Proton T2 relaxation of cerebral metabolites of normal human brain over large TE range

Integrated Short-TE and Hadamard-edited Multi-Sequence (ISTHMUS) for Advanced MRS

Background

To examine data quality and reproducibility using ISTHMUS, which has been implemented as the standardized MR spectroscopy sequence for the multi-site Healthy Brain and Child Development (HBCD) study.

Methods

ISTHMUS is the consecutive acquisition of short-TE PRESS (32 transients) and long-TE HERCULES (224 transients) data with dual-TE water reference scans. Voxels were positioned in the centrum semiovale, dorsal anterior cingulate cortex, posterior cingulate cortex and bilateral thalamus regions. After acquisition, ISTHMUS data were separated into the PRESS and HERCULES portions for analysis and modeled separately using Osprey. In vivo experiments were performed in 10 healthy volunteers (6 female; 29.5±6.6 years). Each volunteer underwent two scans on the same day. Differences in metabolite measurements were examined. T2 correction based on the dual-TE water integrals were compared with: 1) T2 correction based the default white matter and gray matter T2 reference values in Osprey; 2) shorter WM and GM T2 values from recent literature; and 3) reduced CSF fractions.

Results

No significant difference in linewidth was observed between PRESS and HERCULES. Bilateral thalamus spectra had produced significantly higher (p<0.001) linewidth compared to the other three regions. Linewidth measurements were similar between scans, with scan-to-scan differences under 1 Hz for most subjects. Paired t-tests indicated a significant difference only in PRESS NAAG between the two thalamus scans (p=0.002). T2 correction based on shorter T2 values showed better agreement to the dual-TE water integral ratio.

Conclusions

ISTHMUS facilitated and standardized acquisition and post-processing and reduced operator workload to eliminate potential human error.

Meta-analysis and open-source database for in vivo brain Magnetic Resonance spectroscopy in health and disease

Proton (1H) Magnetic Resonance Spectroscopy (MRS) is a non-invasive tool capable of quantifying brain metabolite concentrations in vivo. Prioritization of standardization and accessibility in the field has led to the development of universal pulse sequences, methodological consensus recommendations, and the development of open-source analysis software packages. One on-going challenge is methodological validation with ground-truth data. As ground-truths are rarely available for in vivo measurements, data simulations have become an important tool. The diverse literature of metabolite measurements has made it challenging to define ranges to be used within simulations. Especially for the development of deep learning and machine learning algorithms, simulations must be able to produce accurate spectra capturing all the nuances of in vivo data. Therefore, we sought to determine the physiological ranges and relaxation rates of brain metabolites which can be used both in data simulations and as reference estimates. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we've identified relevant MRS research articles and created an open-source database containing methods, results, and other article information as a resource. Using this database, expectation values and ranges for metabolite concentrations and T2 relaxation times are established based upon a meta-analyses of healthy and diseased brains.

Meta-analysis and Open-source Database for In Vivo Brain Magnetic Resonance Spectroscopy in Health and Disease

Proton ( 1 H) Magnetic Resonance Spectroscopy (MRS) is a non-invasive tool capable of quantifying brain metabolite concentrations in vivo . Prioritization of standardization and accessibility in the field has led to the development of universal pulse sequences, methodological consensus recommendations, and the development of open-source analysis software packages. One on-going challenge is methodological validation with ground-truth data. As ground-truths are rarely available for in vivo measurements, data simulations have become an important tool. The diverse literature of metabolite measurements has made it challenging to define ranges to be used within simulations. Especially for the development of deep learning and machine learning algorithms, simulations must be able to produce accurate spectra capturing all the nuances of in vivo data. Therefore, we sought to determine the physiological ranges and relaxation rates of brain metabolites which can be used both in data simulations and as reference estimates. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we've identified relevant MRS research articles and created an open-source database containing methods, results, and other article information as a resource. Using this database, expectation values and ranges for metabolite concentrations and T 2 relaxation times are established based upon a meta-analyses of healthy and diseased brains.

Cerebellar Abnormalities on Proton MR Spectroscopy and Imaging in Patients With Gluten Ataxia: A Pilot Study

Gluten ataxia is a rare immune-mediated neurological disorder caused by the ingestion of gluten. The diagnosis is not straightforward as antibodies are present in only up to 38% of patients, but often at lower titers. The symptoms of ataxia may be mild at the onset but lead to permanent damage if remain untreated. It is characterized by damage to the cerebellum however, the pathophysiology of the disease is not clearly understood. The present study investigated the neurochemical profile of vermis and right cerebellum and structural changes in various brain regions of patients with gluten ataxia (n = 6, age range 40–65 years) and compared it with healthy controls (n = 10, 40–55 years). Volumetric 3-D T1 and T1-weighted magnetic resonance imaging (MRI) in the three planes (axial, coronal, and sagittal) of the whole brain and single-voxel ¹H- magnetic resonance spectroscopy (MRS) of the vermis and right cerebellum were acquired on 3 T human MR scanner. The metabolite concentrations were estimated using LC Model (6.1–4A) while brain volumes were estimated using the online tool volBrain pipeline and CERES and corrected for partial volumes. The levels of neuro-metabolites (N-acetyl aspartate + N-acetyl aspartate glutamate, glycerophosphocholine + phosphocholine, and total creatine) were found to be significantly lower in vermis, while N-acetyl aspartate + N-acetyl aspartate glutamate and glycerophosphocholine + phosphocholine was lower in cerebellum regions in the patients with gluten ataxia compared to healthy controls. A significant reduction in the white matter of (total brain, cerebellum, and cerebrum); reduction in the volumes of cerebellum lobe (X) and thalamus while lateral ventricles were increased in the patients with gluten ataxia compared to healthy controls. The reduced neuronal metabolites along with structural changes in the brain suggested neuronal degeneration in the patients with gluten ataxia. Our preliminary findings may be useful in understanding the gluten-induced cerebral damage and indicated that MRI and MRS may serve as a non-invasive useful tool in the early diagnosis, thereby enabling better management of these patients.

Resolving the omega-3 methyl resonance with long echo time magnetic resonance spectroscopy in mouse adipose tissue at 9.4 T

Tissue omega-3 (ω-3) content is biologically important to disease; however, its quantification with magnetic resonance spectroscopy in vivo is challenging due to its low concentration. In addition, the ω-3 methyl resonance (≈ 0.98 ppm) overlaps that of the non-ω-3 (≈ 0.90 ppm), even at 9.4 T. We demonstrate that a Point-RESolved Spectroscopy (PRESS) sequence with an echo time (TE) of 109 ms resolves the ω-3 and non-ω-3 methyl peaks at 9.4 T. Sequence efficacy was verified on five oils with differing ω-3 fat content; the ω-3 content obtained correlated with that measured using 16.5 T NMR (R² = 0.97). The PRESS sequence was also applied to measure ω-3 content in visceral adipose tissue of three different groups (all n = 3) of mice, each of which were fed a different 20% w/w fat diet. The fat portion of the diet consisted of low (1.4%), medium (9.0%) or high (16.4%) ω-3 fat. The sequence was also applied to a control mouse fed a standard chow diet (5.6% w/w fat, which was 5.9% ω-3). Gas chromatography (GC) analysis of excised tissue was performed for each mouse. The ω-3 fat content obtained with the PRESS sequence correlated with the GC measures (R² = 0.96). Apparent T₂ times of methyl protons were assessed by obtaining spectra from the oils and another group of four mice (fed the high ω-3 diet) with TE values of 109 and 399 ms. Peak areas were fit to a mono-exponentially decaying function and the apparent T₂ values of the ω-3 and non-ω-3 methyl protons were 906 ± 148 and 398 ± 78 ms, respectively, in the oils. In mice, the values were 410 ± 68 and 283 ± 57 ms for ω-3 and non-ω-3 fats, respectively.

Changes in the intracellular microenvironment in the aging human brain

Normal brain aging is associated with changes occurring at all levels. This study investigates age-related differences in the brain intracellular microenvironment by comparing the apparent diffusion coefficients (ADC) and apparent transverse relaxation time constants (T₂) of 5 neurochemicals (i.e., total N-acetyl-aspartate, total creatine, total choline, glutamate, and myo-inositol) between young and older adults. Thirty-two young healthy adults (18-22 years) and 26 older healthy adults (70-83 years) were recruited. Three brain regions were studied at 3 T: prefrontal, posterior cingulate and occipital cortices. ADC and T₂ were measured using stimulated echo acquisition mode and localization by adiabatic selective refocusing sequences, respectively. This study shows that the diffusivities of several neurochemicals are higher in older than in younger adults. In contrast, shorter apparent T₂ values for several metabolites were measured in older adults. Age-related difference in ADC and apparent T₂ of metabolites seem to be region-specific. Furthermore, this study shows that it is feasible to observe age-related differences in the cellular microenvironment of neurochemicals in the normal aging brain.

Variation of T2 relaxation times in pediatric brain tumors and their effect on metabolite quantification

Background

Metabolite concentrations are fundamental biomarkers of disease and prognosis. Magnetic resonance spectroscopy (MRS) is a noninvasive method for measuring metabolite concentrations; however, quantitation is affected by T₂ relaxation.

Purpose

To estimate T₂ relaxation times in pediatric brain tumors and assess how variation in T₂ relaxation affects metabolite quantification.

Study Type

Retrospective.

Population

Twenty‐seven pediatric brain tumor patients (n = 17 pilocytic astrocytoma and n = 10 medulloblastoma) and 24 age‐matched normal controls.

Field Strength/Sequence

Short‐ (30 msec) and long‐echo (135 msec) single‐voxel MRS acquired at 1.5T.

Assessment

T₂ relaxation times were estimated by fitting signal amplitudes at two echo times to a monoexponential decay function and were used to correct metabolite concentration estimates for relaxation effects.

Statistical Tests

One‐way analysis of variance (ANOVA) on ranks were used to analyze the mean T₂ relaxation times and metabolite concentrations for each tissue group and paired Mann–Whitney U‐tests were performed.

Results

The mean T₂ relaxation of water was measured as 181 msec, 123 msec, 90 msec, and 86 msec in pilocytic astrocytomas, medulloblastomas, basal ganglia, and white matter, respectively. The T₂ of water was significantly longer in both tumor groups than normal brain (P < 0.001) and in pilocytic astrocytomas compared with medulloblastomas (P < 0.01). The choline T₂ relaxation time was significantly longer in medulloblastomas compared with pilocytic astrocytomas (P < 0.05), while the T₂ relaxation time of NAA was significantly shorter in pilocytic astrocytomas compared with normal brain (P < 0.001). Overall, the metabolite concentrations were underestimated by ∼22% when default T₂ values were used compared with case‐specific T₂ values at short echo time. The difference was reduced to 4% when individually measured water T₂s were used.

Data Conclusion

Differences exist in water and metabolite T₂ relaxation times for pediatric brain tumors, which lead to significant underestimation of metabolite concentrations when using default water T₂ relaxation times.

Level of Evidence: 3

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2019;49:195–203.

Comparison of direct 13C and indirect 1H-[13C] MR detection methods for the study of dynamic metabolic turnover in the human brain

A wide range of direct ¹³C and indirect ¹H-[¹³C] MR detection methods exist to probe dynamic metabolic pathways in the human brain. Choosing an optimal detection method is difficult as sequence-specific features regarding spatial localization, broadband decoupling, spectral resolution, power requirements and sensitivity complicate a straightforward comparison. Here we combine density matrix simulations with experimentally determined values for intrinsic ¹H and ¹³C sensitivity, T₁ and T₂ relaxation and transmit efficiency to allow selection of an optimal ¹³C MR detection method for a given application and magnetic field. The indirect proton-observed, carbon-edited (POCE) detection method provides the highest accuracy at reasonable RF power deposition both at 4T and 7T. The various polarization transfer methods all have comparable performances, but may become infeasible at 7T due to the high RF power deposition. 2D MR methods have limited value for the metabolites considered (primarily glutamate, glutamine and γ-amino butyric acid (GABA)), but may prove valuable when additional information can be extracted, such as isotopomers or lipid composition. While providing the lowest accuracy, the detection of non-protonated carbons is the simplest to implement with the lowest RF power deposition. The magnetic field homogeneity is one of the most important parameters affecting the detection accuracy for all metabolites and all acquisition methods.

Transverse relaxation time constants of the five major metabolites in human brain measured in vivo using LASER and PRESS at 3 T

PURPOSE

The goal of this study was to measure and compare the apparent transverse relaxation time constants (T₂ ) of five intracellular metabolites using localization by adiabatic selective refocusing (LASER) and point-resolved spectroscopy (PRESS) sequences in the human brain at 3 T.

METHODS

Five healthy subjects were studied at 3 T. ¹ H spectra from the prefrontal cortex were acquired at six different echo times using LASER and PRESS sequences. Postprocessed data were analyzed with LCModel, and the resulting amplitudes were fitted using a mono-exponential decay function to determine the T₂ of metabolites.

RESULTS

Twenty-one percent higher apparent T₂ values for the singlet resonances of N-acetyl aspartate, total creatine, and total choline were measured with LASER as compared with PRESS, whereas comparable apparent T₂ values were measured for strongly coupled metabolites, glutamate, and myo-inositol, with both sequences.

CONCLUSIONS

Reliable T₂ measurements were obtained with both sequences for the five major intracellular metabolites. The LASER sequence appears to be more efficient in suppressing the diffusion component for singlets (having nonexchangeable protons) compared to J-coupled metabolites. Magn Reson Med 79:1260-1265, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Characterization of the response of taurine protons to PRESS at 9.4 T for Resolving choline and Determining taurine T2

Point-resolved spectroscopy (PRESS), characterized by two TEs (TE1 and TE2 ), can be employed to perform animal magnetic resonance spectroscopy (MRS) studies at 9.4 T. Taurine (Tau) and choline (Cho) are relevant metabolites that can be measured by MRS. In this work, the response of the J-coupled protons of Tau as a function of PRESS TE1 and TE2 was characterized at 9.4 T to achieve two objectives. The first was to determine two TE1 and TE2 combinations that could be used to obtain T2 -corrected measures of Tau (3.42 ppm) that were minimally influenced by J coupling. The second was to exploit the Tau J coupling to find a timing combination that minimized the 3.25-ppm Tau signal to enable the Cho (3.22 ppm) resonance to be resolved from the overlapping Tau signal. The response of Tau protons was investigated both numerically and experimentally. It was numerically determined that the timings {TE1 , TE2 } = {17 ms, 10 ms} and {TE1 , TE2 } = {80 ms, 70 ms} yielded similar 3.42-ppm Tau resonance areas (5% difference), rendering them suitable for Tau T2 determination. {TE1 , TE2 } = {25 ms, 50 ms} was found to yield minimal 3.25-ppm Tau signal, reducing its interference with Cho. The efficacy of the timings was demonstrated on phantom solutions and in vivo in four Sprague Dawley rats. LCModel was employed to analyse the in vivo spectra and Tau T2 values were estimated by fitting the Tau peak areas obtained with {TE1 , TE2 } = {17 ms, 10 ms} and {TE1 , TE2 } = {80 ms, 70 ms} to a monoexponentially decaying function. An average Tau T2 of 106 ms (standard deviation, 12 ms) was obtained. LCModel analysis of rat spectra obtained with {TE1 , TE2 } = {25 ms, 50 ms} demonstrated negligible levels of Tau signal, compared with that obtained with short TE.

Brain magnetic resonance metabolic and microstructural changes in adult-onset autosomal dominant leukodystrophy

INTRODUCTION

adult-onset autosomal dominant leukodystrophy (ADLD) is a rare inherited disorder due to a duplication of lamin-B1 (LMNB1) gene. The aim of this study was to investigate brain metabolic and microstructural alterations by using advanced MR techniques.

METHODS

we performed brain MR scans including single-voxel proton-MR Spectroscopy ((1)H-MRS) of the lateral ventricles and parietal white matter and diffusion tensor imaging (DTI) in 4 subjects with LMNB1 gene duplication, 6 non-mutated relatives and 7 unrelated healthy controls. Cervical and thoracic spinal cord MR was performed in three symptomatic subjects with LMNB1 mutation. All participants underwent clinical and neuropsychological evaluation.

RESULTS

all subjects with LMNB1 gene duplication presented pathological accumulation of lactate in lateral ventricles CSF and no alterations of brain white matter absolute metabolites concentrations or metabolites/Cr ratios. We found increased white matter intra- and extracellular water transverse relaxation times. Tract-based spatial statistics analysis detected a significantly reduced fractional anisotropy in the genu of the corpus callosum in mutated cases compared to unrelated healthy controls and non-mutated relatives. Moreover, we detected different degrees of the typical white matter signal intensity alterations and brain and spinal atrophy at conventional MRI in symptomatic subjects with LMNB1 mutation. A mild impairment of executive functions was found in subjects with LMNB1 gene mutation.

CONCLUSION

in subjects with LMNB1 gene duplication, we found a pathological increase in CSF lactate, likely due to active demyelination along with glial activation, and microstructural changes in the genu of the corpus callosum possibly underpinning the mild neuropsychological deficits.

In vivo T(2) relaxation time measurement with echo-time averaging

The accuracy of metabolite concentrations measured using in vivo proton ((1) H) MRS is enhanced following correction for spin-spin (T2 ) relaxation effects. In addition, metabolite proton T2 relaxation times provide unique information regarding cellular environment and molecular mobility. Echo-time (TE) averaging (1) H MRS involves the collection and averaging of multiple TE steps, which greatly simplifies resulting spectra due to the attenuation of spin-coupled and macromolecule resonances. Given the simplified spectral appearance and inherent metabolite T2 relaxation information, the aim of the present proof-of-concept study was to develop a novel data processing scheme to estimate metabolite T2 relaxation times from TE-averaged (1) H MRS data. Spectral simulations are used to validate the proposed TE-averaging methods for estimating methyl proton T2 relaxation times for N-acetyl aspartate, total creatine, and choline-containing compounds. The utility of the technique and its reproducibility are demonstrated using data obtained in vivo from the posterior-occipital cortex of 10 healthy control subjects. Compared with standard methods, distinct advantages of this approach include built-in macromolecule resonance attenuation, in vivo T2 estimates closer to reported values when maximum TE ≈ T2 , and the potential for T2 calculation of metabolite resonances otherwise inseparable in standard (1) H MRS spectra recorded in vivo.

Various MRS application tools for Alzheimer disease and mild cognitive impairment

MR spectroscopy is a noninvasive technique that allows the detection of several naturally occurring compounds (metabolites) from well-defined regions of interest within the human brain. Alzheimer disease, a progressive neurodegenerative disorder, is the most common cause of dementia in the elderly. During the past 20 years, multiple studies have been performed on MR spectroscopy in patients with both mild cognitive impairment and Alzheimer disease. Generally, MR spectroscopy studies have found decreased N-acetylaspartate and increased myo-inositol in both patients with mild cognitive impairment and Alzheimer disease, with greater changes in Alzheimer disease than in mild cognitive impairment. This review summarizes the information content of proton brain MR spectroscopy and its related technical aspects, as well as applications of MR spectroscopy to mild cognitive impairment and Alzheimer disease. While MR spectroscopy may have some value in the differential diagnosis of dementias and assessing prognosis, more likely its role in the near future will be predominantly as a tool for monitoring disease response or progression in treatment trials. More work is needed to evaluate the role of MR spectroscopy as a biomarker in Alzheimer disease and its relationship to other imaging modalities.

T2 measurement of J-coupled metabolites in the human brain at 3T

Proton T(2) relaxation times of metabolites in the human brain were measured using point resolved spectroscopy at 3T in vivo. Four echo times (54, 112, 246 and 374 ms) were selected from numerical and phantom analyses for effective detection of the glutamate multiplet at ~ 2.35 ppm. In vivo data were obtained from medial and left occipital cortices of five healthy volunteers. The cortices contained predominantly gray and white matter, respectively. Spectra were analyzed with LCModel software using volume-localized calculated spectra of brain metabolites. The estimate of the signal strength vs. TE was fitted to a monoexponential function for estimation of apparent T(2) (T(2)(†)). T(2)(†) was estimated to be similar between the brain regions for creatine, choline, glutamate and myo-inositol, but significantly different for N-acetylaspartate singlet and multiplet. T(2)(†)s of glutamate and myo-inositol were measured as 181 ± 16 and 197 ± 14 ms (mean ± SD, N = 5) for medial occipital cortices, and 180 ± 12 and 196 ± 17 ms for left occipital cortices, respectively.

1H-MRS of hepatic fat using short TR at 3T: SNR optimization and fast T2 relaxometry

OBJECT

To increase the signal-to-noise ratio (SNR) efficiency of hepatic fat signals in proton magnetic resonance spectroscopy (1H MRS) at 3 T, in order to improve the quantitation of hepatic fat and allow fast, single breath-hold T2 relaxometry of hepatic water and fat.

MATERIALS AND METHODS

Since the T1 of lipid protons is relatively short, we hypothesized that it could be possible to increase the lipid SNR efficiency by choosing a TR shorter than that typically employed (≥1.5 s). The lipid SNR per unit-time was calculated using published values of lipid (CH2)n protons' T1 at 3 T. 1H MRS PRESS spectra were acquired from VOIs located in the right lobe of the liver in 28 healthy volunteers. At the short TR of 0.6 s, fast T2 relaxometry with the acquisition of 16 echo times (30, 40, ..., 180 ms), was performed in a single breath-hold measurement using a modified PRESS sequence.

RESULTS

Good agreement was observed between simulated and experimental data, with the shortening of TR to 0.6 s yielding an ~50% SNR improvement of hepatic lipid (CH2)n resonances, compared to the SNR at TR=2 s. The T2 relaxation time of water and lipid (CH2)n protons at 3 T was 25.8±1.1 ms and 55.4±3.9 ms, respectively, across five healthy volunteers.

CONCLUSION

The short-TR approach allows for an improved SNR efficiency of lipids and for fast T2 relaxometry of hepatic water and fat, with a detailed coverage of the T2 relaxation decay curve, within a single breath-hold experiment.

Measurement of transverse relaxation times of J-coupled metabolites in the human visual cortex at 4 T

Accurate quantification of (1) H NMR spectra often requires knowledge of the relaxation times to correct for signal losses due to relaxation and saturation. In human brain, T(2) values for singlets such as N-acetylaspartate, creatine, and choline have been reported, but few T(2) values are available for J-coupled spin systems. The purpose of this study was to measure the T(2) relaxation times of J-coupled metabolites in the human occipital lobe using the LASER sequence. Spectra were acquired at multiple echo times and were analyzed with an LCModel using basis sets simulated at each echo time. Separate basis spectra were used for resonances of protons belonging to the same molecule but having very different T(2) values (e.g., two separate basis spectra were used for the singlet and multiplet signal in N-acetylaspartate). The T(2) values for the N-acetylaspartate multiplet (149 ± 12 ms), glutamate (125 ± 10 ms), myo-inositol (139 ± 20 ms), and taurine (196 ± 28 ms) were successfully measured in the human visual cortex at 4 T. These measured T(2) relaxation times have enabled the accurate and absolute quantification of cerebral metabolites at longer echo times.

Clinical pitfalls related to short and long echo times in cerebral MR spectroscopy

MR-spectroscopy (MRS) is a multiparameter diagnostic tool and modification of each parameter results in spectrum morphology changes. In particular, changing the echo time (TE) represents a useful tool to highlight different diagnostic elements, but also has significant impact on the spectrum morphology. Diagnostic errors can result if the role of TE is not properly considered. This article reviews the four most common TE-related pitfalls of MRS interpretation. Clinical practical methods to avoid such pitfalls are also suggested.

In vivo 1H NMR spectroscopy of the human brain at 9.4 T: initial results

In vivo proton NMR spectroscopy allows non-invasive detection and quantification of a wide range of biochemical compounds in the brain. Higher field strength is generally considered advantageous for spectroscopy due to increased signal-to-noise and increased spectral dispersion. So far (1)H NMR spectra have been reported in the human brain up to 7 T. In this study we show that excellent quality short echo time STEAM and LASER (1)H NMR spectra can be measured in the human brain at 9.4 T. The information content of the human brain spectra appears very similar to that measured in the past decade in rodent brains at the same field strength, in spite of broader linewidth in human brain. Compared to lower fields, the T(1) relaxation times of metabolites were slightly longer while T(2) relaxation values of metabolites were shorter (<100 ms) at 9.4 T. The linewidth of the total creatine (tCr) resonance at 3.03 ppm increased linearly with magnetic field (1.35 Hz/T from 1.5 T to 9.4 T), with a minimum achievable tCr linewidth of around 12.5 Hz at 9.4 T. At very high field, B(0) microsusceptibility effects are the main contributor to the minimum achievable linewidth.

Pitfalls and advantages of different strategies for the absolute quantification of N-acetyl aspartate, creatine and choline in white and grey matter by 1H-MRS

This study extensively investigates different strategies for the absolute quantitation of N-acetyl aspartate, creatine and choline in white and grey matter by (1)H-MRS at 1.5 T. The main focus of this study was to reliably estimate metabolite concentrations while reducing the scan time, which remains as one of the main problems in clinical MRS. Absolute quantitation was based on the water-unsuppressed concentration as the internal standard. We compared strategies based on various experimental protocols and post-processing strategies. Data were obtained from 30 control subjects using a PRESS sequence at several TE to estimate the transverse relaxation time, T(2), of the metabolites. Quantitation was performed with the algorithm QUEST using two different metabolite signal basis sets: a whole-metabolite basis set (WhoM) and a basis set in which the singlet signals were split from the coupled signals (MSM). The basis sets were simulated in vivo for each TE used. Metabolites' T(2)s were then determined by fitting the estimated signal amplitudes of the metabolites obtained at different TEs. Then the absolute concentrations (mM) of the metabolites were assessed for each subject using the estimated signal amplitudes and either the mean estimated relaxation times of all subjects (mean protocol, MP) or the T(2) estimated from the spectra derived from the same subject (individual protocol, IP). Results showed that MP represents a less time-consuming alternative to IP in the quantitation of brain metabolites by (1)H-MRS in both grey and white matter, with a comparable accuracy when performed by MSM. It was also shown that the acquisition time might be further reduced by using a variant of MP, although with reduced accuracy. In this variant, only one water-suppressed and one water-unsuppressed spectra were acquired, drastically reducing the duration of the entire MRS examination. However, statistical analysis highlights the reduced accuracy of MP when performed using WhoM, particularly at longer echo times.

Quantitative spectroscopic imaging with in situ measurements of tissue water T1, T2, and density

The use of tissue water as a concentration standard in proton magnetic resonance spectroscopy ((1)H-MRS) of the brain requires that the water proton signal be adjusted for relaxation and partial volume effects. While single voxel (1)H-MRS studies have often included measurements of water proton T(1), T(2), and density based on additional (1)H-MRS acquisitions (e.g., at multiple echo or repetition times), this approach is not practical for (1)H-MRS imaging ((1)H-MRSI). In this report we demonstrate a method for using in situ measurements of water T(1), T(2), and density to calculate metabolite concentrations from (1)H-MRSI data. The relaxation and density data are coregistered with the (1)H-MRSI data and provide detailed information on the water signal appropriate to the individual subject and tissue region. We present data from both healthy subjects and a subject with brain lesions, underscoring the importance of water parameter measurements on a subject-by-subject and voxel-by-voxel basis.

Retrospective correction for T1-weighting bias in T2 values obtained with various spectroscopic spin-echo acquisition schemes

Localized tissue transverse relaxation time (T(2)) is obtained by fitting a decaying exponential to the signals from several spin-echo experiments at different echo times (TE). Unfortunately, time constraints in magnetic resonance spectroscopy (MRS) often mandate in vivo acquisition schemes at short repetition times (TR), that is, comparable with the longitudinal relaxation constant (T(1)). This leads to different T(1)-weighting of the signals at each TE. Unaccounted for, this varying weighting causes systematic underestimation of the T(2)'s, sometimes by as mush as 30%. In this article, we (i) analyze the phenomenon for common MRS spin-echo T(2) acquisition schemes; (ii) propose a general post hoc T(1)-bias correction for any (TR, TE) combination; (iii) show that approximate knowledge of T(1) is sufficient, since a 20% uncertainty in T(1) leads to under 3% bias in T(2); and consequently, (iv) efficient, precision-optimized short TR spin-echo T(2) measurement protocols can be designed and used without risk of accuracy loss. Tables of correction for single-refocusing (conventional) spin-echo and double refocusing, such as, PRESS acquisitions, are provided.

Absolute metabolite concentrations calibrated using the total water signal in brain (1)H MRS

Magnetic resonance spectroscopy (MRS) has been coupled with a multi-echo imaging sequence to determine the relaxation corrected signal areas of the metabolites and the tissue water. Stimulated echo acquisition mode (STEAM) spectra (TE/TM/TR 30/13.7/5000 ms) acquired from gray and white matter voxels in 43 healthy volunteers were fit using LCModel. Corresponding water signals, measured using a multi-echo T(2) imaging sequence, were fit with a Non-Negative Least Squares algorithm. Using this approach the water area could be T(1) and T(2) corrected for all three water compartments: cerebrospinal fluid (CSF), intra- and extra-cellular water, and myelin water. The image-based water measurement is an improvement over spectroscopy methods because it can be more sensitive to water changes in diseased tissue. Metabolite areas were also corrected for relaxation losses. In occipital gray matter, the concentrations of Cho, Cr, and N-acetyl aspartate (NAA) were 1.27 (0.06), 8.9 (0.3), and 9.3 (0.3) mmol/L tissue, respectively and in parietal white matter they were 1.90 (0.05), 7.9 (0.2), and 9.8 (0.2) mmol/L tissue. The Cho and Cr concentrations were different in occipital gray compared to parietal white matter (p < 0.0001 and <0.005, respectively).

1H MR spectroscopy as a diagnostic tool for cerebral creatine deficiency

OBJECTIVE

Total creatine (tCr) constitutes one of the most prominent signals in human brain MR spectra. A significant decrease in the tCr signal indicates a severe disorder of creatine metabolism. We describe the potential of 1H MR spectroscopy in differential diagnosis of creatine transporter (SLC6A8) deficiency syndrome.

MATERIALS AND METHODS

Two siblings, a 7-year-old female presenting with mild psychomotor delay, and a 5-year-old male with severe psychomotor retardation, epilepsy and autistic spectrum of problems including speech delay, underwent MR examination because of suspected creatine deficiency. After the MRI examination, 1H MR spectroscopy using the CSI technique was performed.

RESULTS

Metabolic images of N-acetylaspartate, tCr and choline concentrations showed a very low tCr signal in the male, which was approximately three times lower than in his sister (male/female/controls: tCr=1.6/4.6/7.5 mM). Despite creatine supplementation, no improvement in clinical status and tCr concentration in the MR spectra of the male was observed and diagnosis of SLC6A8 deficiency was proposed. Sequence analysis of the SLC6A8 gene revealed a novel pathogenic frameshift mutation c.219delC; p.Asn74ThrfsX23, hemizygous in the male and heterozygous in the female.

CONCLUSIONS

The diagnosis of X-linked mental retardation caused by the SLC6A8 deficiency can be independently established by 1H MR spectroscopy.

Normal-appearing white matter in patients with phenylketonuria: water content, myelin water fraction, and metabolite concentrations

PURPOSE

To prospectively assess relative water content (RWC), myelin water fraction (MWF), and hydrogen 1 magnetic resonance (MR) spectroscopy findings in the white matter (WM) of patients with phenylketonuria (PKU).

MATERIALS AND METHODS

This study was approved by the institution's investigational review board, and informed consent was obtained. T2 water relaxation data were acquired by using a 48-echo measurement in a transverse plane through the genu and splenium of the corpus callosum in 16 patients (six men, 10 women; age range, 18-40 years) with PKU and 16 age- and sex-matched control subjects. MR spectroscopy was performed in a voxel (94x70x15 mm) above the ventricles. WM in control subjects (defined as normal WM) was compared with normal-appearing WM (NAWM) and diffuse WM lesions in patients with PKU by using a Student t test.

RESULTS

Patients with PKU had two forms of NAWM: (a) areas that looked normal on intermediate-weighted (IW) and T2-weighted MR images and long T2 maps and (b) areas that looked normal on IW and T2-weighted MR images but were hyperintense on long T2 maps. Both forms of NAWM showed increased RWC (up to 2.5%, P<.001) and reduced MWF (up to 56%, P<.001) relative to normal WM; these changes paralleled those seen in diffuse WM lesions. Approximately 9% of the water in diffuse WM lesions was in a reservoir with a long T2 time of 200-800 msec. Myoinositol concentrations were reduced by 14% (P=.003) in patients with PKU.

CONCLUSION

In patients with PKU, NAWM and diffuse WM lesions have altered RWC and MWF relative to normal WM, and diffuse WM lesions show a redistribution of water into an extracellular reservoir with a long T2 time.

Fast mapping of theT2 relaxation time of cerebral metabolites using proton echo-planar spectroscopic imaging (PEPSI)

Metabolite T2 is necessary for accurate quantification of the absolute concentration of metabolites using long-echo-time (TE) acquisition schemes. However, lengthy data acquisition times pose a major challenge to mapping metabolite T2. In this study we used proton echo-planar spectroscopic imaging (PEPSI) at 3T to obtain fast T2 maps of three major cerebral metabolites: N-acetyl-aspartate (NAA), creatine (Cre), and choline (Cho). We showed that PEPSI spectra matched T2 values obtained using single-voxel spectroscopy (SVS). Data acquisition for 2D metabolite maps with a voxel volume of 0.95 ml (32 x 32 image matrix) can be completed in 25 min using five TEs and eight averages. A sufficient spectral signal-to-noise ratio (SNR) for T2 estimation was validated by high Pearson's correlation coefficients between logarithmic MR signals and TEs (R2 = 0.98, 0.97, and 0.95 for NAA, Cre, and Cho, respectively). In agreement with previous studies, we found that the T2 values of NAA, but not Cre and Cho, were significantly different between gray matter (GM) and white matter (WM; P < 0.001). The difference between the T2 estimates of the PEPSI and SVS scans was less than 9%. Consistent spatial distributions of T2 were found in six healthy subjects, and disagreement among subjects was less than 10%. In summary, the PEPSI technique is a robust method to obtain fast mapping of metabolite T2.

Human brain-structure resolvedT2 relaxation times of proton metabolites at 3 tesla

The transverse relaxation times, T(2), of N-acetylaspartate (NAA), total choline (Cho), and creatine (Cr) obtained at 3T in several human brain regions of eight healthy volunteers are reported. They were obtained simultaneously in 320 voxels with three-dimensional (3D) proton MR spectroscopy ((1)H-MRS) at 1 cm(3) spatial resolution. A two-point protocol, optimized for the least error per given time by adjusting both the echo delay (TE(i)) and number of averages, N(i), at each point, was used. Eight healthy subjects (four males and four females, age = 26 +/- 2 years) underwent the hour-long procedure of four 15-min, 3D acquisitions (TE(1) = 35 ms, N(1) = 1; and TE(2) = 285 ms, N(2) = 3). The results reveal that across all subjects the NAA and Cr T(2)s in gray matter (GM) structures (226 +/- 17 and 137 +/- 12 ms, respectively) were 13-17% shorter than the corresponding T(2)s in white matter (WM; 264 +/- 10 and 155 +/- 7 ms, respectively). The T(2)s of Cho did not differ between GM and WM (207 +/- 17 and 202 +/- 8, respectively). For the purpose of metabolic quantification, these values justify to within +/-10% the previous use of one T(2) per metabolite for 1) the entire brain and 2) all subjects. These T(2) values (which to our knowledge were obtained for the first time at this field, spatial resolution, coverage, and precision) are essential for reliable absolute metabolic quantification.

Use of tissue water as a concentration reference for proton spectroscopic imaging

A strategy for using tissue water as a concentration standard in (1)H magnetic resonance spectroscopic imaging studies on the brain is presented, and the potential errors that may arise when the method is used are examined. The sensitivity of the method to errors in estimates of the different water compartment relaxation times is shown to be small at short echo times (TEs). Using data from healthy human subjects, it is shown that different image segmentation approaches that are commonly used to account for partial volume effects (SPM2, FSL's FAST, and K-means) lead to different estimates of metabolite levels, particularly in gray matter (GM), owing primarily to variability in the estimates of the cerebrospinal fluid (CSF) fraction. While consistency does not necessarily validate a method, a multispectral segmentation approach using FAST yielded the lowest intersubject variability in the estimates of GM metabolites. The mean GM and white matter (WM) levels of N-acetyl groups (NAc, primarily N-acetylaspartate), choline (Ch), and creatine (Cr) obtained in these subjects using the described method with FAST multispectral segmentation are reported: GM [NAc] = 17.16 +/- 1.19 mM; WM [NAc] = 14.26 +/- 1.38 mM; GM [Ch] = 3.27 +/- 0.47 mM; WM [Ch] = 2.65 +/- 0.25 mM; GM [Cr] = 13.98 +/- 1.20 mM; and WM [Cr] = 7.10 +/- 0.67 mM.

(1)H magnetic resonance spectroscopy of autosomal ataxias

Multiple forms of autosomal ataxia exist which can be identified by genetic testing. Due to their wide variety, the identification of the appropriate genetic test is difficult but could be aided by magnetic resonance data. In this study, magnetic resonance spectroscopy (MRS) and imaging (MRI) data were recorded for 20 ataxia patients of six different types and compared to 20 normal subjects. Spectra were acquired in the pons, left frontal lobe, left basal ganglia, left cerebellar hemisphere and vermis. Both metabolite spectra and absolute metabolite concentrations were determined. Differences in metabolite levels were observed between ataxia patients and control subjects and between ataxia patients of different types. A number of correlations were found between metabolite ratios, atrophy levels, number of repeats on the small and large allele, age at examination, symptoms duration and age at symptoms onset for ataxia patients. These MR characteristics are expected to be useful for the identification of the ataxia type.

Integrated data acquisition and processing to determine metabolite contents, relaxation times, and macromolecule baseline in single examinations of individual subjects

Absolute quantitation of clinical (1)H-MR spectra is virtually always incomplete for single subjects because the separate determination of spectrum, baseline, and transverse and longitudinal relaxation times in single subjects is prohibitively long. Integrated Processing and Acquisition of Data (IPAD) based on a combined 2-dimensional experimental and fitting strategy is suggested to substantially improve the information content from a given measurement time. A series of localized saturation-recovery spectra was recorded and combined with 2-dimensional prior-knowledge fitting to simultaneously determine metabolite T(1) (from analysis of the saturation-recovery time course), metabolite T(2) (from lineshape analysis based on metabolite and water peak shapes), macromolecular baseline (based on T(1) differences and analysis of the saturation-recovery time course), and metabolite concentrations (using prior knowledge fitting and conventional procedures of absolute standardization). The procedure was tested on metabolite solutions and applied in 25 subjects (15-78 years old). Metabolite content was comparable to previously found values. Interindividual variation was larger than intraindividual variation in repeated spectra for metabolite content as well as for some relaxation times. Relaxation times were different for various metabolite groups. Parts of the interindividual variation could be explained by significant age dependence of relaxation times.