MRI detection of glycogen in vivo by using chemical exchange saturation transfer imaging (glycoCEST)

Application of Chemical Exchange Saturation Transfer (CEST) in neuroimaging

Since the early eighties MRI has become the most powerful technic for in-vivo imaging particularly in the field of brain research. This non-invasive method allows acute anatomical observations of the living brain similar to post-mortem dissected tissues. However, one of the main limitation of MRI is that it does not make possible the neurochemical identification of the tissues conversely to positron emission tomography scanner which can provide a specific molecular characterization of tissue, in spite of poor anatomical definition. To gain neurochemical information using MRI, new categories of contrast agents were developed from the beginning of the 2000's, particularly using the chemical-exchange saturation transfer (CEST) method. This method induces a significant change in the magnitude of the water proton signal and allows the detection of specific molecules within the tissues like sugars, amino acids, transmitters, and nucleosides. This short review presents several CEST contrast agents and their recent developments for in vivo detection of metabolites and neurotransmitters in the brain for research and clinical purposes.

Paracetamol and other acetanilide analogs as inter-molecular hydrogen bonding assisted diamagnetic CEST MRI contrast agents

Paracetamol and a few other acetanilide derivatives are reported as a special class of diamagnetic Chemical Exchange Saturation Transfer (diaCEST) MRI contrast agents, that exhibit contrast only when the molecules form inter-molecular hydrogen bonding mediated molecular chains or sheets. Without the protection of the hydrogen bonding their contrast producing labile proton exchanges too quickly with the solvent to produce any appreciable contrast. Through a number of variable temperature experiments we demonstrate that under the conditions when the hydrogen bond network breaks and the high exchange returns back, the contrast drops quickly. The well-known analgesic drug paracetamol shows 12% contrast at a concentration of 15 mM at physiological conditions. With the proven safety track-record for human consumption and appreciable physiological contrast, paracetamol shows promise as a diaCEST agent for in vivo studies.

Brain pH Imaging and its Applications

Acid-base homeostasis and pH regulation are critical for normal tissue metabolism and physiology, and brain tissue pH alters in many diseased states. Several noninvasive tissue pH Magnetic Resonance (MR) techniques have been developed over the past few decades to shed light on pH change during tissue function and dysfunction. Nevertheless, there are still challenges for mapping brain pH noninvasively at high spatiotemporal resolution. To address this unmet biomedical need, chemical exchange saturation transfer (CEST) MR techniques have been developed as a sensitive means for non-invasive pH mapping. This article briefly reviews the basic principles of different pH measurement techniques with a focus on CEST imaging of pH. Emerging pH imaging applications in the tumor are provided as examples throughout the narrative, and CEST pH imaging in acute stroke is discussed in the final section.

Cardiac 1H MR spectroscopy: development of the past five decades and future perspectives

Continued advances in laboratory medicine are required to realize the potential of individualized medicine to impact common cardiovascular diseases. Magnetic resonance imaging (MRI) and spectroscopy (MRS) techniques have advanced over recent years and offer unique, powerful insights into cardiac anatomic and metabolic changes, respectively, occurring in both nascent and advanced heart disease. Although numerous MRI-based in vivo diagnostics are already used in routine clinical practice and more are anticipated, MRS has been less incorporated into routine clinical practice. Given the ability of ¹H MRS to identify and quantify specific molecules with high sensitivity and specificity, its potential utility should be successfully transition from "bench-to-bedside" is tantalizing. The present review will highlight the development of ¹H MRS techniques for cardiac applications, observations in seminal studies with ¹H MRS, and the prospects and challenges for widespread application in patients with cardiovascular disease.

Tetrakis-(N-methyl-4-pyridinium)-porphyrin as a diamagnetic chemical exchange saturation transfer (diaCEST) MRI contrast agent

Easily synthesizable tetrakis-(N-methyl-4-pyridinium)-porphyrin as a diaCEST agent that shows nearly pH independent good contrast in a wide range of pH.

High-sensitivity CEST mapping using a spatiotemporal correlation-enhanced method

PURPOSE

To obtain high-sensitivity CEST maps by exploiting the spatiotemporal correlation between CEST images.

METHODS

A postprocessing method accomplished by multilinear singular value decomposition (MLSVD) was used to enhance the CEST SNR by exploiting the correlation between the Z-spectrum for each voxel and the low-rank property of the overall CEST data. The performance of this method was evaluated using CrCEST in ischemic mouse brain at 11.7 tesla. Then, MLSVD CEST was applied to obtain Cr, amide, and amine CEST maps of the ischemic mouse brain to demonstrate its general applications.

RESULTS

Complex-valued Gaussian noise was added to CEST k-space data to mimic a low SNR situation. MLSVD CEST analysis was able to suppress the noise, recover the degraded CEST peak, and provide better CrCEST quality compared to the smoothing and singular value decomposition (SVD)-based denoising methods. High-resolution Cr, amide, and amine CEST maps of an ischemic stroke using MLSVD CEST suggest that CrCEST is also a sensitive pH mapping method, and a wide range of pH changes can be detected by combing CrCEST with amine CEST at high magnetic fields.

CONCLUSION

MLSVD CEST provides a simple and efficient way to improve the SNR of CEST images.

Redesigned reporter gene for improved proton exchange-based molecular MRI contrast

Reporter gene imaging allows for non-invasive monitoring of molecular processes in living cells, providing insights on the mechanisms underlying pathology and therapy. A lysine-rich protein (LRP) chemical exchange saturation transfer (CEST) MRI reporter gene has previously been developed and used to image tumor cells, cardiac viral gene transfer, and oncolytic virotherapy. However, the highly repetitive nature of the LRP reporter gene sequence leads to DNA recombination events and the expression of a range of truncated LRP protein fragments, thereby greatly limiting the CEST sensitivity. Here we report the use of a redesigned LRP reporter (rdLRP), aimed to provide excellent stability and CEST sensitivity. The rdLRP contains no DNA repeats or GC rich regions and 30% less positively charged amino-acids. RT-PCR of cell lysates transfected with rdLRP demonstrated a stable reporter gene with a single distinct band corresponding to full-length DNA. A distinct increase in CEST-MRI contrast was obtained in cell lysates of rdLRP transfected cells and in in vivo LRP expressing mouse brain tumors ([Formula: see text], n = 10).

Skeletal muscle magnetic resonance imaging in Pompe disease

Pompe disease is characterized by a deficiency of acid alpha-glucosidase that results in muscle weakness and a variable degree of disability. There is an approved therapy based on enzymatic replacement that has modified disease progression. Several reports describing muscle magnetic resonance imaging (MRI) features of Pompe patients have been published. Most of the studies have focused on late-onset Pompe disease (LOPD) and identified a characteristic pattern of muscle involvement useful for the diagnosis. In addition, quantitative MRI studies have shown a progressive increase in fat in skeletal muscles of LOPD over time and they are increasingly considered a good tool to monitor progression of the disease. The studies performed in infantile-onset Pompe disease patients have shown less consistent changes. Other more sophisticated muscle MRI sequences, such as diffusion tensor imaging or glycogen spectroscopy, have also been used in Pompe patients and have shown promising results.

Pulse sequences for measuring exchange rates between proton species: From unlocalised NMR spectroscopy to chemical exchange saturation transfer imaging

Within the field of NMR spectroscopy, the study of chemical exchange processes through saturation transfer techniques has a long history. In the context of MRI, chemical exchange techniques have been adapted to increase the sensitivity of imaging to small fractions of exchangeable protons, including the labile protons of amines, amides and hydroxyls. The MR contrast is generated by frequency-selective irradiation of the labile protons, which results in a reduction of the water signal associated with transfer of the labile protons' saturated magnetization to the protons of the surrounding free water. The signal intensity depends on the rate of chemical exchange and the concentration of labile protons as well as on the properties of the irradiation field. This methodology is referred to as CEST (chemical exchange saturation transfer) imaging. Applications of CEST include imaging of molecules with short transverse relaxation times and mapping of physiological parameters such as pH, temperature, buffer concentration and chemical composition due to the dependency of this chemical exchange effect on all these parameters. This article aims to describe these effects both theoretically and experimentally. In depth analysis and mathematical modelling are provided for all pulse sequences designed to date to measure the chemical exchange rate. Importantly, it has become clear that the background signal from semi-solid protons and the presence of the Nuclear Overhauser Effect (NOE), either through direct dipole-dipole mechanisms or through exchange-relayed signals, complicates the analysis of CEST effects. Therefore, advanced methods to suppress these confounding factors have been developed, and these are also reviewed. Finally, the experimental work conducted both in vitro and in vivo is discussed and the progress of CEST imaging towards clinical practice is presented.

Frequency-stabilized chemical exchange saturation transfer imaging with real-time free-induction-decay readout

PURPOSE

To correct the temporal B₀ drift in chemical exchange saturation transfer (CEST) imaging in real-time with extra free-induction-decay (FID) readout.

THEORY AND METHODS

The frequency stabilization module of the recently proposed frequency-stabilized CEST (FS-CEST) sequence was further simplified by replacing the original three k-space lines of gradient-echo (GRE) readout with a single k-space line of FID readout. The B₀ drift was quantified using the phase difference between the odd and even parts of the FID signal in the frequency stabilization module and then used to update the B₀ frequency in the succeeding modules. The proposed FS-CEST sequence with FID readout (FID FS-CEST) was validated in phantoms and 16 human subjects on cross-vendor scanners.

RESULTS

In the Siemens experiments, the FID FS-CEST sequence successfully corrected the user-induced B₀ drift, generating consistent amide proton transfer-weighted (APTw) images and magnetization transfer ratio asymmetry (MTR_asym ) spectra with those from the non-frequency-stabilized CEST (NFS-CEST) sequence without B₀ drift. In the Philips experiments, the FID FS-CEST sequence produced more stable APTw images and MTR_asym spectra than the NFS-CEST sequence in the presence of practical B₀ drift. Quantitatively, the SD of the APTw signal values in the deep gray matter from 15 subjects was 0.26% for the FID FS-CEST sequence compared to 1.03% for the NFS-CEST sequences, with the fluctuations reduced by nearly three-quarters.

CONCLUSIONS

The proposed FS-CEST sequence with FID readout can effectively correct the temporal B₀ drift on cross-vendor scanners.

Mechanism and quantitative assessment of saturation transfer for water-based detection of the aliphatic protons in carbohydrate polymers

PURPOSE

CEST MRI experiments of mobile macromolecules, for example, proteins, carbohydrates, and phospholipids, often show signals due to saturation transfer from aliphatic protons to water. Currently, the mechanism of this nuclear Overhauser effect (NOE)-based transfer pathway is not completely understood and could be due either to NOEs directly to bound water or NOEs relayed intramolecularly via exchangeable protons. We used glycogen as a model system to investigate this saturation transfer pathway in sugar polymer solution.

METHODS

To determine whether proton exchange affected saturation transfer, saturation spectra (Z-spectra) were measured for glycogen solutions of different pH, D₂ O/H₂ O ratio, and glycogen particle size. A theoretical model was derived to analytically describe the NOE-based signals in these spectra. Numerical simulations were performed to verify this theory, which was further tested by fitting experimental data for different exchange regimes.

RESULTS

Signal intensities of aliphatic NOEs in Z-spectra of glycogen in D₂ O solution were influenced by hydroxyl proton exchange rates, whereas those in H₂ O were not. This indicates that the primary transfer pathway is an exchange-relayed NOE from these aliphatic protons to neighboring hydroxyl protons, followed by the exchange to water protons. Experimental data for glycogen solutions in D₂ O and H₂ O could be analyzed successfully using an analytical theory derived for such relayed NOE transfer, which was further validated using numerical simulations with the Bloch equations.

CONCLUSION

The predominant mechanism underlying aliphatic signals in Z-spectra of mobile carbohydrate polymers is intramolecular relayed NOE transfer followed by proton exchange.

N-Aryl Amides as Chemical Exchange Saturation Transfer Magnetic Resonance Imaging Contrast Agents

Chemical exchange saturation transfer (CEST) MRI has recently emerged as a versatile molecular imaging approach in which diamagnetic compounds can be utilized to generate an MRI signal. To expand the scope of CEST MRI applications, herein, we systematically investigated the CEST properties of N-aryl amides with different N-aromatic substitution, revealing their chemical shifts (4.6-5.8 ppm) and exchange rates (up to thousands s^-1 ) are favorable to be used as CEST agents as compared to alkyl amides. As the first proof-of-concept study, we used CEST MRI to detect the enzymatic metabolism of the drug acebutolol directly by its intrinsic CEST signal without any chemical labeling. Our study implies that N-aryl amides may enable the label-free CEST MRI detection of the metabolism of many N-aryl amide-containing drugs and a variety of enzymes that act on N-aryl amides, greatly expanding the scope of CEST MR molecular imaging.

Diffusion Tensor Imaging and Chemical Exchange Saturation Transfer MRI Evaluation on the Long-Term Effects of Pulsed Focused Ultrasound and Microbubbles Blood Brain Barrier Opening in the Rat

Blood-brain barrier opening (BBBO) with pulsed Focused Ultrasound (pFUS) and microbubbles (MB) has received increasing interest as a method for neurotherapeutics of the central nervous system. In general, conventional MRI [i.e., T2w, T2^∗w, gadolinium (Gd) enhanced T1w] is used to monitor the effects of pFUS+MB on BBBO and/or assess whether sonication results in parenchymal damage. This study employed multimodal MRI techniques and ¹⁸F-Fludeoxyglucose (FDG) PET to evaluate the effects of single and multiple weekly pFUS+MB sessions on morphology and glucose utilization levels in the rat cortex and hippocampus. pFUS was performed with 0.548 MHz transducer with a slow infusion over 1 min of Optison^TM (5–8 × 10⁷ MB) in nine focal points in cortex and four in hippocampus. During pFUS+MB treatment, Gd-T1w was performed at 3 T to confirm BBBO, along with subsequent T2w, T2^∗w, DTI and glucose CEST (glucoCEST)-weighted imaging by high field 9.4 T and compared with FDG-PET and immunohistochemistry. Animals receiving a single pFUS+MB exhibited minimal hypointense voxels on T2^∗w. Brains receiving multiple pFUS+MB treatments demonstrated persistent T2w and T2^∗ abnormalities associated with changes in DTI and glucoCEST when compared to contralateral parenchyma. Decreased glucoCEST contrast was substantiated by FDG-PET in cortex following multiple sonications. Immunohistochemistry showed significantly dilated vessels and decreased neuronal glucose transporter (GLUT3) expression in sonicated cortex and hippocampus without changes in neuronal counts. These results suggest the importance to standardize MRI protocols in concert with advanced imaging techniques when evaluating long term effects of pFUS+MB BBBO in clinical trials for neurological diseases.

Regional Mapping of Brain Glutamate Distributions Using Glutamate-Weighted Chemical Exchange Saturation Transfer Imaging

PURPOSE

To investigate glutamate signal distributions in multiple brain regions of a healthy rat brain using glutamate-weighted chemical exchange saturation transfer (GluCEST) imaging.

METHOD

The GluCEST data were obtained using a 7.0 T magnetic resonance imaging (MRI) scanner, and all data were analyzed using conventional magnetization transfer ratio asymmetry in eight brain regions (cortex, hippocampus, corpus callosum, and rest of midbrain in each hemisphere). GluCEST data acquisition was performed again one month later in five randomly selected rats to evaluate the stability of the GluCEST signal. To evaluate glutamate level changes calculated by GluCEST data, we compared the results with the concentration of glutamate acquired from 1H magnetic resonance spectroscopy (1H MRS) data in the cortex and hippocampus.

RESULTS

GluCEST signals showed significant differences (all p ≤ 0.001) between the corpus callosum (-1.71 ± 1.04%; white matter) and other brain regions (3.59 ± 0.41%, cortex; 5.47 ± 0.61%, hippocampus; 4.49 ± 1.11%, rest of midbrain; gray matter). The stability test of GluCEST findings for each brain region was not significantly different (all p ≥ 0.263). In line with the GluCEST results, glutamate concentrations measured by 1H MRS also appeared higher in the hippocampus (7.30 ± 0.16 μmol/g) than the cortex (6.89 ± 0.72 μmol/g).

CONCLUSION

Mapping of GluCEST signals in the healthy rat brain clearly visualize glutamate distributions. These findings may yield a valuable database and insights for comparing glutamate signal changes in pre-clinical brain diseases.

Follow-up of late-onset Pompe disease patients with muscle magnetic resonance imaging reveals increase in fat replacement in skeletal muscles

BACKGROUND

Late-onset Pompe disease (LOPD) is a genetic disorder characterized by progressive degeneration of the skeletal muscles produced by a deficiency of the enzyme acid alpha-glucosidase. Enzymatic replacement therapy with recombinant human alpha-glucosidase seems to reduce the progression of the disease; although at the moment, it is not completely clear to what extent. Quantitative muscle magnetic resonance imaging (qMRI) is a good biomarker for the follow-up of fat replacement in neuromuscular disorders. The aim of this study was to describe the changes observed in fat replacement in skeletal muscles using qMRI in a cohort of LOPD patients followed prospectively.

METHODS

A total of 36 LOPD patients were seen once every year for 4 years. qMRI, several muscle function tests, spirometry, activities of daily living scales, and quality-of-life scales were performed on each visit. Muscle MRI consisted of two-point Dixon studies of the trunk and thigh muscles. Computer analysis of the images provided the percentage of muscle degenerated and replaced by fat in every muscle (known as fat fraction). Longitudinal analysis of the measures was performed using linear mixed models applying the Greenhouse-Geisser test.

RESULTS

We detected a statistically significant and continuous increase in mean thigh fat fraction both in treated (+5.8% in 3 years) and in pre-symptomatic patients (+2.6% in 3years) (Greenhouse-Geisser p < 0.05). As an average, fat fraction increased by 1.9% per year in treated patients, compared with 0.8% in pre-symptomatic patients. Fat fraction significantly increased in every muscle of the thighs. We observed a significant correlation between changes observed in fat fraction in qMRI and changes observed in the results of the muscle function tests performed. Moreover, we identified that muscle performance and mean thigh fat fraction at baseline visit were independent parameters influencing fat fraction progression over 4 years (analysis of covariance, p < 0.05).

CONCLUSIONS

Our study identifies that skeletal muscle fat fraction continues to increase in patients with LOPD despite the treatment with enzymatic replacement therapy. These results suggest that the process of muscle degeneration is not stopped by the treatment and could impact muscle function over the years. Hereby, we show that fat fraction along with muscle function tests can be considered a good outcome measures for clinical trials in LOPD patients.

Diffusion tensor imaging reveals changes in non-fat infiltrated muscles in late onset Pompe disease

MRI is a helpful tool for monitoring disease progression in late-onset Pompe disease (LOPD). Our study aimed to evaluate if muscle diffusion tensor imaging (mDTI) shows alterations in muscles of LOPD patients with <10% fat-fraction. We evaluated 6 thigh and 7 calf muscles (both legs) of 18 LOPD and 29 healthy controls (HC) with muscle diffusion tensor imaging (mDTI), T1w, and mDixonquant sequences in a 3T MRI scanner. The quantitative mDTI-values axial diffusivity (λ₁ ), mean diffusivity (MD), radial diffusivity (RD), and fractional anisotropy (FA) as well as fat-fraction were analyzed. 6-Minute Walk Test (6-MWT) data were correlated to diffusion metrics. We found that mDTI showed significant differences between LOPD and HC in diffusion parameters (P < .05). Thigh muscles with <10% fat-fraction showed significant differences in MD, RD, and λ_1-3 . MD positively correlated with 6-MWT (P = .06). To conclude, mDTI reveals diffusion restrictions in muscles of LOPD with and without fat-infiltration and reflects structural changes prior to fatty degeneration.

HDO production from [2H7]glucose Quantitatively Identifies Warburg Metabolism

Increased glucose uptake and aerobic glycolysis are striking features of many cancers. These features have led to many techniques for screening and diagnosis, but many are expensive, less feasible or have harmful side-effects. Here, we report a sensitive 1H/2H NMR method to measure the kinetics of lactate isotopomer and HDO production using a deuterated tracer. To test this hypothesis, HUH-7 hepatocellular carcinoma and AML12 normal hepatocytes were incubated with [2H7]glucose. 1H/2H NMR data were recorded for cell media as a function of incubation time. The efflux rate of lactate-CH3, lactate-CH2D and lactate-CHD2 was calculated as 0.0033, 0.0071, and 0.0.012 µmol/106cells/min respectively. Differential production of lactate isotopomers was due to deuterium loss during glycolysis. Glucose uptake and HDO production by HUH-7 cells showed a strong correlation, indicating that monitoring the HDO production could be a diagnostic feature in cancers. Deuterium mass balance of [2H7]glucose uptake to 2H-lactate and HDO production is quantitatively matched, suggesting increasing HDO signal could be used to diagnose Warburg (cancer) metabolism. Measuring the kinetics of lactate isotopomer and HDO production by 1H and 2H MR respectively are highly sensitive. Increased T1 of 2H-lactate isotopomers indicates inversion/saturation recovery methods may be a simple means of generating metabolism-based contrast.

Model-Based Chemical Exchange Saturation Transfer MRI for Robust z-Spectrum Analysis

This paper introduces a novel, model-based chemical exchange saturation transfer (CEST) magnetic resonance imaging (MRI), in which asymmetric spectra of interest are directly estimated from complete or incomplete measurements by incorporating subspace-based spectral signal decomposition into the measurement model of CEST MRI for a robust z-spectrum analysis. Spectral signals are decomposed into symmetric and asymmetric components. The symmetric component, which varies smoothly, is delineated by the linear superposition of a finite set of vectors in a basis trained from the simulated (Lorentzian) signal vectors augmented with data-driven signal vectors, while the asymmetric component is to be inherently lower than or equal to zero due to saturation transfer phenomena. Spectral decomposition is performed directly on the measured spectral data by solving a constrained optimization problem that employs the linearized spectral decomposition model for the symmetric component and the weighted Frobenius norm regularization for the asymmetric component while utilizing additional spatial sparsity and low-rank priors. The simulations and in vivo experiments were performed to demonstrate the feasibility of the proposed method as a reliable molecular MRI.

Magnetic resonance imaging of glycogen using its magnetic coupling with water

Glycogen plays a central role in glucose homeostasis and is abundant in several types of tissue. We report an MRI method for imaging glycogen noninvasively with enhanced detection sensitivity and high specificity, using the magnetic coupling between glycogen and water protons through the nuclear Overhauser enhancement (NOE). We show in vitro that the glycogen NOE (glycoNOE) signal is correlated linearly with glycogen concentration, while pH and temperature have little effect on its intensity. For validation, we imaged glycoNOE signal changes in mouse liver, both before and after fasting and during glucagon infusion. The glycoNOE signal was reduced by 88 ± 16% (n = 5) after 24 h of fasting and by 76 ± 22% (n = 5) at 1 h after intraperitoneal (i.p.) injection of glucagon, which is known to rapidly deplete hepatic glycogen. The ability to noninvasively image glycogen should allow assessment of diseases in which glucose metabolism or storage is altered, for instance, diabetes, cardiac disease, muscular disorders, cancer, and glycogen storage diseases.

Assessment of Rapid Hepatic Glycogen Synthesis in Humans Using Dynamic 13C Magnetic Resonance Spectroscopy

Carbon-13 magnetic resonance spectroscopy (MRS) following oral intake of ¹³C-labeled glucose is the gold standard for imaging glycogen metabolism in humans. However, the temporal resolution of previous studies has been >13 minutes. Here, we describe a high-sensitivity ¹³C MRS method for imaging hepatic glycogen synthesis with a temporal resolution of 1 minute or less. Nuclear magnetic resonance spectra were acquired from the liver of 3 healthy volunteers, using a ¹³C clamshell radiofrequency transmit and paddle-shaped array receive coils in a 3 Tesla magnetic resonance imaging system. Following a 15-minute baseline ¹³C MRS scan of the liver, [1-¹³C]-glucose was ingested and ¹³C MRS data were acquired for an additional 1-3 hours. Dynamic change of the hepatic glycogen synthesis level was analyzed by reconstructing the acquired MRS data with temporal resolutions of 30 seconds to 15 minutes. Plasma levels of ¹³C-labeled glucose and lactate were measured using gas chromatography-mass spectrometry. While not detected at baseline ¹³C MRS, [1-¹³C]-labeled α-glucose and β-glucose and glycogen peaks accumulated rapidly, beginning as early as ~2 minutes after oral administration of [1-¹³C]-glucose. The [1-¹³C]-glucose signals peaked at ~5 minutes, whereas [1-¹³C]-glycogen peaked at ~25 minutes after [1-¹³C]-glucose ingestion; both signals declined toward baseline levels over the next 1-3 hours. Plasma levels of ¹³C-glucose and ¹³C-lactate rose gradually, and approximately 20% of all plasma glucose and 5% of plasma lactate were ¹³C-labeled by 2 hours after ingestion. Conclusion: We observed rapid accumulation of hepatic [1-¹³C]-glycogen following orally administered [1-¹³C]-glucose, using a dynamic ¹³C MRS method with a temporal resolution of 1 minute or less. Commercially available technology allows high temporal resolution studies of glycogen metabolism in the human liver.

Proton Exchange Magnetic Resonance Imaging: Current and Future Applications in Psychiatric Research

Proton exchange provides a powerful contrast mechanism for magnetic resonance imaging (MRI). MRI techniques sensitive to proton exchange provide new opportunities to map, with high spatial and temporal resolution, compounds important for brain metabolism and function. Two such techniques, chemical exchange saturation transfer (CEST) and T1 relaxation in the rotating frame (T1ρ), are emerging as promising tools in the study of neurological and psychiatric illnesses to study brain metabolism. This review describes proton exchange for non-experts, highlights the current status of proton-exchange MRI, and presents advantages and drawbacks of these techniques compared to more traditional methods of imaging brain metabolism, including positron emission tomography (PET) and MR spectroscopy (MRS). Finally, this review highlights new frontiers for the use of CEST and T1ρ in brain research.

Furin-mediated intracellular self-assembly of olsalazine nanoparticles for enhanced magnetic resonance imaging and tumour therapy

Among the strategies used for enhancement of tumour retention of imaging agents or anticancer drugs is the rational design of probes that undergo a tumour-specific enzymatic reaction preventing them from being pumped out of the cell. Here, the anticancer agent olsalazine (Olsa) was conjugated to the cell-penetrating peptide RVRR. Taking advantage of a biologically compatible condensation reaction, single Olsa-RVRR molecules were self-assembled into large intracellular nanoparticles by the tumour-associated enzyme furin. Both Olsa-RVRR and Olsa nanoparticles were readily detected with chemical exchange saturation transfer magnetic resonance imaging by virtue of exchangeable Olsa hydroxyl protons. In vivo studies using HCT116 and LoVo murine xenografts showed that the OlsaCEST signal and anti-tumour therapeutic effect were 6.5- and 5.2-fold increased, respectively, compared to Olsa without RVRR, with an excellent 'theranostic correlation' (R2 = 0.97) between the imaging signal and therapeutic response (normalized tumour size). This furin-targeted, magnetic resonance imaging-detectable platform has potential for imaging tumour aggressiveness, drug accumulation and therapeutic response.

High-resolution creatine mapping of mouse brain at 11.7 T using non-steady-state chemical exchange saturation transfer

The current study aims to optimize the acquisition scheme for the creatine chemical exchange saturation transfer weighted (CrCESTw) signal on mouse brain at 11.7 T, in which a strong magnetization transfer contrast (MTC) is present, and to further develop the polynomial and Lorentzian line-shape fitting (PLOF) method for quantifying CrCESTw signal with a non-steady-state (NSS) acquisition scheme. Studies on a Cr phantom with cross-linked bovine serum albumin (BSA) as well as on mouse brain demonstrated that the maximum CrCESTw signal was reached with a short saturation time determined by the rotating frame relaxation time of the MTC pool instead of the steady-state saturation. The saturation power for the maximal signal was around 1-1.5 μT for Cr with 20% cross-linked BSA and in vivo applications, but 2 μT was found to be most practical for signal stability. For the CrCEST acquisition with strong MTC interference, the optimal saturation power and length are completely different from those on Cr solution alone. This observation could be explained well using R_1ρ theory by incorporating the strong MTC pool. Finally, a high-resolution Cr map was obtained on mouse brain using the PLOF method with the NSS CEST acquisition and a cryogenic coil. The Cr map obtained by CEST showed homogenous intensity across the mouse brain except for regions with cerebrospinal fluid.

Approximated analytical characterization of the steady-state chemical exchange saturation transfer (CEST) signals

PURPOSE

CEST MRI can indirectly detect low-concentrated molecules via their proton exchange with the bulk water and is widely measured by a sensitivity index, the asymmetry of magnetization transfer ratio (MTRasym ). Because CEST applications are often limited by their low sensitivity or specificity, it is important to characterize MTRasym analytically to optimize its sensitivity or specifity.

METHODS

Approximated analytical solutions of the MTRasym spectrum were derived based on a 2-pool chemical exchange model for slow-to-intermediate exchanges. The optimal saturation pulse power for maximizing the MTRasym or tuning MTRasym to a specific exchange rate and the peak position and linewidth of a MTRasym spectrum were also derived. These approximated analytical solutions were compared with the solutions from the Bloch-McConnell equations using computer simulations.

RESULTS

The approximated analytical solutions of the MTRasym spectra, the optimizing parameters, and the peak and linewidth of MTRasym matched well with the solutions of Bloch-McConnell equations in the slow or slow-to-intermediate exchange regimes.

CONCLUSION

These approximate analytical solutions can provide insights to the understanding of CEST signal property and help the optimization of saturation parameters and the interpretation of CEST data.

Repeatability and reproducibility of prospective motion- and shim corrected 2D glycoCEST MRI

Background

Repeated glycoCEST MRI measurements on the same subject should produce similar results under the same environmental and experimental conditions. However, fluctuations in the static B₀ field, which may occur between and within measurements due to heating of the shim iron or subject motion, may alter results and affect reproducibility. Here we investigate the repeatability and reproducibility of glycoCEST measurements and examine the effectiveness of a real-time shim- and motion navigated chemical exchange saturation transfer (CEST) sequence to improve reproducibility.

Methods

In nine subjects, double volumetric navigated (DvNav)-CEST acquisitions in the calf muscle were repeated five times in each of two sessions-the first without correction, and the second with real-time shim- and motion correction applied. In both sessions a dynamically changing field was introduced by running a 5-minute gradient intensive diffusion sequence. We evaluated the effect of the introduced B₀ inhomogeneity on the reproducibility of glycoCEST, where the small chemical shift difference between the hydroxyl and bulk water protons at 3 T makes CEST quantification extremely sensitive to magnetic field inhomogeneities.

Results

With real-time shim- and motion correction, glycoCEST results were relatively consistent with mean coefficient of variation (CoV) 2.7%±1.4% across all subjects, whereas without correction the results were less consistent with CoV 84%±71%.

Conclusions

Our results demonstrate that real-time shim- and motion correction can mitigate effects of B0 field fluctuations and improve reproducibility of glycoCEST data. This is important when conducting longitudinal studies or when using glycoCEST MRI to assess treatment or physiological responses over time.

Molecular imaging of tumors by chemical exchange saturation transfer MRI of glucose analogs

Early detection of the cancerous process would benefit greatly from imaging at the cellular and molecular level. Increased glucose demand has been recognized as one of the hallmarks of cancerous cells (the "Warburg effect"), hence glucose and its analogs are commonly used for cancer imaging. One example is FDG-PET technique, that led to the use of chemical exchange saturation transfer (CEST) MRI of glucose ("glucoCEST") for tumor imaging. This technique combines high-resolution MRI obtained by conventional imaging with simultaneous molecular information obtained from the exploitation of agents with exchangeable protons from amine, amide or hydroxyl residues with the water signal. In the case of glucoCEST, these agents are based on glucose or its analogs. Recently, preclinical glucoCEST studies demonstrated the ability to increase the sensitivity of MRI to the level of metabolic activity, enabling identification of tumor staging, biologic potential, treatment planning, therapy response and local recurrence, in addition to guiding target biopsy for clinically suspected cancer. However, natural glucose limits this method because of its rapid conversion to lactic acid, leading to reduced CEST effect and short signal duration. For that reason, a variety of glucose analogs have been tested as alternatives to the original glucoCEST. This review discusses the merits of these analogs, including new data on glucose analogs heretofore not reported in the literature. This summarized preclinical data may help strengthen the translation of CEST MRI of glucose analogs into the clinic, improving cancer imaging to enable early intervention without the need for invasive techniques. The data should also broaden our knowledge of fundamental biological processes.

Chemical exchange saturation transfer magnetic resonance imaging and its main and potential applications in pre-clinical and clinical studies

Chemical exchange saturation transfer (CEST) imaging is a novel contrast mechanism, relying on the exchange between mobile protons in amide (-NH), amine (-NH2) and hydroxyl (-OH) groups and bulk water. Due to the targeted protons present in endogenous molecules or exogenous compounds applied externally, CEST imaging can respectively, generate endogenous or exogenous contrast. Nowadays, CEST imaging for endogenous contrast has been explored in pre-clinical and clinical studies. Amide CEST, also called amide proton transfer weighted (APT) imaging, generates CEST effect at 3.5 ppm away from the water signal and has been widely investigated. Given the sensitivity to amide proton concentration and pH level, APT imaging has shown robust performance in the assessment of ischemia, brain tumors, breast and prostate cancer as well as neurodegenerative diseases. With advanced methods proposed, pure APT and Nuclear Overhauser Effect (NOE) mediated CEST effects were separately fitted from original APT signal. Using both effects, early but promising results were obtained for glioma patients in the evaluation of tumor response to therapy and patient survival. Compared to amide CEST, amine CEST is also mobile proton concentration and pH dependent, but has a faster exchange rate between amine protons and water. The resultant CEST effect is usually introduced at 1.8-3 ppm. Glutamate and creatine, as two main metabolites with amine groups for CEST imaging, have been applied to quantitatively assess diseases in the central nervous system and muscle system, respectively. Glycosaminoglycan (Gag) as a representative metabolite with hydroxyl groups has also been measured to evaluate the cartilage of knee or intervertebral discs in CEST MRI. Due to limited frequency difference between hydroxyl protons and water, 7T for better spectral separation is preferred over 3T for GagCEST measurement. The applications of CEST MRI with exogenous contrast agents are still quite limited in clinic. While certain diamagnetic CEST agents, such as dynamic-glucose, have been tried in human for brain tumor or neck cancer assessment, most exogenous agents, i.e., paramagnetic CEST agents, are still tested in the pre-clinical stage, mainly due to potential toxicity. Engineered tissues for tissue regeneration and drug delivery have also shown a great potential in CEST imaging, as many of them, such as hydrogel and polyamide materials, contain mobile protons or can be incorporated with CEST specific chemical compounds. These engineered tissues can thus generate CEST effect in vivo, allowing a possibility to understand the fate of them in vivo longitudinally. Although the CEST MRI with engineered tissues has only been established in early stage, the obtained first evidence is crucial for further optimizing these biomaterials and finally accomplishing the translation into clinical use.

In vivo quantification of proton exchange rate in healthy human brains with omega plot

Background

To implement omega plot method for in vivo mapping of proton exchange rates in human brain by taking into account the water direct saturation (DS) effect and multiple saturation transfer exchanging species in vivo.

Methods

Four Z-spectra were collected with chemical exchange saturation transfer (CEST) saturation power =1, 2, 3 & 4 µT. Water DS was estimated by fitting the Z-spectrum to a linear combination of multiple Lorentzian components and its contribution to the signal was subsequently removed. Exchange rate maps were derived by the omega plot, consisting of fitting the inverse of the signal intensity, M_z /(M ₀-M_z ), as a function of 1/(γB₁)².

Results

The exchange rate values quantified with the DS removed omega plot were significantly higher in the GM region than in the WM region (616±29 vs. 575±20 s^-1, P<0.001). Phantom studies confirmed that the exchange rates from DS-removed plots varied linearly with pH (R²=0.998) for the pH range of 6.2 to 7.4, whereas exchange rates from conventional omega plots failed to show such linearity in the entire physiological pH range.

Conclusions

The calculated exchange rate with DS-corrected omega plot is a weighted average for all saturation transfer exchanging proton species which contribute to Z-spectral signal. The healthy brain exchange rate map provided by DS-removed omega plots may serve as a baseline for detecting any pathological changes.

Voxel-wise Optimization of Pseudo Voigt Profile (VOPVP) for Z-spectra fitting in chemical exchange saturation transfer (CEST) MRI

BACKGROUND

Chemical exchange saturation transfer (CEST) MRI is a promising approach for detecting biochemical alterations in cancers and neurological diseases, but the quantification can be challenging. Among numerous quantification methods, Lorentzian difference (LD) is relatively simple and widely used, which employs Lorentzian line-shape as a reference to describe the direct saturation (DS) of water and takes account of difference against experimental CEST spectra data. However, LD often overestimates CEST and nuclear overhauser enhancement (NOE) effects. Specifically, for fast-exchanging CEST species require higher saturation power (B1_sat) or in the presence of strong magnetization transfer (MT) contrast, Z-spectrum appears more like a Gaussian line-shape rather than a Lorentzian line-shape.

METHODS

To improve the conventional LD analysis, the present study developed and validated a novel fitting algorithm through a linear combination of Gaussian and Lorentzian function as the reference spectra, namely, Voxel-wise Optimization of Pseudo Voigt Profile (VOPVP). The experimental Z-spectra were pre-fitted with Gaussian and Lorentzian method independently, in order to determine Lorentzian proportionality coefficient (a). To further compensate for the line-shape changes under different B1_sat's, a B1-dependent adjustment was applied to the experimental Z-spectra (Z_exp) according to the prior knowledge learned from 5-pool Bloch equation-based simulations at a range of B1_sat's. Then, the obtained Z-spectra (Z_B1adj) was fitted by the previously defined VOPVP function. Considering the asymmetric component of MT, the positive- and negative-side of Z-spectra were fitted separately, while the middle part (-0.6 to 0.6 ppm, consisted primarily of DS) was fitted using Lorentzian function. Finally, the difference between Z_VOPVP and Z_exp was defined as the CEST and NOE contrast. To validate our VOPVP method, an extensive simulation of CEST Z-spectra was performed using 5-pool model and 6-pool model with greater MT component.

RESULTS

In comparison with LD approach, VOPVP exhibited lower sum of squares due to error (SSE) and higher goodness of fit (R-square) for the experimental Z-spectra at all B1_sat. Moreover, the results indicated that VOPVP fitting improved the overestimated contributions from amide proton transfer (APT) and NOE through LD at all B1_sat. Despite that the relationship for B1-dependent adjustment was pre-determined using a single 5-pool model, the VOPVP fittings obtained accurate quantification for multiple 6-pool models with a range of T1w's and T2w's. The robustness of VOPVP fitting was also proved by simulations using 3T parameters. Furthermore, we assessed VOPVP in vivo in a glioblastoma-bearing mouse. Compared to LD maps, VOPVP quantification maps displayed higher contrast-to-noise ratio between tumor and normal contralateral tissue for APT, glutamate and nuclear overhauser effect (NOE), when B1_sat >1 µT.

CONCLUSIONS

As an improvement of LD method, VOPVP fitting can serve as a simple, robust and more accurate approach for quantifying CEST and NOE contrast.

Effect of Liposomal Encapsulation on the Chemical Exchange Properties of Diamagnetic CEST Agents

Exogenous chemical exchange saturation transfer (CEST) contrast agents such as glucose or 2-deoxy-d-glucose (2-DG) have shown high sensitivities and significant potential for monitoring glucose uptake in tumors with MRI. Here, we show that liposome encapsulation of such agents can be exploited to enhance the CEST signal by reducing the overall apparent exchange rate. We have developed a concise analytical model to describe the liposomal contrast dependence on several parameters such as pH, temperature, irradiation amplitude, and intraliposomal water content. This is the first study in which a model has been constructed to measure the exchange properties of diamagnetic CEST agents encapsulated inside liposomes. Experimentally measured exchange rates of glucose and 2-DG in the liposomal system were found to be reduced due to the intermembrane exchange between the intra- and extraliposomal compartments because of restrictions in water transfer imposed by the lipid membrane. These new theoretical and experimental findings will benefit applications of diamagnetic liposomes to image biological processes. In addition, combining this analytical model with measurements of the CEST signal enhancement using liposomes as a model membrane system is an important new general technique for studying membrane permeability.

Free-base porphyrins as CEST MRI contrast agents with highly upfield shifted labile protons

PURPOSE

CEST has become a preeminent technology for the rapid detection and grading of tumors, securing its widespread use in both laboratory and clinical research. However, many existing CEST MRI agents exhibit a sensitivity limitation due to small chemical shifts between their exchangeable protons and water. We propose a new group of CEST MRI agents, free-base porphyrins and chlorin, with large exchangeable proton chemical shifts from water for enhanced detection.

METHODS

To test these newly identified CEST agents, we acquired a series of Z-spectra at multiple pH values and saturation field strengths to determine their CEST properties. The data were analyzed using the quantifying exchange using saturation power method to quantify exchange rates. After identifying several promising candidates, a porphyrin solution was injected into tumor-bearing mice, and MR images were acquired to assess detection feasibility in vivo.

RESULTS

Based on the Z-spectra, the inner nitrogen protons in free-base porphyrins and chlorin resonate from -8 to -13.5 ppm from water, far shifted from the majority of endogenous metabolites (0-4 ppm) and Nuclear Overhauser enhancements (-1 to -3.5 ppm) and far removed from the salicylates, imidazoles, and anthranillates (5-12 ppm). The exchange rates are sufficiently slow to intermediate (500-9000 s-1 ) to allow robust detection and were sensitive to substituents on the porphyrin ring.

CONCLUSION

These results highlight the capabilities of free-base porphyrins and chlorin as highly upfield CEST MRI agents and provide a new scaffold that can be integrated into a variety of diagnostic or theranostic agents for biomedical applications.

Carbon Dots as a New Class of Diamagnetic Chemical Exchange Saturation Transfer (diaCEST) MRI Contrast Agents

While carbon dots (C-dots) have been extensively investigated pertaining to their fluorescent, phosphorescent, electrochemiluminescent, optoelectronic, and catalytic features, their inherent chemical exchange saturation transfer magnetic resonance imaging (CEST MRI) properties are unknown. By virtue of their hydrophilicity and abundant exchangeable protons of hydroxyl, amine, and amide anchored on the surface, we report here that C-dots can be adapted as effective diamagnetic CEST (diaCEST) MRI contrast agents. As a proof-of-concept demonstration, human glioma cells were labeled with liposomes with or without encapsulated C-dots and implanted in mouse brain. In vivo CEST MRI was able to clearly differentiate labeled cells from non-labeled cells. The present findings may encourage new applications of C-dots for in vivo imaging in deep tissues, which is currently not possible using conventional fluorescent (near-infrared) C-dots.

Fast 3D chemical exchange saturation transfer imaging with variably-accelerated sensitivity encoding (vSENSE)

PURPOSE

To extend the variably-accelerated sensitivity encoding (vSENSE) method from 2D to 3D for fast chemical exchange saturation transfer (CEST) imaging, and prospectively implement it for clinical MRI.

METHODS

The CEST scans were acquired from 7 normal volunteers and 15 brain tumor patients using a 3T clinical scanner. The 2D and 3D "artifact suppression" (AS) vSENSE algorithms were applied to generate sensitivity maps from a first scan acquired with conventional SENSE-accelerated 2D and 3D CEST data. The AS sensitivity maps were then applied to reconstruct the other CEST frames at higher acceleration factors. Both retrospective and prospective acceleration in phase-encoding and slice-encoding dimensions were implemented.

RESULTS

Applying the 2D AS vSENSE algorithm to a 2-fold undersampled 3.5-ppm CEST frame halved the scan time of conventional SENSE, while generating essentially identical reconstruction errors (p ≈ 1.0). The 3D AS vSENSE algorithm permitted prospective acceleration by up to 8-fold, in total, from phase-encoding and slice-encoding directions for individual source CEST images, and an overall speed-up in scan time of 5-fold. The resulting vSENSE-accelerated amide proton transfer-weighted images agreed with conventional 2-fold-accelerated SENSE CEST results in brain tumor patients and healthy volunteers. Importantly, the vSENSE method eliminated unfolding artifacts in the slice-encoding direction that compromised conventional SENSE CEST scans.

CONCLUSION

The vSENSE method can be extended to 3D CEST imaging to provide higher acceleration factors than conventional SENSE without compromising accuracy.

Self-adapting multi-peak water-fat reconstruction for the removal of lipid artifacts in chemical exchange saturation transfer (CEST) imaging

PURPOSE

Artifacts caused by strong lipid signals pose challenges in body chemical exchange saturation transfer (CEST) imaging. This study aimed to develop an accurate water-fat reconstruction method based on the multi-echo Dixon technique to remove lipid artifacts in CEST imaging.

THEORY AND METHODS

It is well known that fat has multiple spectral peaks. Furthermore, RF pulses in CEST preparation saturate each fat peak at different levels, complicating fat modeling. Therefore, a self-adapting multi-peak model (SMPM) is proposed to update relative amplitudes of fat peaks using numerical calculation. With the SMPM-based updating, nonlinear least-squares fitting combined with IDEAL (Iterative Decomposition of water and fat with Echo Asymmetry and Least-squares estimation) algorithms was used for water-fat reconstruction and B₀ mapping. The proposed method was compared with the reported 3-point Dixon method and the fixed multi-peak model in a phantom study using a fat-free Z-spectrum obtained from MR spectroscopy acquisition as the ground truth. This method was also validated by in vivo experiments on human breast.

RESULTS

In the phantom experiments, the Z-spectrum from the SMPM-based method agreed well with the fat-free Z-spectrum from CEST-PRESS (point-resolved spectroscopy), validating the effective removal of lipid artifacts, while a decrease or a rise that appeared at -3.5 ppm was observed in the Z-spectrum from the 3-point method and the FMPM-based method, respectively. In the in vivo experiments, no lipid artifacts were observed in the Z-spectrum or the amide CEST map from the SMPM-based method in the fibro-glandular region of the breast with high fat fractions.

CONCLUSION

The SMPM-based method successfully removes lipid artifacts and significantly improves the accuracy of CEST contrast.

Extradomain-B Fibronectin-Targeted Dextran-Based Chemical Exchange Saturation Transfer Magnetic Resonance Imaging Probe for Detecting Pancreatic Cancer

A dextran-peptide conjugate was developed for magnetic resonance (MR) molecular imaging of pancreatic ductal adenocarcinoma (PDAC) through its overexpressed microenvironment biomarker, extradomain-B fibronectin (EDB-FN). This new agent consists of diamagnetic and biocompatible dextran and a targeting peptide. Dextrans can be directly detected by chemical exchange saturation transfer magnetic resonance imaging (CEST MRI) without the need for radionuclide or metallic labeling. In addition, large molecular weight dextran, dextran 10 (MW ∼ 10 kDa), provides an approximately 50 times higher sensitivity per molecule than a single glucose unit. The potential of this highly biocompatible diamagnetic probe is demonstrated in a murine syngeneic allograft PDAC tumor model. The biocompatibility and sensitivity of this new agent clearly show potential for a path to clinical translation.

Ultrafast multi-slice chemical exchange saturation transfer imaging scheme based on segmented spatiotemporal encoding

Chemical exchange saturation transfer (CEST) imaging is an important magnetic resonance molecular imaging technology. However, long acquisition time limits its clinical application, especially when multi-slice CEST imaging is needed. Though single-shot EPI can be used to accelerate CEST imaging, images are often distorted under inhomogeneous magnetic fields. In this work, we propose a new method called CEST-SeSPEN for ultrafast multi-slice CEST imaging based on segmented spatiotemporally encoded (SeSPEN) MRI. Experiments were performed on creatine phantom and hen egg. The results show that CEST-SeSPEN can provide good CEST contrast images. Its acquisition time is much shorter than other multi-slice CEST methods currently available. It may be used in challenging situation where high temporal resolution and robustness to field inhomogeneity are vital.

Chemical exchange saturation transfer (CEST) as a new method of signal obtainment in magnetic resonance molecular imaging in clinical and research practice

The work describes the physical basis of the chemical exchange saturation transfer (CEST) technique; it presents the beginnings of the implementation of the method and its possible applications. The principles of correct data acquisition and possible solutions used during the design of the CEST sequence are shown. The main problems related to data analysis are indicated, and an example Z-spectrum from in vivo study of the rat brain is introduced. Furthermore, the parameters related to spectrum analyses such as magnetisation transfer asymmetry (MTRasym) and amide proton transfer asymmetry (APTasym) are presented. In the following part, different types of the CEST method often mentioned in the literature are discussed. Subsequently, the possible applications of the CEST method in both clinical and experimental practice are described.

Dynamic Imaging of Glucose and Lactate Metabolism by 13C-MRS without Hyperpolarization

Metabolic reprogramming is one of the defining features of cancer and abnormal metabolism is associated with many other pathologies. Molecular imaging techniques capable of detecting such changes have become essential for cancer diagnosis, treatment planning, and surveillance. In particular, ¹⁸F-FDG (fluorodeoxyglucose) PET has emerged as an essential imaging modality for cancer because of its unique ability to detect a disturbed molecular pathway through measurements of glucose uptake. However, FDG-PET has limitations that restrict its usefulness in certain situations and the information gained is limited to glucose uptake only.¹³C magnetic resonance spectroscopy theoretically has certain advantages over FDG-PET, but its inherent low sensitivity has restricted its use mostly to single voxel measurements unless dissolution dynamic nuclear polarization (dDNP) is used to increase the signal, which brings additional complications for clinical use. We show here a new method of imaging glucose metabolism in vivo by MRI chemical shift imaging (CSI) experiments that relies on a simple, but robust and efficient, post-processing procedure by the higher dimensional analog of singular value decomposition, tensor decomposition. Using this procedure, we achieve an order of magnitude increase in signal to noise in both dDNP and non-hyperpolarized non-localized experiments without sacrificing accuracy. In CSI experiments an approximately 30-fold increase was observed, enough that the glucose to lactate conversion indicative of the Warburg effect can be imaged without hyper-polarization with a time resolution of 12s and an overall spatial resolution that compares favorably to ¹⁸F-FDG PET.

Analysis of chemical exchange saturation transfer contributions from brain metabolites to the Z-spectra at various field strengths and pH

Chemical exchange saturation transfer (CEST) exploits the chemical exchange of labile protons of an endogenous or exogenous compound with water to image the former indirectly through the water signal. Z-spectra of the brain have traditionally been analyzed for two most common saturation phenomena: downfield amide proton transfer (APT) and upfield nuclear Overhauser enhancement (NOE). However, a great body of brain metabolites, many of interest in neurology and oncology, contributes to the downfield saturation in Z-spectra. The extraction of these “hidden” metabolites from Z-spectra requires careful design of CEST sequences and data processing models, which is only possible by first obtaining CEST signatures of the brain metabolites possessing labile protons. In this work, we measured exchange rates of all major-for-CEST brain metabolites in the physiological pH range at 37 °C. Analysis of their contributions to Z-spectra revealed that regardless of the main magnetic field strength and pH, five main contributors, i.e. myo-inositol, creatine, phosphocreatine, glutamate, and mobile (poly)peptides, account for ca. 90% of downfield CEST effect. The fundamental CEST parameters presented in this study can be exploited in the design of novel CEST sequences and Z-spectra processing models, which will enable simultaneous and quantitative CEST imaging of multiple metabolites: multicolor CEST.

Combined Amino Acid Positron Emission Tomography and Advanced Magnetic Resonance Imaging in Glioma Patients

Imaging techniques such as positron emission tomography (PET) and magnetic resonance imaging (MRI) provide valuable information about brain tumor patients. Particularly amino acid PET, advanced MRI techniques, and combinations thereof are of great interest for the non-invasive assessment of biological characteristics in patients with primary or secondary brain cancer. A methodological innovation that potentially advances research in patients with brain tumors is the increasing availability of hybrid PET/MRI systems, which enables the simultaneous acquisition of both imaging modalities. Furthermore, the advent of ultra-high field MRI scanners operating at magnetic field strengths of 7 T or more will allow further development of metabolic MR imaging at higher resolution. This review focuses on the combination of amino acid PET with MR spectroscopic imaging, perfusion- and diffusion-weighted imaging, as well as chemical exchange saturation transfer in patients with high-grade gliomas, especially glioblastomas.

Renal and adrenal masses containing fat at MRI: Proposed nomenclature by the society of abdominal radiology disease-focused panel on renal cell carcinoma

This article proposes a consensus nomenclature for fat-containing renal and adrenal masses at MRI to reduce variability, improve understanding, and enhance communication when describing imaging findings. The MRI appearance of "macroscopic fat" occurs due to a sufficient number of aggregated adipocytes and results in one or more of: 1) intratumoral signal intensity (SI) loss using fat-suppression techniques, or 2) chemical shift artifact of the second kind causing linear or curvilinear India-ink (etching) artifact within or at the periphery of a mass at macroscopic fat-water interfaces. "Macroscopic fat" is most commonly observed in adrenal myelolipoma and renal angiomyolipoma (AML) and only rarely encountered in other adrenal cortical tumors and renal cell carcinomas (RCC). Nonlinear noncurvilinear signal intensity loss on opposed-phase (OP) compared with in-phase (IP) chemical shift MRI (CSI) may be referred to as "microscopic fat" and is due to: a) an insufficient amount of adipocytes, or b) the presence of fat within tumor cells. Determining whether the signal intensity loss observed on CSI is due to insufficient adipocytes or fat within tumor cells cannot be accomplished using CSI alone; however, it can be inferred when other imaging features strongly suggest a particular diagnosis. Fat-poor AML are homogeneously hypointense on T₂ -weighted (T₂ W) imaging and avidly enhancing; signal intensity loss at OP CSI is uncommon, but when present is usually focal and is caused by an insufficient number of adipocytes within adjacent voxels. Conversely, clear-cell RCC are heterogeneously hyperintense on T₂ W imaging and avidly enhancing, with the signal intensity loss observed on OP CSI being typically diffuse and due to fat within tumor cells. Adrenal adenomas, adrenal cortical carcinoma, and adrenal metastases from fat-containing primary malignancies also show signal intensity loss on OP CSI due to fat within tumor cells and not from intratumoral adipocytes. Level of Evidence: 5 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;49:917-926.