PET/MRI Imaging of Neuraxial Inflammation in Sciatica Patients

描述（由申请人提供）：治疗坐骨神经痛的一个基本问题仍然没有答案：慢性坐骨神经痛是由持续炎症介导的吗？坐骨神经痛是指有神经根成分的背痛。坐骨神经痛占所有背痛的40%，这是美国损失工作日的主要原因，每年给雇主造成的损失估计为74亿美元，也是45岁以下美国人残疾的主要原因。坐骨神经痛的主要原因是椎间盘移位和椎间孔狭窄导致神经结构炎症和剧烈疼痛。椎间和经椎间孔注射硬膜外类固醇被广泛用于治疗坐骨神经痛。其基本原理是，类固醇促进的局部炎症的减少将导致症状的改善。然而，关于脊柱结构异常、神经根周围相应的炎症变化以及与背部和坐骨神经痛相关的感觉或运动症状之间的关联的证据非常有限。注射类固醇治疗的有效性也存在重大疑问。磁共振成像（MRI）是评估与脊柱起源疼痛相关的结构变化的主要成像技术。最近，正电子发射断层扫描（PET）的进展引入了示踪剂[11C]PBR28来特异性研究神经炎症。PET/MRI相机的可用性为研究这一主要医学问题中神经炎症和结构变化之间的关系提供了一个独特的机会。我们建议使用PET/MRI检测[11C]PBR28来研究坐骨神经痛患者炎症、结构改变、症状和治疗结果之间的关系。在这项研究中发展的神经轴炎症成像能力有可能彻底改变腰痛的诊断和治疗。我们计划通过[11C]PBR28 PET/MRI对坐骨神经痛患者腰骶棘进行初步研究，以建立该方法，并探讨该技术在指导坐骨神经痛临床治疗中的作用。

DESCRIPTION (provided by applicant): A fundamental question in managing sciatica pain remains unanswered: Is chronic sciatica pain mediated by persistent inflammation? Sciatica refers to back pain with a radicular component. Sciatica pain accounts for up to 40% of all back pain, which is a leading cause of lost workdays in the US, costs employers an estimated $7.4 billion/year, and is the main reason for disability in Americans under 45 years old. Among the main causes of sciatica pain are intervertebral disk displacement and stenosis of the intervertebral foramen producing inflammation of neural structures and severe pain. Interlaminar and transforaminal injection of epidural steroids are extensively used to treat sciatica. The rationale is that reduction in regional inflammation promoted by steroids will lead to improvement of symptoms. However, there is very limited evidence on the association between structural abnormalities in the vertebral column, corresponding inflammatory changes around nerve roots, and sensory or motor symptoms associated with back and sciatica pain. There is also significant doubt on the effectiveness of steroid injections for treatment. Magnetic resonance imaging (MRI) is the main imaging technique to assess structural changes associated with pain of spinal origin. Recently, advances in Positron Emission Tomography (PET) introduced the tracer [11C]PBR28 to specifically investigate neuroinflammation. Availability of PET/MRI cameras offers a unique opportunity to study the association between neuroinflammation and structural changes in this major medical problem. We propose to use PET/MRI with [11C]PBR28 to study the association between inflammation, structural changes, symptoms and treatment outcome in patients with sciatica. The ability to image neuraxial inflammation developed in this study has the potential to revolutionize the diagnosis and treatment of low back pain. We plan to perform a pilot study of [11C]PBR28 PET/MRI of the lumbosacral spine in patients with sciatica pain to establish this methodology and explore the role of this technology in guiding clinical treatment of sciatica pain.