Proton magnetic resonance spectroscopy in the brain: report of AAPM MR Task Group #9

In vivo proton magnetic resonance spectroscopy of breast cancer: a review of the literature

An emerging clinical modality called proton magnetic resonance spectroscopy ((1)H-MRS) enables the non-invasive in vivo assessment of tissue metabolism and is demonstrating applications in improving the specificity of MR breast lesion diagnosis and monitoring tumour responsiveness to neoadjuvant chemotherapies. Variations in the concentration of choline-based cellular metabolites, detectable with (1)H-MRS, have shown an association with malignant transformation of tissue in in vivo and in vitro studies. (1)H-MRS exists as an adjunct to the current routine clinical breast MR examination. This review serves as an introduction to the field of breast (1)H-MRS, discusses modern high-field strength and quantitative approaches and technical considerations, and reviews the literature with respect to the application of (1)H-MRS for breast cancer.

Reliable non-invasive measurement of human neurochemistry using proton spectroscopy with an anatomically defined amygdala-specific voxel

Given the central role of the amygdala in fear perception and expression and its likely abnormality in affective disorders and autism, there is great demand for a technique to measure differences in neurochemistry of the human amygdala. Unfortunately, it is also a technically complex target for magnetic resonance spectroscopy (MRS) due to a small volume, high field inhomogeneity and a shared boundary with hippocampus, which can undergo opposite changes in response to stress. We attempted to achieve reliable PRESS-localized single-voxel MRS at 3T of the isolated human amygdala by using anatomy to guide voxel size and location. We present data from 106 amygdala-MRS sessions from 58 volunteers aged 10 to 52 years, including two tests of one-week stability and a feasibility study in an adolescent sample. Our main outcomes were indices of spectral quality, repeated measurement variability (within- and between-subject standard deviations), and sensitivity to stable individual differences measured by intra-class correlation (ICC). We present metrics of amygdala-MRS reliability for n-acetyl-aspartate, creatine, choline, myo-Inositol, and glutamate+glutamine (Glx). We found that scan quality suffers an age-related difference in field homogeneity and modified our protocol to compensate. We further identified an effect of anatomical inclusion near the endorhinal sulcus, a region of high synaptic density, that contributes up to 29% of within-subject variability across 4 sessions (n=14). Remaining variability in line width but not signal-to-noise also detracts from reliability. Statistical correction for partial inclusion of these strong neurochemical gradients decreases n-acetyl-aspartate reliability from an intraclass correlation of 0.84 to 0.56 for 7-minute acquisitions. This suggests that systematic differences in anatomical inclusion can contribute greatly to apparent neurochemical concentrations and could produce false group differences in experimental studies. Precise, anatomically-based prescriptions that avoid age-related sources of inhomogeneity and use longer scan times may permit study of individual differences in neurochemistry throughout development in this late-maturing structure.

A systematic review of the literature on the effects of dexamethasone on the brain from in vivo human-based studies: implications for physiological brain imaging of patients with intracranial tumors

BACKGROUND

Among glucocorticoids, dexamethasone is most widely used for treatment of cerebral edema because of its long biological half-life and its low mineralocorticoid activity (sodium retaining).

OBJECTIVE

A systematic review of the literature on the effects of dexamethasone on the brain from in vivo studies in humans.

METHODS

A MEDLINE database search (via the PubMed interface) and an EMBASE database search (via the Dialog interface) of the past 35 years was performed. Every article relating to human use reported in English was included. In addition, references of all eligible articles were searched to identify other possible sources.

RESULTS

Twenty-four articles matched the eligibility criteria. There were disparate methodologies and conflicting results, although they tended to indicate a decrease in blood-tumor barrier permeability, decreased tumoral perfusion, decreased tumoral diffusivity, and the possibility of decreased perfusion in contralateral normal-appearing brain tissue.

CONCLUSION

Treatment with dexamethasone may alter imaging parameters from cerebral perfusion studies used in the management of brain tumors. In adequately powered studies, it may be possible to assess the longer term effects of dexamethasone on normal brain tissue to help optimize use with longer term survivors that are emerging as improvements in glioma treatment are made.

Comparison of 3.0 T proton magnetic resonance spectroscopy short and long echo-time measures of intramyocellular lipids in obese and normal-weight women

PURPOSE

To compare correlations of intramyocellular lipids (IMCL) measured by short and long echo-time proton magnetic resonance spectroscopy (1H-MRS) with indices of body composition and insulin resistance in obese and normal-weight women.

MATERIALS AND METHODS

We quantified IMCL of tibialis anterior (TA) and soleus (SOL) muscles in 52 premenopausal women (37 obese and 15 normal weight) using single-voxel 1H-MRS PRESS at 3.0 T with short (30 msec) and long (144 msec) echo times. Statistical analyses were performed to determine correlations of IMCL with body composition as determined by computed tomography (CT) and insulin resistance indices and to compare correlation coefficients from short and long echo-time data. Signal-to-noise ratio (SNR), linewidth, and coefficients of variation (CV) of short and long echo-time spectra were calculated.

RESULTS

Short and long echo-time IMCL from TA and SOL significantly correlated with body mass index (BMI) and abdominal fat depots (r = 0.32 to 0.70, P = <0.05), liver density (r = -0.39 to -0.50, P < 0.05), and glucose area under the curve as a measure of insulin resistance (r = 0.47 to 0.49, P < 0.05). There was no significant difference between correlation coefficients of short and long echo-time spectra (P > 0.5). Short echo-time IMCL in both muscles showed significantly higher SNR (P < 0.0001) and lower CVs when compared to long echo-time acquisitions. Linewidth measures were not significantly different between groups.

CONCLUSION

IMCL quantification using short and long echo-time 1H-MRS at 3.0 T is useful to detect differences in muscle lipid content in obese and normal-weight subjects. In addition, IMCL correlates with body composition and markers of insulin resistance in this population with no significant difference in correlations between short and long echo-times. Short echo-time IMCL quantification of TA and SOL muscles at 3.0 T was superior to long echo-time due to better SNR and better reproducibility.

(1)H-MRS of brain metabolites in migraine without aura: absolute quantification using the phantom replacement technique

OBJECTIVE

Several studies have demonstrated differences in migraine patients when performing (1)H-MRS; however, no studies have performed (1)H-MRS in migraine without aura (MwoA), the most common migraine subtype. The aim of this (1)H-MRS study was to elucidate whether any differences could be found between MwoA patients and controls by performing absolute quantification.

MATERIALS AND METHODS

(1)H-MRS was performed in 22 MwoA patients and 25 control subjects. Absolute quantification was based on the phantom replacement technique. Corrections were made for T (1) and T (2) relaxation effects, CSF content, coil loading and temperature. The method was validated by phantom measurements and in vivo measurements in the occipital visual cortex.

RESULTS

After calibration of the quantification procedure and the implementation of the required correction factors, measured absolute concentrations in the visual cortex of MwoA patients showed no significant differences compared to controls, in contrast to relative results obtained in earlier studies.

CONCLUSION

In this study, we demonstrate the implementation of quantitative in vivo (1)H-MRS spectroscopy in migraine patients. Despite rigorous quantification, no spectroscopic abnormalities could be found in patients with migraine without aura.

Assessment of lipids in skeletal muscle by LCModel and AMARES

PURPOSE

To process single voxel spectra of the human skeletal muscle by using an advanced method for accurate, robust, and efficient spectral fitting (AMARES) and by linear combination of model spectra (LCModel). To determine absolute concentrations of extra- (EMCL) and intramyocellular lipids (IMCL).

MATERIALS AND METHODS

Single-voxel proton magnetic resonance spectroscopy (PRESS) was used to obtain the spectra of the calf muscles. Unsuppressed water line was used as a concentration reference. A new prior knowledge for AMARES was proposed to estimate the concentrations of EMCL and IMCL. The prior knowledge was derived from the spectrum of vegetable oil. The results were compared with the values estimated by LCModel. Absolute concentrations of total lipid content in millimoles per kilogram wet weight were used for the comparisons.

RESULTS

Absolute concentrations of total lipid content in skeletal muscle were estimated by AMARES and LCModel. Very good correlation of the total fat (EMCL + IMCL) and IMCL concentrations was achieved between both data processing approaches.

CONCLUSION

Assessment the absolute concentrations of muscular lipids by AMARES and LCModel can be performed with comparable accuracy.

Brainstem 1H nuclear magnetic resonance (NMR) spectroscopy: marker of demyelination and repair in spinal cord

Measuring in vivo spinal cord injury and repair remains elusive. Using magnetic resonance spectroscopy (MRS) we examined brainstem N-acetyl-aspartate (NAA) as a surrogate for spinal cord injury in two mouse strains with different reparative phenotypes following virus-induced demyelination. Swiss Jim Lambert (SJL) and Friend Virus B (FVB) mice progressively demyelinate with axonal loss. FVB mice demyelinate similarly but eventually remyelinate coincident with functional recovery. Brainstem NAA levels drop in both but recover in FVB mice. Chronically infected SJL mice lost 30.5% of spinal cord axons compared to FVB mice (7.3%). In remyelination-enhancing or axon-preserving clinical trials, brainstem MRS may be a viable endpoint to represent overall spinal cord dysfunction.

The use of proton magnetic resonance spectroscopy in PTSD research--meta-analyses of findings and methodological review

Different neuroimaging techniques provided evidence for structural and functional brain alterations in posttraumatic stress disorder (PTSD). Due to technical improvements, especially concerning localization techniques and more reliable analysis methods, one technique, proton magnetic resonance spectroscopy ((1)H-MRS), has increasingly become of interest because it allows further insight into metabolic mechanisms that may contribute to these alterations. The aim of this article is, therefore, to review recent studies utilizing (1)H-MRS of the hippocampus and other brain structures in PTSD. Using meta-analytic methods, we attempted to answer the question if PTSD, as compared to different types of control samples, is accompanied by altered neurometabolite ratios and concentrations in the tissue of different brain regions. A second intent was to review methodological aspects to advise on a minimal standard for reliable results with respect to the application of (1)H-MRS in PTSD. Finally, we discussed the implications of the findings with respect to current PTSD models and future research.

Proton magnetic resonance spectroscopy in school-aged autistic children

PURPOSE

This study aims to assess cerebral metabolites in school-aged autistic patients through proton magnetic resonance spectroscopy.

METHODS

This case-control study included 10 right-handed male children (median age, 9.53 years +/- 1.80) with autism according to DSM-IV criteria, and 10 healthy age- and sex-matched healthy controls (median age, 8.52 years +/- 1.42). Imaging was performed on a 1.5-T scanner utilizing a single voxel point-resolved spectroscopy (PRESS) technique (TR = 1,500 ms, TE = 30 ms). Four cerebral areas were evaluated: bilateral anterior cingulate, left striatum, left cerebellar hemisphere, and left frontal lobe. Peak areas and ratios to creatine (Cr) of N-acetylaspartate (NAA), choline (Cho), and myo-inositol (mI) were analyzed.

RESULTS

Compared with controls, autistic children showed a significant increase in mI (P= .021) and Cho (P= .042) peak areas in anterior cingulate and in mI/Cr ratio in anterior cingulate (P= .037) and left striatum (P= .035). The remaining metabolites and ratios were not significantly different between the 2 groups.

CONCLUSIONS

This study found a statistically significant increase in myo-inositol and choline in anterior cingulate and left striatum of autistic children compared with controls. In contrast to previous studies, NAA peak area and NAA/Cr and NAA/Cho ratios had no statistically significant decrease in any of the 4 brain regions.

Usefulness of susceptibility-weighted imaging for voxel placement in MR spectroscopy

MR spectroscopy is used to provide in vivo biochemical information about cerebral metabolites. Magnetic field homogeneity secondary to anatomic interfaces, hemorrhage, or necrosis may lead to suboptimal MR spectroscopy. Susceptibility-weighted imaging (SWI) can identify field inhomogeneity and could be used to guide MR spectroscopy voxel placement, leading to higher-quality MR spectroscopy examinations.

Short-echo spectroscopic imaging combined with lactate editing in a single scan

A short-echo spectroscopic imaging sequence extended with a frequency-selective multiple-quantum- coherence technique (Sel-MQC) is presented. The method enables acquisition of a complete water-suppressed proton spectrum with a short echo time and filtering of the J-coupling metabolite, lactate, from co-resonant lipids in one scan. The purpose of the study was to validate this combined pulse sequence in vitro and in vivo. Measurements on phantoms confirmed the feasibility of the method, and, for a practical in vivo application, experiments were carried out on eight tumors from two different tumor models [UT-SCC-8 (n = 4) and SAS (n = 4)]. T(1)- and T(2)-weighted metabolite and lipid ratios were calculated, and the tumors showed different values in the central and outer regions. The ratio of the lipid methylene peak area (1.30 ppm) to choline peak area (3.20 ppm) was significantly (p < 0.01) different in the central tumor area between the two models, and lactate was detected in only three out of four tumors in the SAS tumor line. The present approach of combining short-echo spectroscopic imaging and lactate editing allows the characterization of tumor-specific metabolites such as choline, lipid methylene and methyl resonances as well as lactate in a single scan.

Assessment of lipids in skeletal muscle by high-resolution spectroscopic imaging using fat as the internal standard: comparison with water referenced spectroscopy

The main purpose of the study was to compare proton (1H) single-voxel MR spectroscopy (MRS) with high-spatial-resolution spectroscopic imaging (MRSI) to determine the lipid content in human skeletal muscle. Unsuppressed water line was used as a concentration reference in the processing of single-voxel spectra. The spectrum from yellow bone marrow with a 100% fat content and probe with the vegetable oil served as internal and external reference for high-spatial-resolution MRSI, respectively. Very good correlation was found between lipid concentrations measured by water referenced single-voxel MRS and high-spatial-resolution MRSI with yellow bone marrow as the internal standard. Excellent correlation was found between total lipid concentrations estimated by high-spatial-resolution MRSI with vegetable oil as the external fat standard and yellow bone marrow as the internal reference. From comparison of single-voxel MRS and MRSI approaches, it follows that relaxation correction of the reference water and methylene fat line is inevitable in processing the standard single-voxel spectra. The high-resolution MRSI approach is recommended to avoid the problem of relaxation corrections and enables using vegetable oil as the external fat standard.

Magnetic resonance spectroscopy and metabolic imaging in white matter diseases and pediatric disorders

This review provides the reader with an overview of the magnetic resonance spectroscopy technique and the clinical, pathological, imaging, and metabolic features for select white matter disorders of interest. With this composite summary, the reader should find it easier to implement and interpret spectroscopy in the clinical setting for the diagnosis and monitoring of patients with white matter disorders.

Fast quantification of proton magnetic resonance spectroscopic imaging with artificial neural networks

Accurate quantification of the MRSI-observed regional distribution of metabolites involves relatively long processing times. This is particularly true in dealing with large amount of data that is typically acquired in multi-center clinical studies. To significantly shorten the processing time, an artificial neural network (ANN)-based approach was explored for quantifying the phase corrected (as opposed to magnitude) spectra. Specifically, in these studies radial basis function neural network (RBFNN) was used. This method was tested on simulated and normal human brain data acquired at 3T. The N-acetyl aspartate (NAA)/creatine (Cr), choline (Cho)/Cr, glutamate+glutamine (Glx)/Cr, and myo-inositol (mI)/Cr ratios in normal subjects were compared with the line fitting (LF) technique and jMRUI-AMARES analysis, and published values. The average NAA/Cr, Cho/Cr, Glx/Cr and mI/Cr ratios in normal controls were found to be 1.58+/-0.13, 0.9+/-0.08, 0.7+/-0.17 and 0.42+/-0.07, respectively. The corresponding ratios using the LF and jMRUI-AMARES methods were 1.6+/-0.11, 0.95+/-0.08, 0.78+/-0.18, 0.49+/-0.1 and 1.61+/-0.15, 0.78+/-0.07, 0.61+/-0.18, 0.42+/-0.13, respectively. These results agree with those published in literature. Bland-Altman analysis indicated an excellent agreement and minimal bias between the results obtained with RBFNN and other methods. The computational time for the current method was 15s compared to approximately 10 min for the LF-based analysis.

Routine testing of magnetic field homogeneity on clinical MRI systems

Poor main magnetic field (B0) homogeneity (H(B)) leads to artifacts and signal losses in magnetic resonance imaging (MRI). The American College of Radiology's MRI quality control manual mandates annual checks of H(B), suggesting tests using spectral linewidth and phase-difference (delta phi) maps. A new method, the bandwidth-difference (deltaBW) method, which compares the distortion for small and large BW acquisitions to determine the HB, is proposed. The deltaBW method has the advantage that it can be used to measure multiple diameters of spherical volumes (DSV) in a single phantom. A phantom has been developed to exploit this method and results obtained with it are compared to those using three standard methods. Small receiver BW in the presence of poor H(B) leads to geometric distortions because gradients are reduced to the level of the B0 inhomogeneities. Data were acquired using seven MRI systems from different manufacturers, ranging in field strength from 0.2 to 3.0 T. Fast gradient echo pulse sequences were scanned twice using small and large BWs. H(B) was measured from the shift of landmarks between the two BW acquisitions. Results were compared with data from the full width at half maximum (FWHM) method, the delta phi method and one manufacturer's resonant frequency mapping data. The FWHM method was available on two systems and the detla phi method was available on one. The deltaBW method could be performed in all scanners investigated. The H(B) measured ranged 0.11-0.32 ppm to 6.7-12.9 ppm for DSV of 13-22.6 cm. Direct comparisons of the data obtained using the deltaBW method showed good agreement with data obtained using the FWHM method. Data obtained using the deltaBW method compared favorably with the manufacturer's resonant frequency map. The deltaBW method produces measurements of H(B) at various DSV values that can be obtained from a single set of phantom images. The accuracy of deltaBW B0 homogeneity measurements are comparable to the other methods tested.

Advanced neuroimaging of pediatric brain tumors: MR diffusion, MR perfusion, and MR spectroscopy

This article highlights the MR imaging techniques of MR perfusion, MR diffusion, and MR spectroscopy in the evaluation of the child with a pediatric brain tumor. These techniques are complementary to conventional MR imaging in providing tumor physiologic information useful for diagnosis and therapy.

Exact quantification of time signals in Padé-based magnetic resonance spectroscopy

This study reports on the fast Padé transform (FPT) for parametric signal processing of realistically synthesized free induction decay curves whose main spectral features are similar to those encoded clinically from a healthy human brain by means of magnetic resonance spectroscopy (MRS). Here, for the purpose of diagnostics, it is of paramount importance to be able to perform accurate and robust quantification of the investigated time signals. This amounts to solving the challenging harmonic inversion problem as a spectral decomposition of the given time signal by means of reconstruction of the unknown total number of resonances, their complex frequencies and amplitudes yielding the peak positions, widths, heights and phases. On theoretical grounds, the FPT solves exactly this mathematically ill-conditioned inverse problem for any noiseless synthesized time signal comprised of an arbitrarily large (finite or infinite) number of damped complex exponentials with stationary and non-stationary polynomial-type amplitudes leading to Lorentzian (non-degenerate) and non-Lorentzian (degenerate) spectra. Convergent validation for this fact is given via the proof-of-principle which is thoroughly demonstrated by the exact numerical solution of a typical quantification problem from MRS. The presently designed study is a paradigm shift for signal processing in MRS with particular relevance to clinical oncology, due to the unprecedented capability of the fast Padé transform to unequivocally resolve and quantify isolated, tightly overlapped and nearly coincident resonances.

In vivomagnetic resonance spectroscopy by the fast Padé transform

The fast Padé transform (FPT) is thoroughly illustrated on two in vivo time signals encoded at 4 T and 7 T via magnetic resonance spectroscopy (MRS). The exact quantum-mechanical spectrum as the Green function series truncated at any partial sum reduces to the unique quotient of two polynomials, which is the FPT. In this Green function as a Maclaurin series in powers of the harmonic variable, the expansion coefficients are the time signal values as damped complex-exponentials with stationary and non-stationary amplitudes for non-degenerate (Lorentzian) and degenerate (non-Lorentzian) spectra. This is automatically shared by the FPT to represent an enormous advantage over the Hankel-Lanczos singular value decomposition (HLSVD) which works only for Lorentzian spectra. Moreover, the resonance amplitudes in the FPT are obtained analytically, rather than solving a system of linear equations as done in the HLSVD. We use two variants of the FPT, initially defined inside and outside the unit circle, but extended automatically to the whole complex frequency plane by the Cauchy analytical continuation. The converged spectra from these two variants of the FPT are found to give the same results, within the experimental background noise level, and this represents an intrinsic cross-validation of the findings and the error analysis.

Can we use 1H MRS shimming values to obtain 31P spectra?

The perfect shimming of 31P magnetic resonance spectroscopy (MRS) is not easy in vivo. The purpose of this study was to examine the feasibility of using 1H MRS shimming values to obtain 31P spectra in a same sequence. Both phantom and volunteer studies were carried out in this study. Phantom was a sphere filled with physiological metabolites of brain. In vivo study was performed on 4 healthy volunteers. The studies were performed on a 3-T GE scanner. A same localizer and a same cursor were used for both 1H and 31P scans. A spin echo MRS sequence was utilized for both 1H scans with a standard head coil and 31P scans with a GE service coil. 1H scan was performed using first and automatic shimming and water linewidth (FWHM) of 3 Hz for phantom and 5 Hz for the volunteer were obtained. Shimming values of 1H scan in x, y, z directions were copied to 31P scan. A routine procedure of 31P scan without value coping was also performed. Spectra were analyzed using SAGE/IDL program. Signal to noise ratio (SNR) was defined as the ratio of the signal height / maximum noise height. Good 1H spectra and 31P spectra were obtained for both phantom and volunteer studies. The 31P spectra with 1H MRS shimming values were similar with the 31P spectra obtained with routine procedure. Lower SNRs of 31P spectra were obtained in phantom with 1H MRS shimming values, compared with routine procedure scan. Average SNR for Pi of 31P spectra was 7.45:1 in the volunteer study with routine procedure, and 7.275:1 with 1H MRS shimming values. 1H MRS shimming values can be used to obtain useful 31P spectra in a same sequence.

In vivo magnetic resonance spectroscopy in cancer

Magnetic resonance spectroscopy (MRS) has been used for more than two decades to interrogate metabolite distributions in living cells and tissues. Techniques have been developed that allow multiple spectra to be obtained simultaneously with individual volume elements as small as 1 uL of tissue (i.e., 1 x 1 x 1 mm(3)). The most common modern applications of in vivo MRS use endogenous signals from (1)H, (31)P, or (23)Na. Important contributions have also been made using exogenous compounds containing (19)F, (13)C, or (17)O. MRS has been used to investigate cardiac and skeletal muscle energetics, neurobiology, and cancer. This review focuses on the latter applications, with specific reference to the measurement of tissue choline, which has proven to be a tumor biomarker that is significantly affected by anticancer therapies.

The fast Padé transform in magnetic resonance spectroscopy for potential improvements in early cancer diagnostics

The convergence rates of the fast Padé transform (FPT) and the fast Fourier transform (FFT) are compared. These two estimators are used to process a time-signal encoded at 4 T by means of one-dimensional magnetic resonance spectroscopy (MRS) for healthy human brain. It is found systematically that at any level of truncation of the full signal length, the clinically relevant resonances that determine concentrations of metabolites in the investigated tissue are significantly better resolved in the FPT than in the FFT. In particular, the FPT has a better resolution than the FFT for the same signal length. Moreover, the FPT can achieve the same resolution as the FFT by using twice shorter signals. Implications of these findings for two-dimensional magnetic resonance spectroscopy as well as for two- and three-dimensional magnetic resonance spectroscopic imaging are highlighted. Self-contained cross-validation of all the results from the FPT is secured by using two conceptually different, equivalent algorithms (inside and outside the unit-circle), that are both valid in the entire complex frequency plane. The difference between the results from these two variants of the FPT is indistinguishable from the background noise. This constitutes robust error analysis of proven validity. The FPT shows promise in applications of MRS for early cancer detection.

Magnetresonanzspektroskopie bei Schizophrenie

Magnetic resonance spectroscopy is a noninvasive investigative technique for in vivo detection of biochemical changes in neuropsychiatric disorders for which especially proton (1H-MRS) and phosphorus (31P-MRS) magnetic resonance spectroscopy have been used. In this review we explain the principles of MRS and summarize the studies in schizophrenia. A systematic literature review was carried out for 1H-MRS studies investigating schizophrenic patients compared to controls. The inconsistent results in the cited studies may be due to different study population, specific neuroimaging technique, and selected brain regions. Frequent findings are decreased PME and increased PDE concentrations (31P-MRS) linked to altered metabolism of membrane phospholipids and decreased N-acetylaspartate (NAA) or NAA/choline ratio (1H-MRS) linked to neuronal damage in frontal (DLPFC) or temporal regions in patients with schizophrenia. These results contribute to the disturbed frontotemporal-thalamic network assumed in schizophrenia and are supported by additional functional neuroimaging, MRI morphometry, and neuropsychological evaluation. The combination of the described investigative techniques with MRS in follow-up studies may provide more specific clues for understanding the pathogenesis and disease course in schizophrenia.

NMR spectroscopy and pediatric brain tumors

Proton nuclear magnetic resonance spectroscopy ((1)H-NMRS) is a noninvasive in vivo technique that utilizes conventional MR imaging hardware to obtain biochemical information from a discrete volume of tissue after suppression of the water signal. MR spectroscopy coupled with conventional MR imaging allows correlation of structural changes with biochemical processes in tissues by measuring specific metabolites present in brain tissue. NMRS is commonly used in the evaluation of patients with brain tumors. This article reviews the basic principles of spectroscopy and its use in evaluating pediatric patients with brain tumors.

Quality assurance of magnetic resonance spectroscopic imaging–derived metabolic data

PURPOSE

Spatially resolved metabolite maps, as measured by magnetic resonance spectroscopic imaging (MRSI) methods, are being increasingly used to acquire metabolic information to guide therapy, with metabolite ratio maps perhaps providing the most diagnostic information. We present a quality assurance procedure for MRSI-derived metabolic data acquired ultimately for guiding conformal radiotherapy.

METHODS AND MATERIALS

An MRSI phantom filled with brain-mimicking solutions was custom-built with an insert holding eight vials containing calibration solutions of precisely varying metabolite concentrations that emulated increasing grade/density of brain tumor. Phantom metabolite ratios calculated from fully relaxed 1D, 2D, and 3D MRS data for each vial were compared with calibrated metabolite ratios acquired at 9.4 T. Additionally, 3D ratio maps were "discretized" to eight pseudoabnormality levels on a slice-by-slice basis and the accuracy of this procedure was verified.

RESULTS

Regression analysis revealed expected linear relationships between experimental and calibration metabolite ratios with intercepts close to zero for the three acquisition modes. 1D MRS data agreed most with theoretical considerations (regression coefficient, b = 0.969; intercept 0.008). The 2D (b = 1.049; intercept -0.199) and 3D (correlation coefficient r(2) = 0.9978-0.7336 for five slices) MRSI indicated reduced MRS data quality in regions of degraded B(0) and B(1) homogeneity. Pseudoabnormality levels were found to be consistent with expectations within regions of adequate B(0) homogeneity.

CONCLUSIONS

This simple phantom-based approach to generate baseline calibration curves for all MRS acquisition modes may be useful to identify temporal deviations from acceptable data quality in a routine clinical environment or for testing new MRS and MRSI acquisition software.