AbstractObjectives: This study aims to evaluate the diagnostic utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in identifying active disease sites in facet joints in patients with chronic neck and back pain.
Methods: A cross-sectional study was conducted on 70 patients presenting with chronic neck and back pain. Patients underwent clinical evaluation, laboratory testing, and imaging assessments, including PET/CT and contrast-enhanced CT. Diagnostic performance metrics such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were compared between PET/CT and CT.
Results: PET/CT identified active facet joint inflammation in 41.4% of 70 patients, while CT detected degenerative changes in 57.1%. PET/CT demonstrated significantly higher sensitivity (86.7% vs. 42.5%), specificity (92.5% vs. 60.0%), accuracy (90.0% vs. 50.0%), PPV (89.7% vs. 58.6%), and NPV (90.2% vs. 43.9%) compared to CT (p<0.001). Cervical facets with abnormal FDG activity were predominantly unilateral (76.9%), while lumbar facets were largely bilateral (81.3%).
Conclusion: 18F-FDG PET/CT offers superior diagnostic accuracy compared to CT in detecting active facet joint pathology, particularly when conventional imaging is inconclusive. This modality may guide targeted treatment in facet arthropathy.
