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
Journal article, 2022

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 18F-fluorodeoxyglucose (FDG) and 18F-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.


sodium fluoride

lumbar vertebrae

positron emission tomography

low back pain


Reza Piri

University of Southern Denmark

Odense Universitetshospital

Amalie H. Nøddeskou-Fink

Odense Universitetshospital

Oke Gerke

University of Southern Denmark

Odense Universitetshospital

Måns Larsson

Eigenvision AB

L. Edenbrandt

University of Gothenburg

Sahlgrenska University Hospital

Olof Enqvist

Eigenvision AB

Imaging and Image Analysis

P. F. Hoilund-Carlsen

University of Southern Denmark

Odense Universitetshospital

Mette J. Stochkendahl

Chiropractic Knowledge Hub

University of Southern Denmark

Clinical Physiology and Functional Imaging

1475-0961 (ISSN) 1475097x (eISSN)

Vol. 42 4 225-232

Subject Categories

Biomedical Laboratory Science/Technology


Radiology, Nuclear Medicine and Medical Imaging





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