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Yablonskiy DA, Sukstanskii AL. Quantum dipole interactions and transient hydrogen bond orientation order in cells, cellular membranes and myelin sheath: Implications for MRI signal relaxation, anisotropy, and T 1 magnetic field dependence. Magn Reson Med 2024; 91:2597-2611. [PMID: 38241135 PMCID: PMC10997466 DOI: 10.1002/mrm.29996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/21/2024]
Abstract
PURPOSE Despite significant impact on the study of human brain, MRI lacks a theory of signal formation that integrates quantum interactions involving proton dipoles (a primary MRI signal source) with brain intricate cellular environment. The purpose of the present study is developing such a theory. METHODS We introduce the Transient Hydrogen Bond (THB) model, where THB-mediated quantum dipole interactions between water and protons of hydrophilic heads of amphipathic biomolecules forming cells, cellular membranes and myelin sheath serve as a major source of MR signal relaxation. RESULTS The THB theory predicts the existence of a hydrogen-bond-driven structural order of dipole-dipole connections within THBs as a primary factor for the anisotropy observed in MRI signal relaxation. We have also demonstrated that the conventional Lorentzian spectral density function decreases too fast at high frequencies to adequately capture the field dependence of brain MRI signal relaxation. To bridge this gap, we introduced a stretched spectral density function that surpasses the limitations of Lorentzian dispersion. In human brain, our findings reveal that at any time point only about 4% to 7% of water protons are engaged in quantum encounters within THBs. These ultra-short (2 to 3 ns), but frequent quantum spin exchanges lead to gradual recovery of magnetization toward thermodynamic equilibrium, that is, relaxation of MRI signal. CONCLUSION By incorporating quantum proton interactions involved in brain imaging, the THB approach introduces new insights on the complex relationship between brain tissue cellular structure and MRI measurements, thus offering a promising new tool for better understanding of brain microstructure in health and disease.
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Affiliation(s)
- Dmitriy A. Yablonskiy
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 4525 Scott Ave. Room 3216, St. Louis MO, 63110
- Hope Center for Neurological Disorder, 660 S. Euclid Ave., St. Louis, Missouri 63110
- Knight Alzheimer Disease Research Center, 4488 Forest Park Ave., St. Louis, MO 63108
- Department of Biomedical Engineering, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130
| | - Alexander L. Sukstanskii
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 4525 Scott Ave. Room 3216, St. Louis MO, 63110
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Wang Y, Sun YX, Yang QY, Gao JH. A generalized QUCESOP method with evaluating CEST peak overlap. NMR Biomed 2024; 37:e5098. [PMID: 38224670 DOI: 10.1002/nbm.5098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/26/2023] [Accepted: 12/04/2023] [Indexed: 01/17/2024]
Abstract
The overlapping peaks of the target chemical exchange saturation transfer (CEST) solutes and other unknown CEST solutes affect the quantification results and accuracy of the chemical exchange parameters-the fractional concentration, f b , exchange rate, k b , and transverse relaxation rate, R 2 b -for the target solutes. However, to date, no method has been established for assessing the overlapping peaks. This study aimed to develop a method for quantifying the f b , k b , and R 2 b values of a specific CEST solute, as well as assessing the overlap between the CEST peaks of the specific solute(s) and other unknown solutes. A simplified R 1 ρ model was proposed, assuming linear approximation of the other solutes' contributions to R 1 ρ . A CEST data acquisition scheme was applied with various saturation offsets and saturation powers. In addition to fitting the f b , k b , and R 2 b values of the specific solute, the overlapping condition was evaluated based on the root mean square error (RMSE) between the trajectories of the acquired and synthesized data. Single-solute and multi-solute phantoms with various phosphocreatine (PCr) concentrations and pH values were used to calculate the f b and k b of PCr and the corresponding RMSE. The feasibility of RMSE for evaluating the overlapping condition, and the accurate fitting of f b and k b in weak overlapping conditions, were verified. Furthermore, the method was employed to quantify the nuclear Overhauser effect signal in rat brains and the PCr signal in rat skeletal muscles, providing results that were consistent with those reported in previous studies. In summary, the proposed approach can be applied to evaluate the overlapping condition of CEST peaks and quantify the f b , k b , and R 2 b values of specific solutes, if the weak overlapping condition is satisfied.
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Affiliation(s)
- Yi Wang
- Public Health Science and Engineering College, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yi-Xuan Sun
- School of Medical Technology, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qiu-Yu Yang
- Public Health Science and Engineering College, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jia-Hong Gao
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
- Beijing City Key Lab for Medical Physics and Engineering, Institute of Heavy Ion Physics, School of Physics, Peking University, Beijing, China
- McGovern Institute for Brain Research, Peking University, Beijing, China
- National Biomedical Imaging Center, Peking University, Beijing, China
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Yu FF, Rathnakar J, Ryder B, Hitt B, Kashmer OM, Sherry AD, Vinogradov E. Differentiation and characterization of healthy versus pathological tau using chemical exchange saturation transfer. NMR Biomed 2024:e5160. [PMID: 38646677 DOI: 10.1002/nbm.5160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 02/29/2024] [Accepted: 03/17/2024] [Indexed: 04/23/2024]
Abstract
Neurofibrillary tangles of tau constitute one of the key biological hallmarks of Alzheimer's disease. Currently, the assessment of regional tau accumulation requires intravenous administration of radioactive tracers for PET imaging. A noninvasive MRI-based solution would have significant clinical implications. Herein, we utilized an MRI technique known as chemical exchange saturation transfer (CEST) to determine the imaging signature of tau in both its monomeric and pathologic fibrillated conformations. Three sets of purified recombinant full-length (4R) tau protein were prepared for collection of CEST spectra using a 9.4 T NMR spectrometer at varying temperatures (25, 37, and 42 °C) and RF intensities (0.7, 1.0, 1.5, and 2.2 μT). Monomeric and fibrillated tau were readily distinguished based on their Z-spectrum profiles. Fibrillated tau demonstrated a less prominent peak at 3.5 ppm with additional peaks near 0.5 and 1.5 ppm. No significant differences were identified between fibrillated tau prepared using heparin versus seed-competent tau. In conclusion, monomeric and fibrillated tau can be readily detected and distinguished based on their CEST-derived Z-spectra, pointing to the potential utility of CEST-MRI as a noninvasive biomarker of regional pathologic tau accumulation in the brain. Further testing and validation in vitro and in vivo will be necessary before this can be applied clinically.
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Affiliation(s)
- Fang Frank Yu
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - James Rathnakar
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bryan Ryder
- Center for Alzheimer's and Neurodegenerative Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brian Hitt
- Center for Alzheimer's and Neurodegenerative Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurology, UCI Medical Center, Orange, California, USA
| | - Omar M Kashmer
- Center for Alzheimer's and Neurodegenerative Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - A Dean Sherry
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Chemistry & Biochemistry, University of Texas at Dallas, Dallas, Texas, USA
| | - Elena Vinogradov
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Zhou IY, Ji Y, Zhao Y, Malvika V, Sun PZ, Zu Z. Specific and rapid guanidinium CEST imaging using double saturation power and QUASS analysis in a rodent model of global ischemia. Magn Reson Med 2024; 91:1512-1527. [PMID: 38098305 PMCID: PMC10872646 DOI: 10.1002/mrm.29960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/17/2023] [Accepted: 11/20/2023] [Indexed: 02/03/2024]
Abstract
PURPOSE Guanidinium CEST is sensitive to metabolic changes and pH variation in ischemia, and it can offer advantages over conventional pH-sensitive amide proton transfer (APT) imaging by providing hyperintense contrast in stroke lesions. However, quantifying guanidinium CEST is challenging due to multiple overlapping components and a close frequency offset from water. This study aims to evaluate the applicability of a new rapid and model-free CEST quantification method using double saturation power, termed DSP-CEST, for isolating the guanidinium CEST effect from confounding factors in ischemia. To further reduce acquisition time, the DSP-CEST was combined with a quasi-steady state (QUASS) CEST technique to process non-steady-state CEST signals. METHODS The specificity and accuracy of the DSP-CEST method in quantifying the guanidinium CEST effect were assessed by comparing simulated CEST signals with/without the contribution from confounding factors. The feasibility of this method for quantifying guanidinium CEST was evaluated in a rat model of global ischemia induced by cardiac arrest and compared to a conventional multiple-pool Lorentzian fit method. RESULTS The DSP-CEST method was successful in removing all confounding components and quantifying the guanidinium CEST signal increase in ischemia. This suggests that the DSP-CEST has the potential to provide hyperintense contrast in stroke lesions. Additionally, the DSP-CEST was shown to be a rapid method that does not require the acquisition of the entire or a portion of the CEST Z-spectrum that is required in conventional model-based fitting approaches. CONCLUSION This study highlights the potential of DSP-CEST as a valuable tool for rapid and specific detection of viable tissues.
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Affiliation(s)
- Iris Y. Zhou
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, US
| | - Yang Ji
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Yu Zhao
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, US
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, US
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Viswanathan Malvika
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, US
| | - Phillip Zhe Sun
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, US
- Primate Imaging Center, Emory National Primate Research Center, Emory University, Atlanta, GA
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Zhongliang Zu
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, US
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, US
- Department of Biomedical Engineering, Vanderbilt University, Nashville, US
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Viswanathan M, Kurmi Y, Zu Z. A rapid method for phosphocreatine-weighted imaging in muscle using double saturation power-chemical exchange saturation transfer. NMR Biomed 2024; 37:e5089. [PMID: 38114069 DOI: 10.1002/nbm.5089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023]
Abstract
Monitoring the variation in phosphocreatine (PCr) levels following exercise provides valuable insights into muscle function. Chemical exchange saturation transfer (CEST) has emerged as a sensitive method with which to measure PCr levels in muscle, surpassing conventional MR spectroscopy. However, existing approaches for quantifying PCr CEST signals rely on time-consuming fitting methods that require the acquisition of the entire or a section of the CEST Z-spectrum. Additionally, traditional fitting methods often necessitate clear CEST peaks, which may be challenging to obtain at low magnetic fields. This paper evaluated the application of a new model-free method using double saturation power (DSP), termed DSP-CEST, to estimate the PCr CEST signal in muscle. The DSP-CEST method requires the acquisition of only two or a few CEST signals at the PCr frequency offset with two different saturation powers, enabling rapid dynamic imaging. Additionally, the DSP-CEST approach inherently eliminates confounding signals, offering enhanced robustness compared with fitting methods. Furthermore, DSP-CEST does not demand clear CEST peaks, making it suitable for low-field applications. We evaluated the capability of DSP-CEST to enhance the specificity of PCr CEST imaging through simulations and experiments on muscle tissue phantoms at 4.7 T. Furthermore, we applied DSP-CEST to animal leg muscle both before and after euthanasia and observed successful reduction of confounding signals. The DSP-CEST signal still has contaminations from a residual magnetization transfer (MT) effect and an aromatic nuclear Overhauser enhancement effect, and thus only provides a PCr-weighted imaging. The residual MT effect can be reduced by a subtraction of DSP-CEST signals at 2.6 and 5 ppm. Results show that the residual MT-corrected DSP-CEST signal at 2.6 ppm has significant variation in postmortem tissues. By contrast, both the CEST signal at 2.6 ppm and a conventional Lorentzian difference analysis of CEST signal at 2.6 ppm demonstrate no significant variation in postmortem tissues.
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Affiliation(s)
- Malvika Viswanathan
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Yashwant Kurmi
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Zhongliang Zu
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Zeng Q, Machado M, Bie C, van Zijl PCM, Malvar S, Li Y, D’souza V, Poon KA, Grimm A, Yadav NN. In vivo characterization of glycogen storage disease type III in a mouse model using glycoNOE MRI. Magn Reson Med 2024; 91:1115-1121. [PMID: 38009988 PMCID: PMC10842402 DOI: 10.1002/mrm.29923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/28/2023] [Accepted: 10/24/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Glycogen storage disease type III (GSD III) is a rare inherited metabolic disease characterized by excessive accumulation of glycogen in liver, skeletal muscle, and heart. Currently, there are no widely available noninvasive methods to assess tissue glycogen levels and disease load. Here, we use glycogen nuclear Overhauser effect (glycoNOE) MRI to quantify hepatic glycogen levels in a mouse model of GSD III. METHODS Agl knockout mice (n = 13) and wild-type controls (n = 10) were scanned for liver glycogen content using glycoNOE MRI. All mice were fasted for 12 to 16 h before MRI scans. GlycoNOE signal was quantified by fitting the Z-spectrum using a four-pool Voigt lineshape model. Next, the fitted direct water saturation pool was removed and glycoNOE signal was estimated from the integral of the residual Z spectrum within -0.6 to -1.4 ppm. Glycogen concentration was also measured ex vivo using a biochemical assay. RESULTS GlycoNOE MRI clearly distinguished Agl knockout mice from wild-type controls, showing a statistically significant difference in glycoNOE signals in the livers across genotypes. There was a linear correlation between glycoNOE signal and glycogen concentration determined by the biochemical assay. The obtained glycoNOE maps of mouse livers also showed higher glycogen levels in Agl knockout mice compared to wild-type mice. CONCLUSION GlycoNOE MRI was used successfully as a noninvasive method to detect liver glycogen levels in mice, suggesting the potential of this method to be applied to assess glycogen storage diseases.
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Affiliation(s)
- Qing Zeng
- Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | | | - Chongxue Bie
- Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Peter C. M. van Zijl
- Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Sofi Malvar
- Ultragenyx Pharmaceutical Inc., Novato, CA, United States
| | - Yuguo Li
- Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Valentina D’souza
- Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | | | - Andrew Grimm
- Ultragenyx Pharmaceutical Inc., Novato, CA, United States
| | - Nirbhay N. Yadav
- Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
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Ju L, Wang K, Schär M, Xu S, Rogers J, Zhu D, Qin Q, Weiss RG, Xu J. Simultaneous creatine and phosphocreatine mapping of skeletal muscle by CEST MRI at 3T. Magn Reson Med 2024; 91:942-954. [PMID: 37899691 PMCID: PMC10842434 DOI: 10.1002/mrm.29907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/20/2023] [Accepted: 10/11/2023] [Indexed: 10/31/2023]
Abstract
PURPOSE To confirm that CrCEST in muscle exhibits a slow-exchanging process, and to obtain high-resolution amide, creatine (Cr), and phosphocreatine (PCr) maps of skeletal muscle using a POlynomial and Lorentzian Line-shape Fitting (PLOF) CEST at 3T. METHODS We used dynamic changes in PCr/CrCEST of mouse hindlimb before and after euthanasia to assign the Cr and PCr CEST peaks in the Z-spectrum at 3T and to obtain the optimum saturation parameters. Segmented 3D EPI was employed to obtain multi-slice amide, PCr, and Cr CEST maps of human skeletal muscle. Subsequently, the PCrCEST maps were calibrated using the PCr concentrations determined by 31 P MRS. RESULTS A comparison of the Z-spectra in mouse hindlimb before and after euthanasia indicated that CrCEST is a slow-exchanging process in muscle (<150.7 s-1 ). This allowed us to simultaneously extract PCr/CrCEST signals at 3T using the PLOF method. We determined optimal B1 values ranging from 0.3 to 0.6 μT for CrCEST in muscle and 0.3-1.2 μT for PCrCEST. For the study on human calf muscle, we determined an optimum saturation time of 2 s for both PCr/CrCEST (B1 = 0.6 μT). The PCr/CrCEST using 3D EPI were found to be comparable to those obtained using turbo spin echo (TSE). (3D EPI/TSE PCr: (2.6 ± 0.3) %/(2.3 ± 0.1) %; Cr: (1.3 ± 0.1) %/(1.4 ± 0.07) %). CONCLUSIONS Our study showed that in vivo CrCEST is a slow-exchanging process. Hence, amide, Cr, and PCr CEST in the skeletal muscle can be mapped simultaneously at 3T by PLOF CEST.
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Affiliation(s)
- Licheng Ju
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kexin Wang
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Schär
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Su Xu
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joshua Rogers
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dan Zhu
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Qin Qin
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert G. Weiss
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jiadi Xu
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Donahue MJ, Donahue PMC, Jones RS, Garza M, Lee C, Patel NJ, Cooper A, De Vis JB, Meszoely I, Crescenzi R. In vivo lymph node CEST-Dixon MRI in breast cancer patients with metastatic lymph node involvement. Magn Reson Med 2024; 91:670-680. [PMID: 37684712 DOI: 10.1002/mrm.29858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023]
Abstract
PURPOSE Axillary lymph nodes (LNs) often present a reservoir for metastatic breast cancer, yet metastatic LN involvement cannot be discerned definitively using diagnostic imaging. This study investigated whether in vivo CEST may discriminate LNs with versus without metastatic involvement. METHODS 3T MRI was performed in patients with breast cancer before clinically-indicated mastectomy or lumpectomy with LN removal, after which LN metastasic involvement was determined using histological evaluation. Non-contrast anatomical imaging, as well as B0 and B1 field maps, were acquired in sequence with three-point CEST-Dixon (3D turbo-gradient-echo; factor = 25; TR/TE1/ΔTE = 851/1.35/1.1 ms; spatial-resolution = 2.5 × 2.5 × 6 mm; slices = 10; four sinc-gauss pulses with duty-cycle = 0.5, total saturation duration = 701.7 ms; B1 = 1.5 μT; saturation offsets = -5.5 to +5.5 ppm; stepsize = 0.2 ppm; scan duration = 6 min 30 s). The mean z-spectrum from LNs with (n = 20) versus without (n = 22) metastatic involvement were analyzed and a Wilcoxon rank-sum test (significance: p < 0.05) was applied to evaluate differences in B0, B1 , and magnetization transfer ratio (MTR) in differing spectral regions of known proton exchange (nuclear Overhauser effect [NOE], amide, amine, and hydroxyl) between cohorts. RESULTS No difference in axillary B1 (p = 0.634) or B0 (p = 0.689) was observed between cohorts. Elevated MTR was observed for the NOE (-1.7 ppm; MTR = 0.285 ± 0.075 vs. 0.248 ± 0.039; p = 0.048), amine (+2.5 ppm; MTR = 0.284 ± 0.067 vs. 0.234 ± 0.31; p = 0.005), and hydroxyl (+1 ppm; MTR = 0.394 ± 0.075 vs. 0.329 ± 0.055; p = 0.002) protons in LNs from participants with versus without metastatic involvement. CONCLUSIONS Findings are consistent with a unique metastatic LN microenvironment detectable by CEST-Dixon and suggest that CEST MRI may have potential for mapping LN metastasis non-invasively in vivo.
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Affiliation(s)
- Manus J Donahue
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paula M C Donahue
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Dayani Center for Health and Wellness, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - R Sky Jones
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Maria Garza
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chelsea Lee
- Department of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Niral J Patel
- Department of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Jill B De Vis
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ingrid Meszoely
- Department of Surgery, Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rachelle Crescenzi
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
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Sun C, Zhao Y, Zu Z. Evaluation of the molecular origin of amide proton transfer-weighted imaging. Magn Reson Med 2024; 91:716-734. [PMID: 37749854 PMCID: PMC10841347 DOI: 10.1002/mrm.29878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/15/2023] [Accepted: 09/08/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE To evaluate the assumption in amide proton transfer weighted (APTw) imaging that the APT dominates over the relayed nuclear Overhauser enhancement (rNOE) and other CEST effects such as those from amines/guanidines, thereby providing imaging of mobile proteins/peptides. METHODS We introduced two auxiliary asymmetric analysis metrics that can vary the relative contributions from amine/guanidinium CEST and other effects. By comparing these metrics with the conventional asymmetric analysis metric on healthy rat brains, we can approximately assess the contribution from amines/guanidines to APTw and determine whether the APT dominates over the rNOE effect. To further investigate the molecular origin of APTw, we used samples of dialyzed tissue homogenates to eliminate small metabolites and supernatants of homogenates to separate lipids from other components. RESULTS When the APTw signal is positive using high saturation amplitudes (e.g., 2-3 μT), the contributions from amines/guanidines are significant and cannot be ignored. The APTw signal from the dialyzed homogenates and the controls has negligible changes, indicating that it primarily originates from macromolecules rather than small metabolites. Additionally, the APTw signals with low saturation amplitudes (e.g., 1 μT) were negative in tissue homogenates but positive in their supernatants, suggesting that proteins contribute positively to APTw signals, whereas lipids contribute negatively to it. CONCLUSION The positive APTw signal using high saturation amplitudes could have significant contributions from soluble proteins through CEST, including amide/amine/guanidine proton transfer effects. In contrast, the negative APTw signal using low saturation amplitudes has significant contribution from lipids through rNOE.
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Affiliation(s)
- Casey Sun
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, US
- Department of Chemistry, University of Florida, Gainesville, US
| | - Yu Zhao
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, US
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, US
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Zhongliang Zu
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, US
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, US
- Department of Biomedical Engineering, Vanderbilt University, Nashville, US
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Zhang Q, Tao Q, Xie Y, Chen Z, Seeliger E, Niendorf T, Chen W, Feng Y. Assessment of rhabdomyolysis-induced acute kidney injury with chemical exchange saturation transfer magnetic resonance imaging. Quant Imaging Med Surg 2023; 13:8336-8349. [PMID: 38106319 PMCID: PMC10722020 DOI: 10.21037/qims-23-699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/26/2023] [Indexed: 12/19/2023]
Abstract
Background Rhabdomyolysis (RM)-induced acute kidney injury (AKI) is a common renal disease with low survival rate and inadequate prognosis. In this study, we investigate the feasibility of chemical exchange saturation transfer (CEST) magnetic resonance imaging (MRI) for assessing the progression of RM-induced AKI in a mouse model. Methods AKI was induced in C57BL/6J mice via intramuscular injection of 7.5 mL/kg glycerol (n=30). Subsequently, serum creatinine (SCr), blood urea nitrogen (BUN), and hematoxylin-eosin (HE) and Masson staining, were performed. Longitudinal CEST-MRI was conducted on days 1, 3, 7, 15, and 30 after AKI induction using a 7.0-T MRI system. CEST-MRI quantification parameters including magnetization transfer ratio (MTR), MTR asymmetric analysis (MTRasym), apparent amide proton transfer (APT*), and apparent relayed nuclear Overhauser effect (rNOE*) were used to investigate the feasibility of detecting RM-induced renal damage. Results Significant increases of SCr and BUN demonstrated established AKI. The HE staining revealed various degrees of tubular damage, and Masson staining indicted an increase in the degree of fibrosis in the injured kidneys. Among CEST parameters, the cortical MTR presented a significant difference, and it also showed the best diagnostic performance for AKI [area under the receiver operating characteristic curve (AUC) =0.915] and moderate negative correlations with SCr and BUN. On the first day of renal damage, MTR was significantly reduced in cortex (22.7%±0.04%, P=0.013), outer stripe of outer medulla (24.7%±1.6%, P<0.001), and inner stripe of outer medulla (27.0%±1.5%, P<0.001) compared to the control group. Longitudinally, MTR increased steadily with AKI progression. Conclusions The MTR obtained from CEST-MRI is sensitive to the pathological changes in RM-induced AKI, indicating its potential clinical utility for the assessment of kidney diseases.
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Affiliation(s)
- Qianqian Zhang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Medical Image Processing & Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China
| | - Quan Tao
- Guangdong Provincial Key Laboratory of Medical Image Processing & Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yuanyao Xie
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Medical Image Processing & Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China
| | - Zelong Chen
- Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Erdmann Seeliger
- Institute of Translational Physiology, Charite-Universitatsmedizin Berlin, Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Wufan Chen
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Medical Image Processing & Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China
| | - Yanqiu Feng
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Medical Image Processing & Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China
- Department of Radiology, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde, Foshan), Foshan, China
- Key Laboratory of Mental Health of the Ministry of Education & Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
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11
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Singh M, Jiang S, Li Y, van Zijl P, Zhou J, Heo HY. Bloch simulator-driven deep recurrent neural network for magnetization transfer contrast MR fingerprinting and CEST imaging. Magn Reson Med 2023; 90:1518-1536. [PMID: 37317675 PMCID: PMC10524222 DOI: 10.1002/mrm.29748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/17/2023] [Accepted: 05/18/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE To develop a unified deep-learning framework by combining an ultrafast Bloch simulator and a semisolid macromolecular magnetization transfer contrast (MTC) MR fingerprinting (MRF) reconstruction for estimation of MTC effects. METHODS The Bloch simulator and MRF reconstruction architectures were designed with recurrent neural networks and convolutional neural networks, evaluated with numerical phantoms with known ground truths and cross-linked bovine serum albumin phantoms, and demonstrated in the brain of healthy volunteers at 3 T. In addition, the inherent magnetization-transfer ratio asymmetry effect was evaluated in MTC-MRF, CEST, and relayed nuclear Overhauser enhancement imaging. A test-retest study was performed to evaluate the repeatability of MTC parameters, CEST, and relayed nuclear Overhauser enhancement signals estimated by the unified deep-learning framework. RESULTS Compared with a conventional Bloch simulation, the deep Bloch simulator for generation of the MTC-MRF dictionary or a training data set reduced the computation time by 181-fold, without compromising MRF profile accuracy. The recurrent neural network-based MRF reconstruction outperformed existing methods in terms of reconstruction accuracy and noise robustness. Using the proposed MTC-MRF framework for tissue-parameter quantification, the test-retest study showed a high degree of repeatability in which the coefficients of variance were less than 7% for all tissue parameters. CONCLUSION Bloch simulator-driven, deep-learning MTC-MRF can provide robust and repeatable multiple-tissue parameter quantification in a clinically feasible scan time on a 3T scanner.
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Affiliation(s)
- Munendra Singh
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shanshan Jiang
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yuguo Li
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Peter van Zijl
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Jinyuan Zhou
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hye-Young Heo
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
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12
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Ali SM, Yadav NN, Wirestam R, Singh M, Heo HY, van Zijl PC, Knutsson L. Deep learning-based Lorentzian fitting of water saturation shift referencing spectra in MRI. Magn Reson Med 2023; 90:1610-1624. [PMID: 37279008 PMCID: PMC10524193 DOI: 10.1002/mrm.29718] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/27/2023] [Accepted: 05/12/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE Water saturation shift referencing (WASSR) Z-spectra are used commonly for field referencing in chemical exchange saturation transfer (CEST) MRI. However, their analysis using least-squares (LS) Lorentzian fitting is time-consuming and prone to errors because of the unavoidable noise in vivo. A deep learning-based single Lorentzian Fitting Network (sLoFNet) is proposed to overcome these shortcomings. METHODS A neural network architecture was constructed and its hyperparameters optimized. Training was conducted on a simulated and in vivo-paired data sets of discrete signal values and their corresponding Lorentzian shape parameters. The sLoFNet performance was compared with LS on several WASSR data sets (both simulated and in vivo 3T brain scans). Prediction errors, robustness against noise, effects of sampling density, and time consumption were compared. RESULTS LS and sLoFNet performed comparably in terms of RMS error and mean absolute error on all in vivo data with no statistically significant difference. Although the LS method fitted well on samples with low noise, its error increased rapidly when increasing sample noise up to 4.5%, whereas the error of sLoFNet increased only marginally. With the reduction of Z-spectral sampling density, prediction errors increased for both methods, but the increase occurred earlier (at 25 vs. 15 frequency points) and was more pronounced for LS. Furthermore, sLoFNet performed, on average, 70 times faster than the LS-method. CONCLUSION Comparisons between LS and sLoFNet on simulated and in vivo WASSR MRI Z-spectra in terms of robustness against noise and decreased sample resolution, as well as time consumption, showed significant advantages for sLoFNet.
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Affiliation(s)
| | - Nirbhay N. Yadav
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Ronnie Wirestam
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Munendra Singh
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Hye-Young Heo
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Peter C. van Zijl
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Linda Knutsson
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
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Zhao Y, Sun C, Zu Z. Assignment of molecular origins of NOE signal at -3.5 ppm in the brain. bioRxiv 2023:2023.02.03.526979. [PMID: 36778370 PMCID: PMC9915742 DOI: 10.1101/2023.02.03.526979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose Nuclear Overhauser Enhancement mediated saturation transfer effect, termed NOE(-3.5 ppm), is a major source of chemical exchange saturation transfer (CEST) MRI contrasts at 3.5 ppm in the brain. Previous phantom experiments have demonstrated that both proteins and lipids, two major components in tissues, have substantial contributions to NOE(-3.5 ppm) signals. Their relative contributions in tissues are informative for the interpretation of NOE(-3.5 ppm) contrasts that could provide potential imaging biomarkers for relevant diseases, which remain incompletely understood. Methods Experiments on homogenates and supernatants of brain tissues collected from healthy rats, that could isolate proteins from lipids, were performed to evaluate the relative contribution of lipids to NOE(-3.5 ppm) signals. On the other hand, experiments on ghost membranes with varied pH, and reconstituted phospholipids with different chemical compositions were conducted to study the dependence of NOE(-3.5 ppm) on physiological conditions. Besides, CEST imaging on rat brains bearing 9L tumors and healthy rat brains was performed to analyze the causes of the NOE(-3.5 ppm) contrast variations between tumors and normal tissues, and between gray matter and white matter. Results Our experiments reveal that lipids have dominant contributions to the NOE (-3.5 ppm) signals. Further analysis suggests that decreased NOE(-3.5 ppm) signals in tumors and higher NOE(-3.5 ppm) signals in white matter than in gray matter are mainly explained by changes in membrane lipids, rather than proteins. Conclusion NOE(-3.5 ppm) could be exploited as a highly sensitive MRI contrast for imaging membrane lipids in the brain.
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Jabehdar Maralani P, Chan RW, Lam WW, Oakden W, Oglesby R, Lau A, Mehrabian H, Heyn C, Chan AK, Soliman H, Sahgal A, Stanisz GJ. Chemical Exchange Saturation Transfer MRI: What Neuro-Oncology Clinicians Need To Know. Technol Cancer Res Treat 2023; 22:15330338231208613. [PMID: 37872686 PMCID: PMC10594966 DOI: 10.1177/15330338231208613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
Chemical exchange saturation transfer (CEST) is a relatively novel magnetic resonance imaging (MRI) technique with an image contrast designed for in vivo measurement of certain endogenous molecules with protons that are exchangeable with water protons, such as amide proton transfer commonly used for neuro-oncology applications. Recent technological advances have made it feasible to implement CEST on clinical grade scanners within practical acquisition times, creating new opportunities to integrate CEST in clinical workflow. In addition, the majority of CEST applications used in neuro-oncology are performed without the use gadolinium-based contrast agents which are another appealing feature of this technique. This review is written for clinicians involved in neuro-oncologic care (nonphysicists) as the target audience explaining what they need to know as CEST makes its way into practice. The purpose of this article is to (1) review the basic physics and technical principles of CEST MRI, and (2) review the practical applications of CEST in neuro-oncology.
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Affiliation(s)
- Pejman Jabehdar Maralani
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Rachel W. Chan
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Wilfred W. Lam
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Wendy Oakden
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Ryan Oglesby
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Angus Lau
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Hatef Mehrabian
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Chris Heyn
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Aimee K.M. Chan
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Hany Soliman
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Greg J. Stanisz
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
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