Beyond Anatomy: The Role of Molecular Imaging in the Evaluation of Low Back Pain

Abstract

Abstract Purpose of Review To review the role of molecular imaging modalities in the evaluation of low back pain and identification of active pain generators. Recent Findings Low back pain is a common condition associated with high utilization of imaging. Identification of a pain source in patients with nonspecific low back pain is an important clinical challenge. However, there is inadequate correlation between anatomic findings on CT and MRI with symptoms of back pain, or clinical response to therapeutic procedures including injection or surgery. In contrast, molecular imaging modalities including single-photon emission-computed tomography (SPECT) or positron emission tomography (PET) with bone-targeting radiotracers like Tc-99m methylene diphosphonate (MDP) and 18F-NaF paired with CT or MRI demonstrate promise to improve test specificity in identification of pain generators in the spine. An accurate identification of pain source in patients with back pain is important in guiding therapeutic interventions including injection and surgery. Summary Molecular imaging modalities have demonstrated improved diagnostic accuracy in identifying active pain generators and predicting response to therapeutic intervention compared to anatomic imaging alone.