Value of 18F-FDG PET/CT in guiding management of facet joint arthropathy

Abstract

Background: Facet joint arthropathy is one of the causes of back and neck pain. Diagnosing facet arthropathy as the source of pain is a medical challenge. The purpose of this study was to investigate the potential role of 18F-FDG PET/CT imaging to precisely target the active inflammatory facet joints. Methods: A prospective study included 129 patients with chronic neck or back pain and no neurologic or radiologic findings to diagnose intervertebral-disk-related pain. 18F-FDG PET/CT imaging was performed to evaluate the cause of pain. None of the patients had any malignant or traumatic lesions in the spine. The PET findings were compared to the CT findings. In addition, the PET/CT findings were correlated with the clinical findings. Results: The images of PET/CT of 54 patients demonstrate abnormally increased FDG uptake in facet joints. Thirty patients had bilateral abnormally increased FDG uptake in facet joints (24 lumbar, 6 cervical facet joints). Of these 30 patients, 12 had a normal appearance of facet joints on CT, 12 had mild degenerative changes limited to the affected facet joints, and 6 had moderate multilevel degenerative changes affecting the facet joints on CT. Twenty-four patients had unilateral increased FDG uptake at facet joints (6 lumbar, 18 cervical facet joints). Among these 24 patients with unilateral increased FDG uptake at facet joints, 12 had a normal facet joints appearance on CT, while the other 12 had marked multilevel degenerative changes affecting the facet joints. The positive findings of PET or CT have been correlated with the neurological examination and injection therapy outcome. Conclusions: 18F-PET/CT has incremental value in the management of pain resulting from facet arthropathy by targeting the affected joints, especially when conventional imaging findings are non-specific or show no abnormality. The most effective management for facet arthropathy is nerve root block; therefore, PET/CT may outline and guide the management to target the active inflammatory facet joints.