Clinical value of 2-deoxy-[18F]fluoro-d-glucose positron emission tomography in patients with cervical spondylotic myelopathy

Eicker, Sven Oliver; Langen, Karl‐Josef; Galldiks, Norbert; Stoffels, Gabriele; Herdmann, Jörg; Steiger, Hans‐Jakob; Floeth, Frank

doi:10.3171/2013.3.focus1379

Cited by 10 publications

(11 citation statements)

References 37 publications

(63 reference statements)

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“…Patients in the acute-onset phase of symptomatic CSM and also patients with chronic-stable myelopathy and new-onset symptoms exhibit a focally increased glucose hypermetabolism (18F-fluorodeoxyglucose uptake) at precisely the individual level of their stenosis and cord compression [76]. Decompressive surgery during the phase when hypermetabolism is present results in a good clinical recovery and favorable outcome.…”

Section: Radiological Variables Affecting Prognosismentioning

confidence: 99%

Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations

Zılelı¹,

Maheshwari²,

Kale³

et al. 2019

Neurospine

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This study is conducted to review the literature systematically to determine most reliable outcome measures, important clinical and radiological variables affecting the prognosis in cervical spondylotic myelopathy patients. A literature search was performed for articles published during the last 10 years. As functional outcome measures we recommend to use modified Japanese Orthopaedic Association scale, Nurick's grade, and Myelopathy Disability Index. Three clinical variables that affect the outcomes are age, duration of symptoms, and severity of the myelopathy. Examination findings require more detailed study to validate their effect on the outcomes. The predictive variables affecting the outcomes are hand atrophy, leg spasticity, clonus, and Babinski's sign. Among the radiological variables, the curvature of the cervical spine is the most important predictor of prognosis. Patients with instability are expected to have a poor surgical outcome. Spinal cord compression ratio is a critical factor for prognosis. High signal intensity on T2-weighted magnetic resonance images is a negative predictor for prognosis. The most important predictors of outcome are preoperative severity and duration of symptoms. T2 hyperintensity and cord compression ratio can also predict outcomes. New radiological tests may give promising results in the future.

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Section: Radiological Variables Affecting Prognosismentioning

confidence: 99%

Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations

Zılelı¹,

Maheshwari²,

Kale³

et al. 2019

Neurospine

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“…24 Second, early decompression of the spinal cord may result in preserving or even improving neurological functions, as the growing understanding of spondylotic myelopathy has shown in the past. 11 Taking all of this into account, the timely surgical treatment of ISCM must be considered an option to protect the remaining functional intact spinal cord. Technology for traction-free dissection, IOM, corticosteroids, potentially fluorescence guidance, and good anatomical knowledge help to achieve positive results.…”

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confidence: 99%

Intramedullary spinal cord metastases: an increasingly common diagnosis

Payer

Mende

Westphal

et al. 2015

FOC

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OBJECT Intramedullary spinal cord metastases (ISCM) represent a small proportion of intramedullary tumors. However, with the lifespans of patients with malignant tumors increasing, incidents of ISCM are on the rise. Due to threateningly severe disabilities in patients, accompanied by limited life expectancy, every attempt should be made to treat these tumors the same way as metastases elsewhere in the CNS, with the goal of complete removal of the ISCM and preservation of neurological functions. The object of this study is to retrospectively analyze the experiences of 22 patients who were surgically treated for ISCM over a 22-year period. METHODS Hospital charts of 22 patients, who were surgically treated for ISCM between 1992 and 2014, were reviewed retrospectively. Demographic data, histopathological diagnoses of primary cancer, chronological sequence of the disease, and neurological status using the simplified McCormick functional classification were collected and reanalyzed. RESULTS The most frequent histology was metastasis of lung cancer, followed by brain and breast cancers. The time span from primary cancer diagnosis to the development of symptomatic spinal metastases ranged from 0 to 285 months, with a mean interval of 38 months. The leading presenting sign was dysesthesia (77% of the population), followed by paresis (68%). Only 5 patients (23%) showed urinary retention. Initial performance status represented by the McCormick Scale was on average 2.47. Total or near-total removal was achieved in 87% of cases. Compared with the clinical status 1−2 days after surgery, there was an improvement in the McCormick Scale grade at the last follow-up from 2.47 to 2.12 (p = 0.009). Likewise, an improvement was detected when comparing the preoperative status with the last follow-up (from 2.45 to 2.12; p = 0.029). The mean survival time after surgery was 11.6 months. CONCLUSIONS These results suggest that surgery for intramedullary metastases—with all of the challenges of a rare and potentially risky procedure—can be beneficial to patients with advanced stages of cancer. Surgery can be performed with minimal new morbidity and results in maintaining neurological performance status.

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“…With a more favorable resolution ratio (spinal cord/scanner resolution) available for human PET imaging, we foresee no limitation for clinical application as supported by a preliminary report in healthy subjects (36). The high sensitivity of SV2A as compared to 18 F-FDG PET and the added value of 18 F-FDG PET as compared to MRI (15) suggest that SV2A PET may be of particular interest in the diagnosis and prognosis of cervical spondylotic myelopathy which is a common pathology in the elderly (37).…”

Section: Discussionmentioning

confidence: 99%

“…Positron emission tomography (PET) imaging of glucose metabolism using 18 F-FDG may represent an imaging modality to monitor metabolic activation and functional neuronal viability at the trauma epicenter. 18 F-FDG PET imaging has been performed in both animal models and SCI patients, demonstrating abnormal metabolic activity in animals during the acute phase of experimental SCI or in patients during the active phases of compressive myelopathies (10)(11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

SV2A PET Imaging Is a Noninvasive Marker for the Detection of Spinal Damage in Experimental Models of Spinal Cord Injury

et al. 2022

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Traumatic spinal cord injury (SCI) is a neurological condition characterized by long-term motor and sensory neurological deficits as a consequence of an external physical impact damaging the spinal cord. Anatomical magnetic resonance imaging (MRI) is considered the gold-standard diagnostic tool to obtain structural information for the prognosis of acute SCI, however, it lacks functional objective information to assess SCI progression and recovery. In this study, we explored the use of synaptic vesicle glycoprotein 2A (SV2A) positron emission tomography (PET) imaging to detect spinal cord lesions non-invasively following SCI.METHODS: Mice (n=7) and rats (n=8) subjected to unilateral moderate cervical (C5) contusion were euthanized 1-week post-SCI for histological and autoradiographic ( 3 H-UCB-J) investigation of SV2A levels. Longitudinal 11 C-UCB-J PET/computed tomography (CT) imaging was performed in sham (n=7) and SCI rats (n=8) 1 week and 6 weeks post-SCI. Animals also underwent an 18 F-FDG PET scan during the latter time point. Post-mortem tissue SV2A analysis to corroborate in vivo PET findings was performed 6 weeks post-SCI. RESULTS:A significant SV2A loss (ranging from -70.3% to -87.3%; P<0.0001) was measured at the epicenter of the impact in vitro in both mouse and rat contusion SCI models. Longitudinal 11 C-UCB-J PET imaging detected SV2A loss in SCI rats (-49.0±8.1% at 1 week and -52.0±12.9% at 6 weeks post-SCI), with no change observed in sham rats. In contrast, 18 F-FDG PET imaging measured only subtle hypometabolism (-17.6±14.7%). Finally, post-mortem 3 H-UCB-J autoradiography correlated with the in vivo SV2A PET findings (r=0.92, P<0.0001).CONCLUSION: 11 C-UCB-J PET/CT imaging is a non-invasive marker for SV2A loss following SCI. Collectively, these findings indicate SV2A PET may provide an objective measure of SCI, and thus a valuable tool to evaluate novel therapeutics. Clinical assessment of SCI with SV2A PET imaging is highly recommended.

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Clinical value of 2-deoxy-[18F]fluoro-d-glucose positron emission tomography in patients with cervical spondylotic myelopathy

Cited by 10 publications

References 37 publications

Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations

Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations

Intramedullary spinal cord metastases: an increasingly common diagnosis

SV2A PET Imaging Is a Noninvasive Marker for the Detection of Spinal Damage in Experimental Models of Spinal Cord Injury

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