Successful treatment of chronic knee pain following localization by a sigma-1 receptor radioligand and PET/MRI: a case report
| Autor: | Michelle L. James, Christopher R. McCurdy, Bin Shen, Frederick T. Chin, Sandip Biswal, Vivianne L. Tawfik, Sheen-Woo Lee, Peter Cipriano, Catherine Curtin, Daehyun Yoon, Jason L. Dragoo |
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| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty Radiofrequency ablation Case Report 18F-FTC-146 law.invention Lesion 03 medical and health sciences 0302 clinical medicine law medicine knee pain medicine.diagnostic_test business.industry Chronic pain Magnetic resonance imaging Lipoma molecular imaging medicine.disease PET/MRI intraarticular synovial lipoma 030104 developmental biology Anesthesiology and Pain Medicine Knee pain sigma-1 receptor Positron emission tomography Imaging technology Radiology medicine.symptom chronic pain business 030217 neurology & neurosurgery |
| Zdroj: | Journal of Pain Research |
| ISSN: | 1178-7090 |
| DOI: | 10.2147/jpr.s167839 |
| Popis: | Background The ability to accurately diagnose and objectively localize pain generators in chronic pain sufferers remains a major clinical challenge since assessment relies on subjective patient complaints and relatively non-specific diagnostic tools. Developments in clinical molecular imaging, including advances in imaging technology and radiotracer design, have afforded the opportunity to identify tissues involved in pain generation based on their pro-nociceptive condition. The sigma-1 receptor (S1R) is a pro-nociceptive receptor upregulated in painful, inflamed tissues, and it can be imaged using the highly specific radioligand 18F-FTC-146 with PET. Case presentation A 50-year-old woman with a 7-year history of refractory, left-knee pain of unknown origin was referred to our pain management team. Over the past several years, she had undergone multiple treatments, including a lateral retinacular release, radiofrequency ablation of a peripheral nerve, and physical therapy. While certain treatments provided partial relief, her pain would inevitably return to its original state. Using simultaneous positron emission tomography/magnetic resonance imaging (PET/MRI) with the novel radiotracer 18F-FTC-146, imaging showed increased focal uptake of 18F-FTC-146 in the intercondylar notch, corresponding to an irregular but equivocal lesion identified in the simultaneously acquired MRI. These imaging results prompted surgical removal of the lesion, which upon resection was identified as an inflamed, intraarticular synovial lipoma. Removal of the lesion relieved the patient's pain, and to date the pain has not recurred. Conclusion We present a case of chronic, debilitating knee pain that resolved with surgery following identification of the pathology with a novel clinical molecular imaging approach that detects chronic pain generators at the molecular and cellular level. This approach has the potential to identify and localize pain-associated pathology in a variety of chronic pain syndromes. |
| Databáze: | OpenAIRE |
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