The purpose of this research is to determine if a PET/MRI scan using FDG can accurately identify the source of chronic pain. Identifying the source of pain may help doctors treat chronic pain more effectively. Approximately 128 participants will be enrolled and can expect to be on study for up to 12 months.
The investigators aim to precisely localize sites of increased inflammation and potentially pain generation and improve understanding of nociception and inflammation using a unique, hybrid PET/MRI approach in conjunction with intravenously, administered fluorodeoxyglucose (FDG), which has been shown with PET imaging to be an sensitive surrogate marker of inflammation. The Primary Objective of this pilot prospective, observational research is to determine whether this approach, which combines PET/MRI and an FDA-approved radiotracer, 18F-Fluorodeoxyglucose (FDG), can accurately localize the sites of painful inflammation in individuals with persistent pain. * Determine if increased FDG uptake on PET as measured by standard uptake value (SUV) or target-to-background (TTB) measurements is increased in area of pain symptoms when compared to same corresponding areas in healthy, asymptomatic volunteers. * Determine whether amount of FDG uptake as measured on PET is able to localize to abnormalities when compared to MR imaging (T2 signal intensity, morphologic aberrations) Secondary Objectives: * Verify that the standard administered adult dose of FDG (0.14 mCi/kg/patient) used currently in the clinics can also be used to detect peripheral pain generators. * Verify that FDG uptake in asymptomatic, healthy controls will be significantly less than their chronic pain cohorts at the same anatomic location. * Determine whether longitudinal FDG PET/MR imaging findings in individual patients directly correlate with symptoms as they evolve over time in joint arthroplasty subjects with PPSP. * Determine if FDG PET/MR imaging findings spatially differ between different pain types.
Study Type
OBSERVATIONAL
Enrollment
128
Fludeoxyglucose F 18 Injection is a positron emitting radiopharmaceutical containing no-carrier added radioactive 2-deoxy-2-\[18F\]fluoro-D-g1ucose, which is used for diagnostic purposes in conjunction with Positron Emission Tomography (PET). It is administered by intravenous injection. Dosage planned 0.14 mCi/kg/patient.
positron emission tomography and magnetic resonance imaging
positron emission tomography and computed tomography imaging
UW School of Medicine and Public Health
Madison, Wisconsin, United States
RECRUITINGChange in SUVmax (chronic pain)
Time frame: baseline (6 months post-op), 12 months post-op, 18 months post-op
SUVmax (chronic pain vs healthy)
Time frame: baseline
Location of Pain Compared to Target-to-Background (TTB) or SUVmax
Time frame: baseline
Number of Participants Where Standard FDG dose was sufficient to detect region of pain (symptomatic groups)
The standard administered adult dose of FDG currently used in clinics is 0.14 mCi/kg/patient.
Time frame: baseline
Variation of the maximum ratio of SUV (SUVRmax) in asymptomatic controls vs symptomatic
Time frame: baseline
Variation of the maximum ratio of SUV (SUVRmax) in symptomatic participants
Time frame: baseline (6 months post-op), 12 months post-op, 18 months post-op
Radiology Review Scores
Radiologists will evaluate MRI and CT images from each exam, and assign 1 point to any abnormality detected in the following compartments: prosthesis itself, bone, joint space, joint capsule, muscle, subcutaneous fat, and skin, for a total of 7 possible points. Differences in scoring from MRI vs CT images will be further investigated with a t-test.
Time frame: up to 18 months post-op
Change in Pain Scores (chronic pain)
Pain will be evaluated on a scale of 0 (no pain) to 10 (worse possible pain).
Time frame: baseline (6 months post-op), 12 months post-op, 18 months post-op
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