Role of 18F FDG PET-CT in characterizing low backache: is it worth doing it?

Abstract Background Lower back pain (LBP) is a prevalent issue worldwide, affecting a significant portion of the population. While most cases resolve within weeks, some progress to chronic conditions, posing challenges in diagnosis and management. Understanding the underlying nociceptive receptors and molecular changes in LBP anatomy is crucial for effective treatment strategies. Methods This observational study enrolled 44 participants with acute or chronic LBP. Clinical, physical, and radiological evaluations were conducted alongside 18F fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET-CT) scans. FDG uptake at nociceptive sites was qualitatively and semiquantitatively assessed, correlating with pain intensity measured on a visual analog scale (VAS). Results FDG-PET-CT localized nociceptive sites in 31 subjects (70.5%), predominantly in facet and sacroiliac joints. A total of 68 FDG avid lesions were identified, with a mean SUVmax of 3.30 ± 1.16. While 24 lesions (54.5%) showed concordance with clinical pain sites, seven lesions (15.9%) did not. There was no significant correlation between VAS scores and FDG avidity (rho = 0.23, p = 0.215). Discussion FDG-PET-CT demonstrates promise in pinpointing active nociceptive sites in LBP, especially in facet and sacroiliac joints. This technique may offer insights beyond conventional imaging modalities, aiding in precise diagnosis and treatment planning. Further studies are warranted to validate these findings and assess clinical outcomes. Conclusion 18F FDG-PET-CT presents a potential adjunctive tool in evaluating LBP, offering insights into metabolic activity at nociceptive sites. Its utility in clinical decision-making and patient outcomes warrants further investigation.