these findings.

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“…18 F-FDG PET also appeared useful as guidance for therapy in patients with cervical facet syndrome. In a study involving 140 facet joints, 100% concordance was found between location of focal 18 F-FDG uptake and painful area in the neck (33).…”

Section: Non-oncologic Pet Imaging Of Head and Neckmentioning

confidence: 99%

Role of Positron Emission Tomography in Imaging of Non-neurologic Disorders of the Head, Neck, and Teeth in Veterinary Medicine

2019

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Positron Emission Tomography (PET) is an imaging technique that provides functional information, in addition to structural information obtained with computed tomography (CT). The most common application is cancer staging, using 18 F-Fluorodeoxyglucose ( 18 F-FDG), a radioactive analog of glucose. Although limited data are available in the veterinary literature, human studies have demonstrated benefit with the addition of PET both for assessment of the primary tumor and for detection of metastatic disease. 18 F-FDG PET appears to be more accurate at detecting the margin of oral neoplasia, in particular for tumors arising from highly vascularized tissue, such as the lingual and laryngeal areas. 18 F-FDG PET has a high sensitivity for the detection of lymph node metastasis, however the specificity is variable between studies. Tracers beyond 18 F-FDG can also be used for oncology imaging. 18 F-Fluoride ( 18 F-NaF) is an excellent osseous tracer, useful in assessing bone involvement of primary tumors or osseous metastasis. Other specific tracers can be used to assess cell proliferation or hypoxia for tumor characterization. 18 F-FDG is also an excellent tracer for detection of inflammation. Human studies have demonstrated its value for the assessment of periodontitis and dental implant infection. 18 F-NaF has been used to assess disorders of the temporomandibular joint in the human literature, demonstrating good correlation with arthralgia and therapeutic outcome. Both 18 F-NaF and 18 F-FDG had good concordance with localization of cervical pain in people. PET will likely have a growing role in veterinary medicine not only for oncologic imaging but also for assessment of inflammation and pain.

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Value of¹⁸F‐FDG PET/MRIfor the outcome ofCT‐guided facet block therapy in cervical facet syndrome: initial results

Abstract: F-FDG PET/MRI can detect PET-positive cervical facet arthropathy and help to identify patients benefitting from facet block therapy. Bone marrow TIRM SI ratio might be a surrogate for PET-positive facet arthropathy.

Cited by 16 publications

References 26 publications

Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group

Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group

Comparison of [¹⁸F] FDG-PET/MRI and Clinical Findings for Assessment of Suspected Lumbar Facet Joint Pain: A Prospective Study to Characterize Candidate Nonanatomic Imaging Biomarkers and Potential Impact on Management

Role of Positron Emission Tomography in Imaging of Non-neurologic Disorders of the Head, Neck, and Teeth in Veterinary Medicine

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Value of18F‐FDG PET/MRIfor the outcome ofCT‐guided facet block therapy in cervical facet syndrome: initial results

Abstract: F-FDG PET/MRI can detect PET-positive cervical facet arthropathy and help to identify patients benefitting from facet block therapy. Bone marrow TIRM SI ratio might be a surrogate for PET-positive facet arthropathy.

Cited by 16 publications

References 26 publications

Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group

Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group

Comparison of [18F] FDG-PET/MRI and Clinical Findings for Assessment of Suspected Lumbar Facet Joint Pain: A Prospective Study to Characterize Candidate Nonanatomic Imaging Biomarkers and Potential Impact on Management

Role of Positron Emission Tomography in Imaging of Non-neurologic Disorders of the Head, Neck, and Teeth in Veterinary Medicine

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Product

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Value of¹⁸F‐FDG PET/MRIfor the outcome ofCT‐guided facet block therapy in cervical facet syndrome: initial results

Comparison of [¹⁸F] FDG-PET/MRI and Clinical Findings for Assessment of Suspected Lumbar Facet Joint Pain: A Prospective Study to Characterize Candidate Nonanatomic Imaging Biomarkers and Potential Impact on Management