CEST MRI: Translational prospects for intervertebral disc degeneration - from basic research to clinical applications

Area of Science:

• Biomedical Imaging
• Molecular MRI
• Biochemistry

Background:

• Low back pain (LBP) is often caused by intervertebral disc degeneration (IVDD), involving complex metabolic changes in the disc microenvironment.
• Conventional MRI techniques struggle to accurately quantify these subtle molecular alterations in the intervertebral disc (IVD).
• Chemical exchange saturation transfer (CEST) MRI is an emerging technique that visualizes molecular changes by targeting exchangeable protons in tissues.

Purpose of the Study:

• To review the application of CEST imaging in evaluating intervertebral disc degeneration (IVDD).
• To compare CEST with other IVD imaging modalities, highlighting its unique advantages.
• To discuss the potential of CEST in identifying key biomarkers for IVDD and its future clinical translation.

Main Methods:

• Comparison of various IVD imaging modalities, emphasizing CEST's strengths.
• Explanation of CEST fundamental concepts, theoretical basis, and quantitative approaches.
• Overview of CEST contrast agents and their correlation with IVDD pathology.

Main Results:

• CEST imaging can identify key biomarkers of IVDD, including glycosaminoglycan content, pH variations, and microenvironmental shifts.
• CEST has the potential to distinguish pain-generating intervertebral discs (IVDs).
• CEST offers molecular-level contrast in vivo, surpassing conventional MRI limitations for metabolic changes.

Conclusions:

• CEST MRI shows significant promise for the precise evaluation and prediction of degenerative diseases like IVDD.
• Integration with artificial intelligence (AI) and multimodal imaging can overcome current CEST limitations.
• CEST advancements will enable a shift towards microscopic molecular analysis and intelligent prediction for precision medicine.