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 IJCM  Vol.10 No.4 , April 2019
Assessment of Glycosaminoglycan Content of Lumbar Intervertebral Discs in Patients with Radiculopathy
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.
Cite this paper: Heüveldop, S. , Fichter, F. , Müller-Lutz, A. , Konieczny, M. , Eichner, M. , Wittsack, H. and Schleich, C. (2019) Assessment of Glycosaminoglycan Content of Lumbar Intervertebral Discs in Patients with Radiculopathy. International Journal of Clinical Medicine, 10, 259-269. doi: 10.4236/ijcm.2019.104020.
References

[1]   Chou, R., Fu, R., Carrino, J.A. and Deyo, R.A. (2009) Imaging Strategies for Low-Back Pain: Systematic Review and Meta-Analysis. The Lancet, 373, 463-472.
https://doi.org/10.1016/S0140-6736(09)60172-0

[2]   Miles, D.E., Mitchell, E.A., Kapur, N., Beales, P.A. and Wilcox, RK. (2016) Peptide: Glycosaminoglycan Hybrid Hydrogels as an Injectable Intervention for Spinal Disc Degeneration. Journal of Materials Chemistry B, 4, 3225-3231.
https://doi.org/10.1039/C6TB00121A

[3]   Griffith, J.F., Wang, Y.X., Antonio, G.E., Choi, K.C., Yu, A., Ahuja, A.T., et al. (2007) Modified Pfirrmann Grading System for Lumbar Intervertebral Disc Degeneration. Spine, 32, e708-e712.
https://doi.org/10.1097/BRS.0b013e31815a59a0

[4]   An, H.S., Anderson, P.A., Haughton, V.M., Iatridis, J.C., Kang, J.D., Lotz, J.C., et al. (2004) Introduction: Disc Degeneration: Summary. Spine, 29, 2677-2678.
https://doi.org/10.1097/01.brs.0000147573.88916.c6

[5]   Urban, J.P. and Winlove, C.P. (2007) Pathophysiology of the Intervertebral Disc and the Challenges for MRI. Journal of Magnetic Resonance Imaging, 25, 419-432.
https://doi.org/10.1002/jmri.20874

[6]   Urban, J.P., McMullin, J.F. (1985) Swelling Pressure of the Inervertebral Disc: Influence of Proteoglycan and Collagen Contents. Biorheology, 22, 145-157.
https://doi.org/10.3233/BIR-1985-22205

[7]   Pfirrmann, C.W., Metzdorf, A., Zanetti, M., Hodler, J. and Boos, N. (2001) Magnetic Resonance Classification of Lumbar Intervertebral Disc Degeneration. Spine, 26, 1873-1878.
https://doi.org/10.1097/00007632-200109010-00011

[8]   Rehnitz, C., Kupfer, J., Streich, N.A., Burkholder, I., Schmitt, B. Lauer, L., et al. (2014) Comparison of Biochemical Cartilage Imaging Techniques at 3 T MRI. Osteoarthritis and Cartilage, 22, 1732-1742.
https://doi.org/10.1016/j.joca.2014.04.020

[9]   Li, Y., Fredrickson, V. and Resnick, D.K. (2015) How Should We Grade Lumbar Disc Herniation and Nerve Root Compression? A Systematic Review. Clinical Orthopaedics and Related Research, 473, 1896-1902.

[10]   Schleich, C., Miese, F., Müller, L. A., Boos, J., Aissa, J., Nasca, A., et al. (2016) Value of Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage for the Pre-Operative Assessment of Cervical Intervertebral Discs. The Journal of Orthopaedic Research, 35, 1824-1830.

[11]   Vaga, S., Raimondi, M.T., Caiani, E.G., Costa, F., Giordano, C., Perona, F., et al. (2008) Quantitative Assessment of Intervertebral Disc Glycosaminoglycan Distribution by Gadolinium-Enhanced MRI in Orthopedic Patients. Magnetic Resonance in Medicine, 59, 85-95.
https://doi.org/10.1002/mrm.21433

[12]   Haneder, S., Ong, M.M., Budjan, J.M., Schmidt, R., Konstandin, S., Morelli, J.N., et al. (2014) 23Na-Magnetic Resonance Imaging of the Human Lumbar Vertebral Discs: In Vivo Measurements at 3.0 T in Healthy Volunteers and Patients with Low Back Pain. The Spine Journal, 14, 1343-1350.
https://doi.org/10.1016/j.spinee.2014.01.031

[13]   Yoo, Y.H., Yoon, C.S., Eun, N.L., Hwang, M.J., Yoo, H., Peters, R.D., et al. (2016) Interobserver and Test-Retest Reproducibility of T1ρ and T2 Measurements of Lumbar Intervertebral Discs by 3T Magnetic Resonance Imaging. Korean Journal of Radiology, 17, 903-911.
https://doi.org/10.3348/kjr.2016.17.6.903

[14]   Ellingson, A.M., Mehta, H., Polly, D.W., Ellermann, J. and Nuckley, D.J. (2013) Disc Degeneration Assessed by Quantitative T2* (T2 Star) Correlated with Functional Lumbar Mechanics. Spine, 38, e1533-e1540.
https://doi.org/10.1097/BRS.0b013e3182a59453

[15]   Ling, W., Regatte, R.R., Navon, G. and Jerschow, A. (2008) Assessment of Glycosaminoglycan Concentration in Vivo by Chemical Exchange-Dependent Saturation Transfer (gagCEST). Proceedings of the National Academy of Sciences of the United States of America, 105, 2266-2270.
https://doi.org/10.1073/pnas.0707666105

[16]   Schleich, C., Müller, L.A., Eichner, M., Schmitt, B., Matuschke, F., Bittersohl, B., et al. (2016) Glycosaminoglycan Chemical Exchange Saturation Transfer of Lumbar Intervertebral Discs in Healthy Volunteers. Spine, 41, 146-152.
https://doi.org/10.1097/BRS.0000000000001144

[17]   Müller, L.A., Schleich, C., Schmitt, B., Antoch, G., Matuschke, F., Quentin, M., et al. (2015) Gender, BMI and T2 Dependencies of Glycosaminoglycan Chemical Exchange Saturation Transfer in Intervertebral Discs. Magnetic Resonance Imaging, 34, 271-275.

[18]   Müller, L.A., Schleich, C., Pentang, G., Schmitt, B., Lanzman, R.S., Matuschke, F., et al. (2015) Age-Dependency of Glycosaminoglycan Content in Lumbar Discs: A 3t gagcEST Study. Journal of Magnetic Resonance Imaging, 42, 1517-1523.
https://doi.org/10.1002/jmri.24945

[19]   Saar, G., Zhang, B., Ling, W., Regatte, R.R., Navon, G. and Jerschow, A. (2012) Assessment of Glycosaminoglycan Concentration Changes in the Intervertebral Disc via Chemical Exchange Saturation Transfer. NMR in Biomedicine, 25, 255-261.
https://doi.org/10.1002/nbm.1741

[20]   Haneder, S., Apprich, S.R., Schmitt, B., Michaely, H.J., Schoenberg, S.O., Friedrich, K.M., et al. (2013) Assessment of Glycosaminoglycan Content in Intervertebral Discs Using Chemical Exchange Saturation Transfer at 3.0 Tesla: Preliminary Results in Patients with Low-Back Pain. European Radiology, 23, 861-868.
https://doi.org/10.1007/s00330-012-2660-6

[21]   Müller, L.A., Schleich, C., Schmitt, B., Topgöz, M., Pentang, G., Antoch, G., et al. (2014) Improvement of gagCEST Imaging in the Human Lumbar Intervertebral Disc by Motion Correction. Skeletal Radiology, 44, 505-511.

[22]   Kim, M., Gillen, J., Landman, B.A., Zhou, J. and van Zijl, P.C. (2009) Water Saturation Shift Referencing (WASSR) for Chemical Exchange Saturation Transfer (CEST) Experiments. Magnetic Resonance in Medicine, 61, 1441-1450.
https://doi.org/10.1002/mrm.21873

[23]   Nachemson, A. (1975) Towards a Better Understanding of Low-Back Pain: A Review of the Mechanics of the Lumbar Disc. Rheumatology, 14, 129-143.
https://doi.org/10.1093/rheumatology/14.3.129

[24]   Videman, T., Battié, M.C., Gibbons, L.E., Maravilla, K., Manninen, H. and Kaprio, J. (2003) Associations between Back Pain History and Lumbar MRI Findings. Spine, 28, 582-588.

[25]   Kraemer, J. (1995) Natural Course and Prognosis of Intervertebral Disc Diseases. Spine, 20, 635-639.
https://doi.org/10.1097/00007632-199503150-00001

 
 
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