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.
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I thank the patient for allowing us to share his details, and thank Dr. Hsu and Dr. Chen for the valuable advice and comments on this manuscript.
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The ideal was conceived by Guo-Shu Huang, Wei-Chou Chang, and Yi-Chih Hsu. Material preparation and data collection were performed by Yi-Chih Hsu, Chih-Chien Wang, and Chih-Ying Su. The first draft of the manuscript was written by Chih-Ying Su, and all authors commented on previous versions of the manuscript. Correction and revision of English content was provided by Chun-Wen Chen and Yi-Chih Hsu. All authors read and approved the final manuscript.
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Chih-Ying Su, Yi-Chih Hsu, Chih-Chien Wang, Guo-Shu Huang, Chun-Wen Chen, and Wei-Chou Chang declare no competing interests.
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The study was approved by the institutional review board of Tri-Service General Hospital (C202215107), and informed consent was obtained from all individual participants included in the study (or the requirement for written consent was waived by the institutional review board). All procedures performed in studies involving human participants were in accordance with the Helsinki declaration as revised in 2013 and its later amendments.
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Su, CY., Huang, GS., Chang, WC. et al. The Value of 18F-FDG PET/MRI in Detecting Lumbar Radiculopathy for Selective Percutaneous Endoscopic Discectomy: a Case Report. Nucl Med Mol Imaging 57, 247–250 (2023). https://doi.org/10.1007/s13139-023-00797-3
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DOI: https://doi.org/10.1007/s13139-023-00797-3