Research ArticleClinical Investigations

Hypermetabolism in 18F-FDG PET Predicts Favorable Outcome Following Decompressive Surgery in Patients with Degenerative Cervical Myelopathy

Frank W. Floeth, Norbert Galldiks, Sven Eicker, Gabriele Stoffels, Jörg Herdmann, Hans-Jakob Steiger, Gerald Antoch, Sascha Rhee and Karl-Josef Langen
Journal of Nuclear Medicine September 2013, 54 (9) 1577-1583; DOI: https://doi.org/10.2967/jnumed.112.113183

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Patient with myelopathy type 1 (patient 3). T2-weighted MR image (A) shows stenosis with compression of cervical spinal cord and intramedullary hyperintensity at level C3/4 (arrow). Corresponding 18F-FDG PET image (C) shows increased 18F-FDG uptake at level of stenosis at C3/4 (arrow). Dotted line indicates position of spinal canal. Postoperatively, symptoms of cervical myelopathy improved considerably (increase of JOA score, 6 points). One year after decompressive surgery, MR image shows reestablished flow of cerebrospinal fluid around cervical spinal cord and intramedullary hyperintensity at level of former stenosis at C3/4 (arrow) is unchanged (B). In contrast, corresponding 18F-FDG PET image (D) indicates almost complete decline of 18F-FDG uptake at level of former stenosis at C3/4 (arrow).

  • FIGURE 2.
    FIGURE 2.

    Patient with myelopathy type 2 (patient 18). T2-weighted MR image (A) shows stenosis with compression of cervical spinal cord and intramedullary hyperintensity at level C3/4 (arrow). Corresponding 18F-FDG PET image (C) shows at level of stenosis no focally increased 18F-FDG uptake (arrow) and poststenotic decrease of glucose metabolism below level of C4. Dotted line indicates position of spinal canal. Postoperatively, symptoms of cervical myelopathy have not improved (pre- and postoperative JOA score, 8 points). Postoperative MR image 12 mo after decompressive surgery (B) shows reestablished flow of cerebrospinal fluid around cervical spinal cord and unchanged intramedullary hyperintensity at level of former stenosis at C3/4 (arrow). Corresponding 18F-FDG PET image shows no significant changes of 18F-FDG uptake pattern (D).

  • FIGURE 3.
    FIGURE 3.

    Preoperative JOA scores and postoperative changes of JOA scores in patients with myelopathy types 1 and 2 (A and B, respectively), assessed at 6 and 12 mo after decompressive surgery. Twelve months after decompressive surgery, patients with myelopathy type 1 (A) show favorable clinical recovery, with significant improvement of JOA scores (preoperative JOA score, 9.5 ± 2.5, vs. postoperative JOA score, 14.6 ± 1.7; P < 0.001). In contrast, patients with myelopathy type 2 (B) show no significant changes of JOA scores (preoperative JOA score, 11.6 ± 2.5, vs. postoperative JOA score, 12.2 ± 2.4; P = 0.081).

Tables

  • TABLE 1

    Demographic and Clinical Data

    Patient no.SexAge (y)Affected levelDuration of symptoms (mo)JOA scoreSUV of 18F-FDG uptake (preoperatively/12 mo after decompressive surgery)
    DeteriorationPreoperativePost-OP-6Post-OP-12ImprovementC1C2C3C4C5C6C7C1–C7
    Myelopathy type 1
    1F54C3–416211161652.1/1.81.9/1.81.8/1.91.9/1.51.5/1.61.5/1.61.3/1.51.7/1.7
    2M71C4–5548141572.2/2.12.3/2.22.3/2.12.3/1.92.7/1.82.2/1.71.8/1.62.3/1.9
    3M83C3–433691262.6/2.42.6/2.13.0/2.22.5/1.82.2/1.71.9/1.61.4/1.62.3/1.9
    4M62C3–4439141562.1/1.71.9/1.41.7/1.32.0/1.31.8/1.21.4/1.31.5/1.31.8/1.4
    5M68C3–41215171721.8/1.71.6/1.41.9/1.31.7/1.41.4/1.31.2/1.21.3/1.11.6/1.4
    6F77C3–4189131672.1/2.62.6/2.42.6/2.51.9/2.41.7/2.61.5/2.41.6/2.32.0/2.5
    7M75C4–59311131542.5/3.22.0/2.71.9/2.42.3/2.51.8/3.41.9/2.61.8/2.22.0/2.7
    8M77C3–4928111241.9/NA1.6/NA1.9/NA1.6/NA1.5/NA1.6/NA1.5/NA1.7/NA
    9M68C4–55510151551.6/2.01.5/1.81.6/1.71.9/1.91.5/1.91.4/2.11.4/1.91.6/1.9
    10M72C3–4298141352.4/2.22.2/1.92.6/2.01.9/2.11.8/1.91.8/1.71.5/1.62.0/1.9
    Mean715.54.19.513.614.44.92.1/2.22.0/2.02.1/1.92.0/1.91.8/1.91.7/1.81.5/1.71.9/1.9
    SD84.72.52.52.31.61.40.3/0.50.4/0.40.5/0.40.3/0.40.4/0.70.3/0.50.2/0.40.3/0.4
    Myelopathy type 2
    11M74C3–47012131312.1/1.82.0/1.62.0/1.62.0/1.51.9/1.51.7/1.51.7/1.61.9/1.6
    12M47C3–481151414−12.2/2.52.1/2.12.2/2.12.2/1.82.0/1.81.7/1.41.4/1.22.0/1.8
    13M45C4–514113131301.9/2.01.9/1.61.7/1.71.6/1.61.7/1.51.5/1.61.2/1.31.6/1.6
    14M51C4–56113131302.2/1.91.8/1.71.7/1.71.7/1.61.6/1.41.4/1.51.6/1.71.7/1.6
    15F83C4–57111111212.1/NA1.7/NA1.7/NA1.7/NA1.5/NA1.5/NA1.7/NA1.7/NA
    16M60C3–422011121321.6/1.51.7/1.51.8/1.41.7/1.31.7/1.31.6/1.31.4/1.21.6/1.4
    17M53C4–51819111122.1/2.62.1/2.42.0/2.52.2/2.12.0/1.71.6/1.41.2/1.81.9/2.1
    18M76C3–430188802.4/2.52.0/1.92.0/1.81.9/1.71.8/1.71.6/1.61.4/1.31.9/1.8
    19M46C3–45115161612.1/2.12.0/2.01.9/2.01.9/2.02.0/1.91.8/1.71.7/1.71.9/1.9
    20M56C4–528099902.0/2.02.1/1.82.0/1.62.0/1.62.1/1.81.9/1.71.6/1.72.0/1.7
    Mean5914.50.711.612.012.20.62.0/2.11.9/1.81.9/1.81.8/1.71.8/1.61.6/1.51.5/1.51.8/1.7
    SD149.50.52.52.42.31.00.2/0.40.2/0.30.2/0.30.2/0.20.2/0.20.2/0.10.2/0.20.2/0.2

    • Clinical deterioration with decrease of JOA score was assessed within last 3 mo before decompressive surgery.

    • Post-OP-6 = postoperative follow-up after 6 mo; Post-OP-12 = postoperative follow-up after 12 mo; NA = not available.

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