Evidence map›Paper›PMID 40591482›Full record

ArticlePain medicine (Malden, Mass.)2026

Bone remodeling, not inflammation, as the predominant pathology in modic type 1 lesions of the lumbar spine.

Virginie Kreutzinger, Katharina Ziegeler, Cynthia T Chin, Misung Han, Emma Bahroos, Daehyun Yoon, Thomas M Link, Sharmila Majumdar

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Pain medicine (Malden, Mass.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Virginie KreutzingerDepartment of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA-94158, United States.ORCID 0009-0005-7378-1068
Katharina ZiegelerDepartment of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA-94158, United States.ORCID 0000-0002-9763-2420
Cynthia T ChinDepartment of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA-94158, United States.
Misung HanDepartment of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA-94158, United States.ORCID 0000-0003-0918-8831
Emma BahroosDepartment of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA-94158, United States.
Daehyun YoonDepartment of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA-94158, United States.
Thomas M LinkDepartment of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA-94158, United States.
Sharmila MajumdarDepartment of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA-94158, United States.ORCID 0000-0002-0201-871X

Funding

Technology Research Site for Advanced, Faster Quantitative Imaging for BACPACUH3AR076724 · NIAMS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI MAJUMDAR, SHARMILA · 2020 to 2023
$4.8M
NIAMS NIH HHS UH3 AR076724NIH HHS UH3AR076724
6 · The paper itself

Abstract

purposeLesions of the vertebral endplates (Modic changes) are associated with low back pain (LBP), and different pathological processes, including inflammation, have been proposed as causative. This study aimed to explore the relationship between [18F]FDG uptake (inflammation) and [18F]NaF uptake (bone remodeling) and patient-reported back pain as well as conventional MRI detected endplate changes.

methodsParticipants were selected from an IRB-approved study, creating 2 arms: [18F]NaF (n = 11) and [18F]FDG (n = 11). Scans were performed on a 3.0 T PET-MRI scanner. An MSK radiologist rated endplates changes using Modic classification and a relative scale: None; only edema; edema > fat; edema=fat; edema< fat; only fat. Radiotracer uptake (SUVmax) in endplate-adjacent bone was measured using ROIs. VAS scores (0-10) for back pain were recorded before imaging. Generalized estimating equations assessed associations between pain and radiotracer uptake as outcomes and radiologic findings as predictors, adjusted for age, sex, and body mass index (BMI).

resultsThe study included 220 endplates from 22 patients (110 per arm). Overall, pain was positively associated with edematous lesions (beta 0.21, P = .024) but not with fatty changes (beta 0.10, P = .567). In the [18F]NaF arm, tracer uptake was associated with edematous lesions (beta 1.79, P = .001) and with pain (beta 0.18, P = .007). In the [18F]FDG arm, tracer uptake was negatively associated with edematous lesions (beta -0.11, P = .013) and showed no significant association with pain (beta -1.50, P = .064).

conclusionOur study shows that [18F]NaF-PET-MRI detected bone-remodeling is more closely linked to painful vertebral end-plate degeneration than inflammatory [18F]FDG signal.

Indexed as

Bone RemodelingInflammationLow Back PainLumbar VertebraeAdultAgedFemaleFluorodeoxyglucose F18HumansMagnetic Resonance ImagingMaleMiddle AgedPositron-Emission TomographyRadiopharmaceuticalsSodium FluorideFluorodeoxyglucose F18RadiopharmaceuticalsSodium FluorideLBPModic changesPET/MR imaging

Identifiers

PMID40591482
PMCPMC12490939

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.