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Background <p>Localization of clinically relevant pain generators remains a major diagnostic challenge. MRI frequently demonstrates structural abnormalities that may lack symptomatic correlation, limiting identification of true nociceptive targets. ¹⁸F-FDG PET/MRI enables simultaneous metabolic and anatomic assessment and may help identify clinically actionable pain generators.</p> Case presentation <p>A 68-year-old man with chronic refractory neck pain underwent ¹⁸F-FDG PET/MRI, which demonstrated focal hypermetabolism within the right obliquus capitis inferior and right longus colli muscles without corresponding structural MRI abnormalities. In conjunction with clinical findings, imaging results supported a presumptive diagnosis of cervical dystonia. Targeted CT- and US-guided lidocaine/triamcinolone injection, followed by botulinum toxin type A injection, was temporally associated with marked symptomatic improvement.</p> Conclusion <p>¹⁸F-FDG PET/MRI may help localize metabolically active pain generators not identified on conventional imaging and support hypothesis-driven image-guided procedural targeting in selected patients with unexplained persistent pain.</p>

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18F-FDG PET/MRI–guided localization of pain generators in chronic neck pain associated with presumed cervical dystonia

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月2日

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  • Taksh Thakur,
  • Seth Taylor,
  • Ali Pirasteh,
  • Joseph McGinley,
  • Sandip Biswal

摘要

Background

Localization of clinically relevant pain generators remains a major diagnostic challenge. MRI frequently demonstrates structural abnormalities that may lack symptomatic correlation, limiting identification of true nociceptive targets. ¹⁸F-FDG PET/MRI enables simultaneous metabolic and anatomic assessment and may help identify clinically actionable pain generators.

Case presentation

A 68-year-old man with chronic refractory neck pain underwent ¹⁸F-FDG PET/MRI, which demonstrated focal hypermetabolism within the right obliquus capitis inferior and right longus colli muscles without corresponding structural MRI abnormalities. In conjunction with clinical findings, imaging results supported a presumptive diagnosis of cervical dystonia. Targeted CT- and US-guided lidocaine/triamcinolone injection, followed by botulinum toxin type A injection, was temporally associated with marked symptomatic improvement.

Conclusion

¹⁸F-FDG PET/MRI may help localize metabolically active pain generators not identified on conventional imaging and support hypothesis-driven image-guided procedural targeting in selected patients with unexplained persistent pain.