The potential of [18F]FDG PET/MRI for identifying pain sources in patients with diagnostically challenging chronic hip pain after total hip replacement
- 1Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- 2Department of Orthopaedics & Sports Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- 3Department of Radiology, University of Wisconsin-Madison, Madison, WI USA
Abstract
Purpose: Chronic hip pain after total hip replacement (THR) poses a diagnostic challenge and frequently yields lengthy and unsatisfactory diagnostic work-up. This study aims to evaluate the diagnostic role and clinical impact of [18F]FDG PET/MRI compared with regular diagnostic work-up in patients with chronic hip pain after THR.
Methods: In this randomized study, 20 patients with persistent hip pain of unclear origin after THR underwent either PET/MRI-guided clinical management or regular diagnostic work-up. Additional diagnostic and therapeutic procedures during 12-month follow-up were recorded and a final expert diagnosis was determined through expert opinion based on all available information. Patient reported outcomes included pain scores, functional scores and quality of life.
Results: In the PET/MRI group, a final expert diagnosis could be established for 8/10 patients compared to 5/10 in the control group. PET-MRI contributed to this diagnosis in 7 of 10 patients by identifying 5 new pain sources, confirming 3 clinically suspected pain sources, and excluding 1 clinically suspected pain source. At 6 months, mean pain scores on NRS 0–10 decreased in both groups (PET/MRI: 6.1 to 5.2; control: 5.2 to 3.4). Between-group differences could not be statistically tested due to insufficient statistical power.
Conclusion: Initial results demonstrate the potential of [18F]FDG PET/MRI for the identification of pain sources in patients with diagnostically challenging chronic hip pain after THR. Further research regarding clinical outcome is warranted in a larger cohort with standardized treatment strategies incorporating PET/MRI findings.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00259-026-08142-4.
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BibTeX
@article{mostert2026potential,
title = {{The potential of [18F]FDG PET/MRI for identifying pain sources in patients with diagnostically challenging chronic hip pain after total hip replacement}},
author = {Jacob M. Mostert and Pieter K. Bos and Michael Ananta and Galied S. R. Muradin and Sandip Biswal and Edwin H.G. Oei and Rianne A. van der Heijden},
journal = {European Journal of Nuclear Medicine and Molecular Imaging},
year = {2026},
month = aug,
doi = {10.1007/s00259-026-08142-4},
url = {https://doi.org/10.1007/s00259-026-08142-4},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The potential of [18F]FDG PET/MRI for identifying pain sources in patients with diagnostically challenging chronic hip pain after total hip replacement
AU - Jacob M. Mostert
AU - Pieter K. Bos
AU - Michael Ananta
AU - Galied S. R. Muradin
AU - Sandip Biswal
AU - Edwin H.G. Oei
AU - Rianne A. van der Heijden
PY - 2026
DA - 2026/08/22
JO - European Journal of Nuclear Medicine and Molecular Imaging
DO - 10.1007/s00259-026-08142-4
UR - https://doi.org/10.1007/s00259-026-08142-4
AB - Purpose: Chronic hip pain after total hip replacement (THR) poses a diagnostic challenge and frequently yields lengthy and unsatisfactory diagnostic work-up. This study aims to evaluate the diagnostic role and clinical impact of [18F]FDG PET/MRI compared with regular diagnostic work-up in patients with chronic hip pain after THR. Methods: In this randomized study, 20 patients with persistent hip pain of unclear origin after THR underwent either PET/MRI-guided clinical management or regular diagnostic work-up. Additional diagnostic and therapeutic procedures during 12-month follow-up were recorded and a final expert diagnosis was determined through expert opinion based on all available information. Patient reported outcomes included pain scores, functional scores and quality of life. Results: In the PET/MRI group, a final expert diagnosis could be established for 8/10 patients compared to 5/10 in the control group. PET-MRI contributed to this diagnosis in 7 of 10 patients by identifying 5 new pain sources, confirming 3 clinically suspected pain sources, and excluding 1 clinically suspected pain source. At 6 months, mean pain scores on NRS 0–10 decreased in both groups (PET/MRI: 6.1 to 5.2; control: 5.2 to 3.4). Between-group differences could not be statistically tested due to insufficient statistical power. Conclusion: Initial results demonstrate the potential of [18F]FDG PET/MRI for the identification of pain sources in patients with diagnostically challenging chronic hip pain after THR. Further research regarding clinical outcome is warranted in a larger cohort with standardized treatment strategies incorporating PET/MRI findings. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00259-026-08142-4.
SN - 1619-7070
SN - 1619-7089
ER -