Abstract
Objective: To assess glycosaminoglycan (GAG) content of lumbar intervertebral discs (IVDs) in patients with radiculopathy compared with healthy volunteers with glycosaminoglycan chemical exchange saturation transfer (gagCEST). Methods: The lumbar spines of 15 patients with radiculopathy (9 women, 6 men; mean age 45 years; range: 19 - 80 years) and 13 healthy controls (10 women, 3 men; mean age 29 years; range: 19 - 38 years) without lumbar back pain or previous spine surgery were examined at a 3 Tesla (T) magnetic resonance imaging (MRI) scanner in this prospective study. The MRI protocol included standard morphological, sagittal, and transverse T2-weighted (T2w) images of the five lumbar IVDs (L1-S1) to assess Pfirrmann score and to detect disc disorders according to the Combined Task Force classification. To analyze biochemically the lumbar IVDs, a gagCEST sequence was applied to measure the GAG content of the nucleus pulposus (NP) and annulus fibrosus (AF). Results: Patients with radiculopathy indicated significantly lower gagCEST values in NP than healthy volunteers (2.82% ± 3.12% vs. 4.09% ± 2.25%, P = 0.017). The GAG content of AF showed no significant difference between volunteers and patients (2.66% ± 2.01% vs. 1.92% ± 2.56%; P = 0.175). Conclusions. Patients with radiculopathy presented with lower GAG values than healthy volunteers in NP, indicating an association between pain and IVD degeneration. gagCEST of lumbar IVDs is a powerful, non-invasive tool to investigate early disc degeneration, which we could demonstrate in the NP in our study collective.
Highlights
Low back pain (LBP) is a common disease in the industrialized world with a high lifetime prevalence [1]
To assess glycosaminoglycan (GAG) content of lumbar intervertebral discs (IVDs) in patients with radiculopathy compared with healthy volunteers with glycosaminoglycan chemical exchange saturation transfer
Patients with radiculopathy presented with lower GAG values than healthy volunteers in nucleus pulposus (NP), indicating an association between pain and IVD degeneration. glycosaminoglycan chemical exchange saturation transfer (gagCEST) of lumbar IVDs is a powerful, non-invasive tool to investigate early disc degeneration, which we could demonstrate in the NP in our study collective
Summary
Low back pain (LBP) is a common disease in the industrialized world with a high lifetime prevalence [1]. It is one of the leading causes of disability and imposes a high socio-economic burden [2]. On T2-weighted (T2w) MR images, normal, non-degenerated intervertebral discs show a bright signal from the nucleus pulposus and inner fibers of the annulus due to a high amount of water [3] [5] [6]. Degenerative disc alterations can be visualized by a decrease in the water content on T2w images and be morphologically graded according to the Pfirrmann classification system [7]. Besides the Pfirrmann classification, IVDs can be graded according to the Combined Task Force (CTF) classification in normal appearance, protrusion, and extrusion of IVDs [8] [9]
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