Glycosaminoglycan chemical exchange saturation transfer in human lumbar intervertebral discs: Effect of saturation pulse and relationship with low back pain

Purpose: To evaluate the dependence of saturation pulse power and duration on glycosaminoglycan chemical exchange saturation transfer (gagCEST) imaging and assess the degeneration of human lumbar intervertebral discs (IVDs) using this method. Materials and Methods: All images were acquired on a 3T magnetic resonance imaging (MRI) scanner. The CEST effects were measured in the glycosaminoglycan (GAG) phantoms with different concentrations. In the human study, CEST effects were measured in the nucleus pulposus of IVD. We compared the CEST effects among the different saturation pulse powers (0.4, 0.8, and 1.6 μT) or durations (0.5, 1.0, and 2.0 sec) at each Pfirrmann grade (I–V). The relationship between the CEST effects and low back pain was also evaluated. Results: The phantom study showed high correlations between the CEST effects and GAG concentration (R² = 0.863, P < 0.0001, linear regression). In the human study, the CEST effect obtained with the 0.8 μT power was significantly greater than those obtained with 0.4 (P < 0.01) and 1.6 μT power (P < 0.05) at Pfirrmann grade I. The CEST effect obtained with a 1.0-sec duration was significantly greater than those derived with 0.5 and 2.0 sec (P < 0.01) durations at Pfirrmann grades I and II. The CEST effects in the group with moderate low back pain were significantly lower than those in the groups without pain (P < 0.001) and with mild pain (P = 0.0216). Conclusion: The contrast of gagCEST imaging in the lumbar IVDs varied with saturation pulse power and duration. GagCEST imaging may serve as a tool for evaluating IVD degeneration in the lumbar spine. Level of Evidence: 2. J. Magn. Reson. Imaging 2017;45:863–871.