Fluoride PET/CT whole body F-18-sodium fluoride (NaF) PET/CT has become an important tool for detecting and evaluating metastatic bone cancer [90,91] and may be a preferable modality for detecting metastatic bone disease in morbidly obese patients; however, there is currently no evidence supporting the validity of F-18 NaF PET/CT as a first-line test evaluating acute neck pain or radicular symptoms in patients with malignancy. Percutaneous Interventions The literature search did not identify any studies regarding the use of cervical facet joint, medial branch blocks, or discography as a first-line test in the evaluation of this clinical presentation. FDG-PET/CT Whole Body FDG-PET/CT is sensitive for detection of metastatic disease and has been compared to detection rates of bone scans [92,93]. However, resolution of PET scans is limited for assessment of involvement of the spinal cord/meninges and exiting nerve roots, and as such, there is currently no evidence supporting the validity of FDG- PET/CT as a first-line test evaluating acute neck pain or radicular symptoms in patients with malignancy. MRA Neck The literature search did not identify any studies regarding the use of MRA in the evaluation of this clinical presentation. MRI Cervical Spine MRI has high sensitivity and specificity for the detection and discrimination of malignant bone lesions [88], with the addition of contrast to delineate the extent of marrow leptomeningeal, epidural, neuroforminal, and paraspinal involvement. Furthermore, local spread of bone metastases and extension into the spinal canal is better assessed on MRI, particularly in the setting of clinical suspicion for nerve root or cord compression [94].
Cervical Neck Pain or Cervical Radiculopathy PCAs. Fluoride PET/CT whole body F-18-sodium fluoride (NaF) PET/CT has become an important tool for detecting and evaluating metastatic bone cancer [90,91] and may be a preferable modality for detecting metastatic bone disease in morbidly obese patients; however, there is currently no evidence supporting the validity of F-18 NaF PET/CT as a first-line test evaluating acute neck pain or radicular symptoms in patients with malignancy. Percutaneous Interventions The literature search did not identify any studies regarding the use of cervical facet joint, medial branch blocks, or discography as a first-line test in the evaluation of this clinical presentation. FDG-PET/CT Whole Body FDG-PET/CT is sensitive for detection of metastatic disease and has been compared to detection rates of bone scans [92,93]. However, resolution of PET scans is limited for assessment of involvement of the spinal cord/meninges and exiting nerve roots, and as such, there is currently no evidence supporting the validity of FDG- PET/CT as a first-line test evaluating acute neck pain or radicular symptoms in patients with malignancy. MRA Neck The literature search did not identify any studies regarding the use of MRA in the evaluation of this clinical presentation. MRI Cervical Spine MRI has high sensitivity and specificity for the detection and discrimination of malignant bone lesions [88], with the addition of contrast to delineate the extent of marrow leptomeningeal, epidural, neuroforminal, and paraspinal involvement. Furthermore, local spread of bone metastases and extension into the spinal canal is better assessed on MRI, particularly in the setting of clinical suspicion for nerve root or cord compression [94].