Localized 2D J-resolved 1H MR spectroscopy of human brain tumors in vivo

Magnetic Resonance Spectroscopy for Cervical Cancer: Review and Potential Prognostic Applications

This review article investigates the utilization of MRS in the setting of cervical cancer. A variety of different techniques have been used in this space including single-voxel techniques such as point-resolved spectroscopy (PRESS) and stimulated echo acquisition mode spectroscopy (STEAM). Furthermore, the experimental parameters for these acquisitions including field strength, repetition times (TR), and echo times (TE) vary greatly. This study critically examines eleven MRS studies that focus on cervical cancer. Out of the eleven studies, ten studies utilized PRESS acquisition, while the remaining study used STEAM acquisition. These studies generally showed that the choline signal is altered in cervical cancer (4/11 studies), the lipid signal is generally increased in cervical cancer or the lipid distribution is changed (5/11 studies), and that diffusion-weighted imaging (DWI) can quantitatively detect lower apparent diffusion coefficient (ADC) values in cervical cancer (2/11 studies). Two studies also investigated the role of MRS for monitoring treatment response and demonstrated mixed results regarding choline signal, and one of these studies showed increased lipid signal for non-responders. There are several new MRS technologies that have yet to be implemented for cervical cancer including advanced spectroscopic imaging and artificial intelligence, and those technologies are also discussed in the article.

SNR Enhancement for Multi-TE MRSI Using Joint Low-Dimensional Model and Spatial Constraints

We present a novel method to enhance the SNR for multi-TE MR spectroscopic imaging (MRSI) data by integrating learned nonlinear low-dimensional model and spatial constraints. A deep complex convolutional autoen-coder (DCCAE) was developed to learn a nonlinear low-dimensional representation of the high-dimensional multi-TE 1 H spectroscopy signals. The learned model significantly reduces the data dimension thus serving as an effective constraint for noise reduction. A reconstruction formulation was proposed to integrate the spatiospectral encoding model, the learned model, and a spatial constraint for an SNR-enhancing reconstruction from multi-TE data. The proposed method has been evaluated using both numerical simulations and in vivo brain MRSI experiments. The superior denoising performance of the proposed over alternative methods was demonstrated, both qualitatively and quantitatively. In vivo multi-TE data was used to assess the improved metabolite quantification reproducibility and accuracy achieved by the proposed method. We expect the proposed SNR-enhancing reconstruction to enable faster and/or higher-resolution multi-TE 1 H-MRSI of the brain, potentially useful for various clinical applications.

Contrast-Enhanced Magnetic Resonance Imaging, Perfusion Magnetic Resonance Imaging, and 1H-Magnetic Resonance Spectroscopy Distinguish Primary Central Nervous System Vasculitis from Glioblastoma

BACKGROUND

We investigated the ability of magnetic resonance imaging (MRI) to distinguish primary central nervous system vasculitis (PCNSV) from glioblastoma to facilitate the development of an appropriate treatment for PCNSV.

METHODS

We enrolled patients who were treated for PCNSV or glioblastoma at our center between January 2007 and August 2018. We compared the diagnoses of the 2 conditions by retrospectively reviewing patients' data for contrast-enhanced MRI, perfusion MRI, flow-sensitive black-blood (FSBB) imaging, and ¹H-magnetic resonance spectroscopy (MRS).

RESULTS

We evaluated 108 patients (6 PCNSV; 102 glioblastoma). We found a statistically significant correlation between diagnosis and the contrast pattern on MRI. Perivascular enhancement was observed in all cases of PCNSV as follows: ring-like, homogeneous, and irregular patterns were observed in 53 (60%), 18 (20%), and 17 (19%) cases of glioblastoma, respectively. We identified a statistically significant correlation between diagnosis and cerebral blood volume (CBV) in 3 patients with PCNSV who underwent perfusion MRI; and all had low CBVs. Among the 55 patients with glioblastoma who underwent perfusion MRI, low and high CBVs were detected in 3 and 52 patients, respectively. There was no significant correlation between diagnosis and FSBB findings. Evaluation of ¹H-MRS data showed statistically significant differences between PCNSV and glioblastoma as functions of neuronal amino acid levels on long echo time MRS, with a slightly different amino acid profile, including glutamine + glutamate on short echo time MRS.

CONCLUSIONS

Contrast-enhanced MRI, perfusion MRI, and quantitative analysis of ¹H-MRS are valuable techniques for distinguishing PCNSV from glioblastoma before surgery.

High-resolution, 3D multi-TE 1 H MRSI using fast spatiospectral encoding and subspace imaging

PURPOSE

To develop a novel method to achieve fast, high-resolution, 3D multi-TE ¹ H-MRSI of the brain.

METHODS

A new multi-TE MRSI acquisition strategy was developed that integrates slab selective excitation with adiabatic refocusing for better volume coverage, rapid spatiospectral encoding, sparse multi-TE sampling, and interleaved water navigators for field mapping and calibration. Special data processing strategies were developed to interpolate the sparsely sampled data, remove nuisance signals, and reconstruct multi-TE spatiospectral distributions with high SNR. Phantom and in vivo experiments have been carried out to demonstrate the capability of the proposed method.

RESULTS

The proposed acquisition can produce multi-TE ¹ H-MRSI data with three TEs at a nominal spatial resolution of 3.4 × 3.4 × 5.3 mm³ in around 20 min. High-SNR brain metabolite spatiospectral reconstructions can be obtained from both a metabolite phantom and in vivo experiments by the proposed method.

CONCLUSION

High-resolution, 3D multi-TE ¹ H-MRSI of the brain can be achieved within clinically feasible time. This capability, with further optimizations, could be translated to clinical applications and neuroscience studies where simultaneously mapping metabolites and neurotransmitters and TE-dependent molecular spectral changes are of interest.

Short-acquisition-time JPRESS and its application to paediatric brain tumours

OBJECTIVE

To develop and assess a short-duration JPRESS protocol for detection of overlapping metabolite biomarkers and its application to paediatric brain tumours at 3 Tesla.

MATERIALS AND METHODS

The short-duration protocol (6 min) was optimised and compared for spectral quality to a high-resolution (38 min) JPRESS protocol in a phantom and five healthy volunteers. The 6-min JPRESS was acquired from four paediatric brain tumours and compared with short-TE PRESS.

RESULTS

Metabolite identification between the 6- and 38-min protocols was comparable in phantom and volunteer data. For metabolites with Cramer-Rao lower bounds > 50%, interpretation of JPRESS increased confidence in assignment of lactate, myo-Inositol and scyllo-Inositol. JPRESS also showed promise for the detection of glycine and taurine in paediatric brain tumours when compared to short-TE MRS.

CONCLUSION

A 6-min JPRESS protocol is well tolerated in paediatric brain tumour patients. Visual inspection of a 6-min JPRESS spectrum enables identification of a range of metabolite biomarkers of clinical interest.

High-resolution two-dimensional 1H J-resolved MRS measurements on in vivo samples

Magnetic resonance spectroscopy (MRS) provides a noninvasive tool for metabolite characterization of in vivo biological samples. Conventional MRS measurements on biological samples generally suffer from field inhomogeneity caused by intrinsic magnetic susceptibility variations inside samples. Compared to one-dimensional MRS, two-dimensional (2D) J-resolved spectroscopy enables resolving J couplings along one of the spectral dimension and benefits to metabolite identification and analyses. Intermolecular double-quantum coherences (iDQC) has been proven to be insensitive to magnetic field inhomogeneity, herein we propose a MRS approach based on iDQC evolution and optimal echo sampling scheme to achieve high-resolution 2D J-resolved measurements on biological samples. The applicability of the proposed method is evaluated with experiments on an ex vivo pig brain tissue and an in vivo rat brain tissue. Compared to conventional MRS method which is sensitive to field inhomogeneity inside investigated biological tissues, the proposed method holds immunity to this field inhomogeneity and the quality of resulting spectra may not be influenced by localized voxel size variation. The signal to noise ratio enhancement of the proposed method benefitting from the optimal echo signal sampling is verified with a solution experiment. The new method provides a promising way for high-resolution MRS measurements on biological samples. In combination with fast acquisition strategy, it may find some promising biomedical applications.

Covariance J-resolved spectroscopy: Theory and application in vivo

Magnetic resonance spectroscopy (MRS) is a powerful tool capable of investigating the metabolic status of several tissues in vivo. In particular, single-voxel-based ¹ H spectroscopy provides invaluable biochemical information from a volume of interest (VOI) and has therefore been used in a variety of studies. Unfortunately, typical one-dimensional MRS data suffer from severe signal overlap and thus important metabolites are difficult to distinguish. One method that is used to disentangle overlapping resonances is the two-dimensional J-resolved spectroscopy (JPRESS) experiment. Due to the long acquisition duration of the JPRESS experiment, a limited number of points are acquired in the indirect dimension, leading to poor spectral resolution along this dimension. Poor spectral resolution is problematic because proper peak assignment may be hindered, which is why the zero-filling method is often used to improve resolution as a post-processing step. However, zero-filling leads to spectral artifacts, which may affect visualization and quantitation of spectra. A novel method utilizing a covariance transformation, called covariance J-resolved spectroscopy (CovJ), was developed in order to improve spectral resolution along the indirect dimension (F₁ ). Comparison of simulated data demonstrates that peak structures remain qualitatively similar between JPRESS and the novel method along the diagonal region (F₁ = 0 Hz), whereas differences arise in the cross-peak (F₁ ≠0 Hz) regions. In addition, quantitative results of in vivo JPRESS data acquired on a 3T scanner show significant correlations (r² >0.86, p<0.001) when comparing the metabolite concentrations between the two methods. Finally, a quantitation algorithm, 'COVariance Spectral Evaluation of ¹ H Acquisitions using Representative prior knowledge' (Cov-SEHAR), was developed in order to quantify γ-aminobutyric acid and glutamate from the CovJ spectra. These preliminary findings indicate that the CovJ method may be used to improve spectral resolution without hindering metabolite quantitation for J-resolved spectra.

Echo-Planar J-resolved Spectroscopic Imaging using Dual Read-outs: Implementation and Quantitation of Human Brain Metabolites

Attempts have been made to reduce the total scan time in multi-dimensional J-resolved spectroscopic imaging (JRESI) using an echo-planar (EP) readout gradient, but acquisition duration remains a limitation for routine clinical use in the brain. We present here a significant acceleration achieved with a 4D EP-JRESI sequence that collects dual phase encoded lines within a single repetition time (TR) using two bipolar read-out trains. The performance and reliability of this novel 4D sequence, called Multi-Echo based Echo-Planar J-resolved Spectroscopic Imaging (ME-EP-JRESI), was evaluated in 10 healthy controls and a brain phantom using a 3 T MRI/MRS scanner. The prior knowledge fitting (ProFit) algorithm, with a new simulated basis set consisting of macromolecules and lipids apart from metabolites of interest, was used for quantitation. Both phantom and in-vivo data demonstrated that localization and spatial/spectral profiles of metabolites from the ME-EP-JRESI sequence were in good agreement with that of the EP-JRESI sequence. Both in the occipital and temporal lobe, metabolites with higher physiological concentrations including Glx (Glu+Gln), tNAA (NAA+NAAG), mI all had coefficient of variations between 9-25%. In summary, we have implemented, validated and tested the ME-EP-JRESI sequence, demonstrating that multi-echo acquisition can successfully reduce the total scan duration for EP-JRESI sequences.

Pilot Assessment of Brain Metabolism in Perinatally HIV-Infected Youths Using Accelerated 5D Echo Planar J-Resolved Spectroscopic Imaging

Purpose

To measure cerebral metabolite levels in perinatally HIV-infected youths and healthy controls using the accelerated five dimensional (5D) echo planar J-resolved spectroscopic imaging (EP-JRESI) sequence, which is capable of obtaining two dimensional (2D) J-resolved spectra from three spatial dimensions (3D).

Materials and Methods

After acquisition and reconstruction of the 5D EP-JRESI data, T₁-weighted MRIs were used to classify brain regions of interest for HIV patients and healthy controls: right frontal white (FW), medial frontal gray (FG), right basal ganglia (BG), right occipital white (OW), and medial occipital gray (OG). From these locations, respective J-resolved and TE-averaged spectra were extracted and fit using two different quantitation methods. The J-resolved spectra were fit using prior knowledge fitting (ProFit) while the TE-averaged spectra were fit using the advanced method for accurate robust and efficient spectral fitting (AMARES).

Results

Quantitation of the 5D EP-JRESI data using the ProFit algorithm yielded significant metabolic differences in two spatial locations of the perinatally HIV-infected youths compared to controls: elevated NAA/(Cr+Ch) in the FW and elevated Asp/(Cr+Ch) in the BG. Using the TE-averaged data quantified by AMARES, an increase of Glu/(Cr+Ch) was shown in the FW region. A strong negative correlation (r < -0.6) was shown between tCh/(Cr+Ch) quantified using ProFit in the FW and CD4 counts. Also, strong positive correlations (r > 0.6) were shown between Asp/(Cr+Ch) and CD4 counts in the FG and BG.

Conclusion

The complimentary results using ProFit fitting of J-resolved spectra and AMARES fitting of TE-averaged spectra, which are a subset of the 5D EP-JRESI acquisition, demonstrate an abnormal energy metabolism in the brains of perinatally HIV-infected youths. This may be a result of the HIV pathology and long-term combinational anti-retroviral therapy (cART). Further studies of larger perinatally HIV-infected cohorts are necessary to confirm these findings.

Localized 2D COSY sequences: Method and experimental evaluation for a whole metabolite quantification approach

Two-dimensional spectroscopy offers the possibility to unambiguously distinguish metabolites by spreading out the multiplet structure of J-coupled spin systems into a second dimension. Quantification methods that perform parametric fitting of the 2D MRS signal have recently been proposed for resolved PRESS (JPRESS) but not explicitly for Localized Correlation Spectroscopy (LCOSY). Here, through a whole metabolite quantification approach, correlation spectroscopy quantification performances are studied. The ability to quantify metabolite relaxation constant times is studied for three localized 2D MRS sequences (LCOSY, LCTCOSY and the JPRESS) in vitro on preclinical MR systems. The issues encountered during implementation and quantification strategies are discussed with the help of the Fisher matrix formalism. The described parameterized models enable the computation of the lower bound for error variance--generally known as the Cramér Rao bounds (CRBs), a standard of precision--on the parameters estimated from these 2D MRS signal fittings. LCOSY has a theoretical net signal loss of two per unit of acquisition time compared to JPRESS. A rapid analysis could point that the relative CRBs of LCOSY compared to JPRESS (expressed as a percentage of the concentration values) should be doubled but we show that this is not necessarily true. Finally, the LCOSY quantification procedure has been applied on data acquired in vivo on a mouse brain.

Posterior Cingulate Lactate as a Metabolic Biomarker in Amnestic Mild Cognitive Impairment

Mitochondrial dysfunction represents a central factor within the pathogenesis of the Alzheimer's disease (AD) spectrum. We hypothesized that in vivo measurements of lactate (lac), a by-product of glycolysis, would correlate with functional impairment and measures of brain health in a cohort of 15 amnestic mild cognitive impairment (aMCI) individuals. Lac was quantified from the precuneus/posterior cingulate (PPC) using 2-dimensional J-resolved magnetic resonance spectroscopy (MRS). Additionally, standard behavioral and imaging markers of aMCI disease progression were acquired. PPC lac was negatively correlated with performance on the Wechsler logical memory tests and on the minimental state examination even after accounting for gray matter, cerebral spinal fluid volume, and age. No such relationships were observed between lac and performance on nonmemory tests. Significant negative relationships were also noted between PPC lac and hippocampal volume and PPC functional connectivity. Together, these results reveal that aMCI individuals with a greater disease progression have increased concentrations of PPC lac. Because lac is upregulated as a compensatory response to mitochondrial impairment, we propose that J-resolved MRS of lac is a noninvasive, surrogate biomarker of impaired metabolic function and would provide a useful means of tracking mitochondrial function during therapeutic trials targeting brain metabolism.

Spatially Localized Two-Dimensional J-Resolved NMR Spectroscopy via Intermolecular Double-Quantum Coherences for Biological Samples at 7 T

Background and Purpose

Magnetic resonance spectroscopy (MRS) constitutes a mainstream technique for characterizing biological samples. Benefiting from the separation of chemical shifts and J couplings, spatially localized two-dimensional (2D) J-resolved spectroscopy (JPRESS) shows better identification of complex metabolite resonances than one-dimensional MRS does and facilitates the extraction of J coupling information. However, due to variations of macroscopic magnetic susceptibility in biological samples, conventional JPRESS spectra generally suffer from the influence of field inhomogeneity. In this paper, we investigated the implementation of the localized 2D J-resolved spectroscopy based on intermolecular double-quantum coherences (iDQCs) on a 7 T MRI scanner.

Materials and Methods

A γ-aminobutyric acid (GABA) aqueous solution, an intact pig brain tissue, and a whole fish (Harpadon nehereus) were explored by using the localized iDQC J-resolved spectroscopy (iDQCJRES) method, and the results were compared to those obtained by using the conventional 2D JPRESS method.

Results

Inhomogeneous line broadening, caused by the variations of macroscopic magnetic susceptibility in the detected biological samples (the intact pig brain tissue and the whole fish), degrades the quality of 2D JPRESS spectra, particularly when a large voxel is selected and some strongly structured components are included (such as the fish spinal cord). By contrast, high-resolution 2D J-resolved information satisfactory for metabolite analyses can be obtained from localized 2D iDQCJRES spectra without voxel size limitation and field shimming. From the contrastive experiments, it is obvious that the spectral information observed in the localized iDQCJRES spectra acquired from large voxels without field shimming procedure (i.e. in inhomogeneous fields) is similar to that provided by the JPRESS spectra acquired from small voxels after field shimming procedure (i.e. in relatively homogeneous fields).

Conclusion

The localized iDQCJRES method holds advantage for recovering high-resolution 2D J-resolved information from inhomogeneous fields caused by external non-ideal field condition or internal macroscopic magnetic susceptibility variations in biological samples, and it is free of voxel size limitation and time-consuming field shimming procedure. This method presents a complementary way to the conventional JPRESS method for MRS measurements on MRI systems equipped with broad inner bores, and may provide a promising tool for in vivo MRS applications.

Evaluation of lactate detection using selective multiple quantum coherence in phantoms and brain tumours

Lactate is a product of glucose metabolism. In tumour tissues, which exhibit enhanced glycolytic metabolism, lactate signals may be elevated, making lactate a potential useful tumour biomarker. Methods of lactate quantitation are complicated because of overlap between the lactate methyl doublet CH3 resonance and a lipid resonance at 1.3 ppm. This study presents the use of a selective homonuclear multiple quantum coherence transfer sequence (SelMQC-CSI), at 1.5 T, to better quantify lactate in the presence of lipids. Work performed on phantoms showed good lactate detection (49%) and lipid suppression (98%) efficiencies. To evaluate the method in the brain, the sequence was tested on a group of 23 patients with treated brain tumours, either glioma (N=20) or secondary metastases in the brain (N=3). Here it was proved to be of use in determining lactate concentrations in vivo. Lactate was clearly seen in SelMQC spectra of glioma, even in the presence of lipids, with high grade glioma (7.3 ± 1.9 mM, mean ± standard deviation) having higher concentrations than low grade glioma (1.9 ± 1.5 mM, p=0.048). Lactate was not seen in secondary metastases in the brain. SelMQC-CSI is shown to be a useful technique for measuring lactate in tumours whose signals are otherwise contaminated by lipid.

Two-dimensional J-resolved proton MR spectroscopy and prior knowledge fitting (ProFit) in the frontal and parietal lobes of healthy volunteers: assessment of metabolite discrimination and general reproducibility

PURPOSE

To investigate human brain metabolite discriminability and general measurement reproducibility of two-dimensional (2D) J-resolved (1)H MRS and Prior Knowledge Fitting (ProFit).

MATERIALS AND METHODS

2D J-resolved (1)H MRS spectra were acquired from the anterior cingulate cortex (ACC) and the parietal-occipital cortex (POC) of 10 healthy subjects at a magnetic field strength of 2.9 Tesla. Amplitude correlation matrices were constructed for each subject and brain region to assess metabolite discriminability. ProFit-estimated metabolite peak areas were normalized to a water reference signal, and intra- and inter-subject reproducibility was evaluated.

RESULTS

Favorable between-metabolite correlation coefficients (<20%) were observed for a range of metabolites. Lower correlation coefficients between a given pair of metabolite estimates were consistently observed for POC metabolites. The group mean correlation coefficient existing between glutamate and glutamine was calculated as -18% and -13% for ACC and POC, respectively. Most ACC and POC metabolites showed intra- and inter-subject CV values of <15% and <20%, respectively.

CONCLUSION

The observed Glu and Gln signal discrimination makes these techniques suitable for investigating a variety of psychiatric disorders. Intra- and inter-subject metabolite level reproducibility was comparable to the existing literature findings. These data serve as a valuable benchmark for assessing future modifications to 2D (1)H MRS data acquisition and ProFit analysis.

3D localized 2D ultrafast J-resolved magnetic resonance spectroscopy: in vitro study on a 7 T imaging system

2D Magnetic Resonance Spectroscopy (MRS) is a well known tool for the analysis of complicated and overlapped MR spectra and was therefore originally used for structural analysis. It also presents a potential for biomedical applications as shown by an increasing number of works related to localized in vivo experiments. However, 2D MRS suffers from long acquisition times due to the necessary collection of numerous increments in the indirect dimension (t(1)). This paper presents the first 3D localized 2D ultrafast J-resolved MRS sequence, developed on a small animal imaging system, allowing the acquisition of a 3D localized 2D J-resolved MRS spectrum in a single scan. Sequence parameters were optimized regarding Signal-to-Noise ratio and spectral resolution. Sensitivity and spatial localization properties were characterized and discussed. An automatic post-processing method allowing the reduction of artifacts inherent to ultrafast excitation is also presented. This sequence offers an efficient signal localization and shows a great potential for in vivo dynamic spectroscopy.

Magnetic resonance spectroscopic detection of lactate is predictive of a poor prognosis in patients with diffuse intrinsic pontine glioma

Diffuse brainstem glioma has a poor prognosis, and there are few long-term survivors. We looked for clinical, conventional magnetic resonance (MR), and MR spectroscopic (MRS) findings predictive of the prognosis of patients with brainstem glioma. Our institutional review board approved this retrospective study of 23 patients with diffuse intrinsic pontine or diffuse medullary brainstem glioma treated during the period 2000-2009. To evaluate prognostic values, we performed a Kaplan-Meier survival analysis (log-rank test) that incorporated the patients' age and sex, symptom duration, the presence or absence of cranial nerve palsy, long tract sign, ataxia, and cysts, the chemotherapeutic regimen, Gd enhancement, longitudinal and cerebellar extension, basilar artery encasement, and MRS parameters. Of the 23 diffuse brainstem gliomas, 19 were located at the pons (ratio of male to female patients, 1.1:1). The mean age of the 23 patients was 15.9 years (range, 4-50 years); 16 were aged <20 years. The duration of overall survival was 19.7 months; in patients with diffuse intrinsic pontine glioma, it was 16.6 months, and in patients aged <20 years, it was 11.8 months. Clinical and conventional MR findings at presentation were not predictive of the prognosis in children with diffuse intrinsic pontine glioma. In addition, a patient age <20 years and the detection of lactate by MRS were poor prognostic factors. The MRS detection of lactate is a prognostic factor in patients with diffuse intrinsic pontine glioma. Additional studies of larger patient populations using other imaging modalities are needed.

Correlation of endorectal 2D JPRESS findings with pathological Gleason scores in prostate cancer patients

To determine the metabolite ratios of (Cho + Cr)/Cit and (Cho + Cr)/Spm in patients with two ranges of pathological Gleason scores, namely (3 + 4) and (4 + 3). By using the localized two-dimensional (2D) J-resolved spectroscopy (JPRESS) technique, the metabolites ratios can be calculated and correlated with prostate cancer aggressiveness. A total of 24 patients who underwent endorectal 2D JPRESS between April 2006 and July 2007 were included in this study. The 2D JPRESS voxel was localized predominantly in the peripheral zone suspected for malignancy based on pathology. Using the metabolites such as total choline (Cho), creatine (Cr), spermine (Spm) and citrate (Cit), the ratios (Cho + Cr)/Cit and (Cho + Cr)/Spm were calculated. In 14 prostate cancer patients who had a final pathologic Gleason scores of i) (3 + 4 = 7, n = 7) and ii) (4 + 3 = 7, n = 7), the metabolite ratios (mean +/- SD) of (Cho + Cr)/Cit and (Cho + Cr)/Spm were calculated using the 2D JPRESS spectra as follows: i) (1.48 +/- 0.83) and (1.59 +/- 0.73); ii) (2.90 +/- 0.94) and (2.71 +/- 1.47), respectively. Higher percentage of aggressive disease correlates with higher metabolites ratio. Our pilot study suggests that 2D JPRESS can be reliably evaluated in a clinical setting using an endorectal coil. In addition to the citrate ratio, the spermine ratio also correlates with pathology based Gleason score.

Molecular classification of brain tumor biopsies using solid-state magic angle spinning proton magnetic resonance spectroscopy and robust classifiers

Brain tumors are one of the leading causes of death in adults with cancer; however, molecular classification of these tumors with in vivo magnetic resonance spectroscopy (MRS) is limited because of the small number of metabolites detected. In vitro MRS provides highly informative biomarker profiles at higher fields, but also consumes the sample so that it is unavailable for subsequent analysis. In contrast, ex vivo high-resolution magic angle spinning (HRMAS) MRS conserves the sample but requires large samples and can pose technical challenges for producing accurate data, depending on the sample testing temperature. We developed a novel approach that combines a two-dimensional (2D), solid-state, HRMAS proton (1H) NMR method, TOBSY (total through-bond spectroscopy), which maximizes the advantages of HRMAS and a robust classification strategy. We used approximately 2 mg of tissue at -8 degrees C from each of 55 brain biopsies, and reliably detected 16 different biologically relevant molecular species. We compared two classification strategies, the support vector machine (SVM) classifier and a feed-forward neural network using the Levenberg-Marquardt back-propagation algorithm. We used the minimum redundancy/maximum relevance (MRMR) method as a powerful feature-selection scheme along with the SVM classifier. We suggest that molecular characterization of brain tumors based on highly informative 2D MRS should enable us to type and prognose even inoperable patients with high accuracy in vivo.

High resolution localized two-dimensional MR spectroscopy in mouse brain in vivo

Localized two-dimensional MR spectroscopy (2D MRS) is impacting the in vivo studies of brain metabolites due to improved spectral resolution and unambiguous assignment opportunities. Despite the large number of transgenic mouse models available for neurological disorders, localized 2D MRS has not yet been implemented in the mouse brain due to size constraints. In this study we optimized a localized 2D proton chemical shift correlated spectroscopic sequence at field strength of 9.4T to obtain highly resolved 2D spectra from localized regions in mouse brains in vivo. The combination of the optimized 2D sequence, high field strength, strong gradient system, efficient water suppression, and the use of a short echo time allowed clear detection of cross-peaks of up to 16 brain metabolites, allowing their direct chemical shift assignments in vivo. To our knowledge this is the first in vivo 2D MRS study of the mouse brain, demonstrating its feasibility to resolve and simultaneously assign several metabolite resonances in the mouse brain in vivo. Implementation of 2D MRS will be invaluable in the identification of new biomarkers during disease progression and treatment using the various available mouse models.

Two-dimensional MR spectroscopy of healthy and cancerous prostates in vivo

OBJECTIVES

A major goal of this article is to summarize the current status of evaluating prostate metabolites non-invasively using spatially resolved two-dimensional (2D) MR Spectroscopy (MRS).

MATERIALS AND METHODS

Due to various technical challenges, the spatially resolved versions of 2D MRS techniques are currently going through the developmental stage. During the last decade, four different versions of 2D MRS sequences have been successfully implemented on 3T and 1.5T MRI scanners manufactured by three different vendors. These sequences include half and maximum echo sampled J-resolved spectroscopy (JPRESS), S-PRESS and L-COSY, which are single volume localizing sequences, and the multi-voxel based JPRESS sequence.

RESULTS

Even though greater than 1ml voxels have been used, preliminary evaluations of 2D JPRESS, S-PRESS and L-COSY sequences have demonstrated unambiguous detection of citrate, creatine, choline, spermine and more metabolites in human prostates. ProFIT-based quantitation of JPRESS and L-COSY data clearly shows the superiority of 2D MRS over conventional one-dimensional (1D) MRS and more than six metabolites have been successfully quantified. These sequences have been evaluated in a small group of prostate pathologies and pilot investigations using these sequences show promising results in prostate pathologies.

CONCLUSION

Implementation of the state-of-the-art 2D MRS techniques and preliminary evaluation in prostate pathologies are discussed in this review. Even though these techniques are going through developmental and early testing phases, it is evident that 2D MRS can be easily added on to any clinical Magnetic Resonance Imaging (MRI) protocol to non-invasively record the biochemical contents of the prostate.

Spectral simplification for resolved glutamate and glutamine measurement using a standard STEAM sequence with optimized timing parameters at 3, 4, 4.7, 7, and 9.4T

The C4 multiplet proton resonances of glutamate (Glu) around 2.35 ppm and glutamine (Gln) around 2.45 ppm usually overlap in MR spectra, particularly at low- and mid-field strengths (1.5-4.7T). A spectral simplification approach is introduced that provides unobstructed Glu and Gln measurement using a standard STEAM localization sequence with optimized interpulse timings. The underlying idea is to exploit the dependence of response of a coupled spin system on the echo time (TE) and mixing time (TM) to find an optimum timing set (TE, TM), at which the outer-wings of C4 "pseudo-triplet" proton resonances of Glu and Gln are significantly suppressed while the central peaks are maintained. The spectral overlap is thus resolved as the overlap exists exclusively at the outer-wings and the central peaks are readily separated due to the approximate 0.1-ppm difference in chemical shift. Density matrix simulation for Glu, Gln, and other overlapping metabolites at 2.3-2.5 ppm was conducted to predict the optimum timing sets. The simulated, phantom, and in vivo results demonstrated that the C4 multiplet proton resonances of Glu and Gln can be resolved for unobstructed detection at 3T, 4T, and 4.7T. For simplicity, only simulated data are illustrated at 7T and 9.4T.

Three-dimensional J-resolved H-1 magnetic resonance spectroscopic imaging of volunteers and patients with brain tumors at 3T

A method that combines two-dimensional (2D) J-resolved spectroscopy with three spatial dimension magnetic resonance spectroscopic imaging (MRSI) is introduced to measure J-coupled metabolites of glutamate (Glu), glutamine (Gln), myo-Inositol (mI), and lactate (Lac) in the brain and to simultaneously obtain T(2) values of choline (Cho), creatine (Cr), and N-acetyl aspartate (NAA). Relatively few points in the t(1) dimension (six echo times) and a flyback echo-planar trajectory were incorporated in the acquisition to speed up the total acquisition time so that it was within a clinically feasible range (23 min). Data obtained using GAMMA software simulations and from phantoms have shown that the (4)CH(2) resonances of Glu can be separated from Gln at 2.35 ppm in TE-averaged spectra. Results from phantoms, six normal volunteers, and four patients demonstrated good signal-to-noise ratio (SNR). The J cross-peaks from the methyl group of Lac were visualized in the 2D spectra from the phantom and the glioma patient, and could be quantified from the spectra at J = +/-4.17 Hz. This technique also enables the evaluation of the changes in metabolite T(2). Compared with the values in normal white matter, the T(2) values of Cho and Cr were statistically significantly increased in regions of glioma.

Recent advances in magnetic resonance neurospectroscopy

Over the past two decades, proton magnetic resonance spectroscopy (proton MRS) of the brain has made the transition from research tool to a clinically useful modality. In this review, we first describe the localization methods currently used in MRS studies of the brain and discuss the technical and practical factors that determine the applicability of the methods to particular clinical studies. We also describe each of the resonances detected by localized solvent-suppressed proton MRS of the brain and discuss the metabolic and biochemical information that can be derived from an analysis of their concentrations. We discuss spectral quantitation and summarize the reproducibility of both single-voxel and multivoxel methods at 1.5 and 3-4 T. We have selected three clinical neurologic applications in which there has been a consensus as to the diagnostic value of MRS and summarize the information relevant to clinical applications. Finally, we speculate about some of the potential technical developments, either in progress or in the future, that may lead to improvements in the performance of proton MRS.

GAVA: spectral simulation for in vivo MRS applications

An application that provides a flexible and easy to use interface to the GAMMA spectral simulation package is described that is targeted at investigations using in vivo MR spectroscopic methods. The program makes available a number of widely used spatially localized MRS pulse sequences and NMR parameters for commonly observed tissue metabolites, enabling spectra to be simulated for any pulse sequence parameter and viewed in an integrated display. The application is interfaced with a database for storage of all simulation parameters and results of the simulations. This application provides a convenient method for generating a priori spectral information used in parametric spectral analyses and for visual examination of the effects of difference pulse sequences and parameter settings.

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.

TE-Averaged two-dimensional proton spectroscopic imaging of glutamate at 3 T

Glutamate and glutamine are important neurochemicals in the central nervous system and the neurotoxic properties of excess glutamate have been associated with several neurodegenerative diseases. The TE-Averaged PRESS technique has been shown by our group to detect an unobstructed glutamate signal at 3 T that is resolved from glutamine and NAA at 2.35 ppm. TE-Averaged PRESS therefore provides an unambiguous measurement of glutamate as well as other metabolites such as NAA, choline, creatine, and myo-inositol. In this study, we extend the single voxel TE-Averaged PRESS technique for two-dimensional (2D) spectroscopic imaging (TE-Averaged MRSI) to generate 2D glutamate maps. To facilitate TE-Averaged MRSI within a reasonable time, a fast encoding trajectory was used. This enabled rapid acquisition of TE-Averaged spectral arrays with good spectral bandwidth (977 Hz) and resolution (approximately 2 Hz). MRSI data arrays of 10 x 16 were acquired with 1.8 cm3 spatial resolution over a approximately 110 cm3 volume in a scan time of approximately 21 min. Two-dimensional metabolite maps were obtained with good SNR and clear differentiation in glutamate levels was observed between gray and white matter with significantly higher glutamate in gray matter relative to white matter as anticipated.

Improved two-dimensional J-resolved spectroscopy

Localised two-dimensional J-resolved spectroscopy (JPRESS) is optimised for the in vivo detection of J-coupled metabolites using magnetic resonance spectroscopy at 3 T. The acquisition of echo signals starts as early as possible (i.e. maximum-echo sampling). This sampling scheme increases sensitivity and decreases overlap of peak tails, hence alleviating baseline problems. Reconstruction issues are discussed and the sensitivity is compared analytically with that of 1D PRESS. The qualitative behaviour of eddy currents in JPRESS is outlined and a 2D eddy current correction procedure based on the 1D phase deconvolution method is proposed.

Localized COSY and DQF-COSY 1H-MRS sequences for investigating human tibial bone marrow in vivo and initial application to patients with acute leukemia

PURPOSE

To develop 2D 1H-MRS measurement sequences for the evaluation of bone marrow lipids, and to assess these measurement sequences in healthy and diseased bone marrow.

MATERIALS AND METHODS

Single-voxel localized variants of COSY and DQF-COSY 2D 1H-MRS sequences were developed for use at 1.5 T to investigate the biochemical composition of human bone marrow in vivo. The performance of each sequence was initially tested in vitro using lipid phantoms. An unsaturated lipid proton index was developed to interrogate the degree of unsaturation within the triacylglyceride (TAG) acyl chains. Localized 2D 1H-MRS data were obtained from the bone marrow of healthy controls (N = 6), patients presenting with acute leukemia (N = 6) and patients with acute leukemia in remission (N = 4).

RESULTS

The COSY and DQF-COSY data recorded from all subject cohorts were similar, and the unsaturated lipid proton index did not reveal significant differences between patient groups. Variations in water content and measured relaxation times showed minor differences between the measurement groups.

CONCLUSIONS

No significant differences were observed in the spectra obtained from bone marrow using the 2D 1H-MRS sequences. A novel unsaturated lipid proton index was developed.

Measurement of brain glutamate and glutamine by spectrally-selective refocusing at 3 tesla

A new single-voxel proton NMR spectrally-selective refocusing method for measuring glutamate (Glu) and glutamine (Gln) in the human brain in vivo at 3T is reported. Triple-resonance selective 180 degrees RF pulses with a bandwidth of 12 Hz were implemented within point-resolved spectroscopy (PRESS) for selective detection of Glu or Gln, and simultaneous acquisition of creatine singlets for use as a reference in phase correction. The carriers of the spectrally-selective 180 degrees pulses and the echo times (TEs) were optimized with both numerical and experimental analyses of the filtering performance, which enabled measurements of the target metabolites with negligible contamination from N-acetylaspartate and glutathione. The concentrations of Glu and Gln in the prefrontal cortex were estimated to be 9.7+/-0.5 and 3.0+/-0.7 mM (mean+/-SD, N=7), with reference to Cr at 8 mM.

Detection of glutamate in the human brain at 3 T using optimized constant time point resolved spectroscopy

A CT-PRESS sequence was implemented on a 3-T MR scanner and optimized for the detection of the C4 resonance of glutamate. By simulating the sequence using the full density matrix it was found that 121 chemical shift encoding steps in t1 with an increment delta t1 = 1.6 ms were sufficient to separate the glutamate C4 resonance. The simulations also showed that the highest signal-to-noise ratio was achieved at an average echo time of 131 ms. When using an eightfold undersampling scheme in f1 in order to reduce the minimum total measurement time, the average echo time was 139 ms with 17 encoding steps (delta t1 = 12.8 ms). The sequence was tested on phantoms containing solutions of various brain metabolites and on healthy human volunteers. Besides resolving glutamate, other resonances detected in vivo comprised N-acetyl aspartate, total creatine, choline containing compounds, and myo-inositol. However, glutamine resonances could not be resolved due to severe signal overlap from glutamate and N-acetyl aspartate.

Noninvasive magnetic resonance spectroscopic imaging biomarkers to predict the clinical grade of pediatric brain tumors

The diagnosis and therapy of childhood brain tumors, most of which are low grade, can be complicated because of their frequent adjacent location to crucial structures, which limits diagnostic biopsy. Also, although new prognostic biomarkers identified by molecular analysis or DNA microarray gene profiling are promising, they too depend on invasive biopsy. Here, we test the hypothesis that combining information from biologically important intracellular molecules (biomarkers), noninvasively obtained by proton magnetic resonance spectroscopic imaging, will increase the diagnostic accuracy in determining the clinical grade of pediatric brain tumors. We evaluate the proton magnetic resonance spectroscopic imaging exams for 66 children with brain tumors. The intracellular biomarkers for choline-containing compounds (Cho), N-acetylaspartate, total creatine, and lipids and/or lactate were measured at the highest Cho region and normalized to the surrounding healthy tissue total creatine. Neuropathological grading was done with WHO criteria. Normalized Cho and lipids and/or lactate were elevated in high-grade (n = 23) versus low-grade (n = 43) tumors, which multiple logistic regression confirmed are independent predictors of tumor grade (for Cho, odds ratio 24.8, P < 0.001; and for lipids and/or lactate, odds ratio 4.4, P < 0.001). A linear combination of normalized Cho and lipids and/or lactate that maximizes diagnostic accuracy was calculated by maximizing the area under the receiver operating characteristic curve. Proton magnetic resonance spectroscopic imaging, although not a proxy for histology, provides noninvasive, in vivo biomarkers for predicting clinical grades of pediatric brain tumors.

A continuous phase-modulated approach to spatial encoding in ultrafast 2D NMR spectroscopy

Ultrafast 2D NMR replaces the time-domain parametrization usually employed to monitor the indirect-domain spin evolution, with an equivalent encoding along a spatial geometry. When coupled to a gradient-assisted decoding during the acquisition, this enables the collection of complete 2D spectra within a single transient. We have presented elsewhere two strategies for carrying out the spatial encoding underlying ultrafast NMR: a discrete excitation protocol capable of imparting a phase-modulated encoding of the interactions, and a continuous protocol yielding amplitude-modulated signals. The former is general but has associated with it a number of practical complications; the latter is easier to implement but unsuitable for certain 2D NMR acquisitions. The present communication discusses a new protocol that incorporates attractive attributes from both alternatives, imparting a continuous spatial encoding of the interactions yet yielding a phase modulation of the signal. This in turn enables a number of basic experiments that have shown particularly useful in the context of in vivo 2D NMR, including 2D J-resolved and 2D H,H-COSY spectroscopies. It also provides a route to achieving sensitivity-enhanced acquisitions for other homonuclear correlation experiments, such as ultrafast 2D TOCSY. The main features underlying this new spatial encoding protocol are derived, and its potential demonstrated with a series of phase-modulated homonuclear single-scan 2D NMR examples.

Ultrafast 2D NMR spectroscopy using sinusoidal gradients: principles and ex vivo brain investigations

A new methodology capable of delivering complete 2D NMR spectra within a single scan was recently introduced. The resulting potential gain in time resolution could open new opportunities for in vivo spectroscopy, provided that the technical demands of the methodology are satisfied by the corresponding hardware. Foremost among these demands are the relatively short switching times expected from the applied gradient-echo trains. These rapid transitions may be particularly difficult to accomplish on imaging systems. As a step toward solving this problem, we assessed the possibility of replacing the square-wave gradient train currently used during the course of the acquisition by a shaped sinusoidal gradient. Examples of the implementation of this protocol are given, and successful ultrafast acquisitions of 2D NMR spectra with suitable spectral widths on a microimaging probe (for both phantom solutions and ex vivo mouse brains) are demonstrated.

In vivo prostate magnetic resonance spectroscopic imaging using two-dimensional J-resolved PRESS at 3 T

In vivo magnetic resonance spectroscopic imaging of the prostate using single-voxel and multivoxel two-dimensional (2D) J-resolved sequences is investigated at a main magnetic field strength of 3 T. Citrate, an important metabolite often used to aid the detection of prostate cancer in magnetic resonance spectroscopic exams, can be reliably detected along with the other metabolites using this method. We show simulations and measurements of the citrate metabolite using 2D J-resolved spectroscopy to characterize the spectral pattern. Furthermore, using spiral readout gradients, the single-voxel 2D J-resolved method is extended to provide the spatial distribution information as well all within a reasonable scan time (17 min). Phantom and in vivo data are presented to illustrate the multivoxel 2D J-resolved spiral chemical shift imaging sequence.

Multi-spin-echo J-resolved spectroscopic imaging without water suppression: application to a rat glioma at 7 T

Two-dimensional J-resolved spectroscopy may be used to separate resonances which overlap in 1D NMR spectra. Coupled with spectroscopic imaging (SI), it would give unequivocal information on the distribution of such resonances. Multi-echo acquisition decreases the minimum experimental time of such 4D experiments. The water peak may be used for phase and chemical-shift reference. This study aimed to demonstrate the feasibility of J-resolved SI based on a multi-echo sequence and without water suppression, and its ability to separate the peaks for lactate and mobile lipid in a rat glioma. Experiments were performed on rat brain, without water suppression, at 7 T. The water signal was used for correcting the phase of the echoes. A FOCSY-like acquisition was used to collect the first part of the echoes at short echo times. Two different data processing methods were tested to overcome the problem of contaminations of metabolite signals by the intense water signal. Maps of N-acetylaspartate, choline, creatine, lactate and mobile lipids were obtained in vivo on a rat glioma in 70 min. The in-plane resolution was 2 mm2. The 2D spatially resolved, 2D J-resolved spectra enabled the separate mapping of lactate and mobile lipids.

2DJ-resolved spiral spectroscopic imaging at 7 T: Application to mobile lipid mapping in a rat glioma

Lactate (Lac) and mobile lipids (Lip), which are present in rat gliomas, are difficult to map because their 1H resonances overlap in the 1.3 ppm region. 2D J-resolved spectroscopy enables proper separation of the two resonance lines. To obtain high-spatial-resolution mapping of Lac and Lip resonances within a reasonable experiment time, we coupled 2D J-resolved spectroscopy with a fast spectroscopic imaging (SI) method, based on an out-and-in spiral k-space description. The method was applied to a rat glioma at 7 T, and Lac and Lip maps were reconstructed. The duration of SI (2D spatial, 2D spectral) was 64 min for a theoretical in-plane resolution of 1 x 1 mm, and a slice thickness of 2 mm (voxel size 8.2 microl, taking into account the point-spread function (PSF)).

Measurement of brain glutamate using TE-averaged PRESS at 3T

A method is introduced that provides improved in vivo spectroscopic measurements of glutamate (Glu), glutamine (Gln), choline (Cho), creatine (Cre), N-acetyl compounds (NAtot, NAA + NAAG), and the inositols (mI and sI). It was found that at 3T, TE averaging, the f1 = 0 slice of a 2D J-resolved spectrum, yielded unobstructed signals for Glu, Glu + Gln (Glx), mI, NA(tot), Cre, and Cho. The C4 protons of Glu at 2.35 ppm, and the C2 protons of Glx at 3.75 ppm were well resolved and yielded reliable measures of Glu/Gln stasis. Apparent T1/T2 values were obtained from the raw data, and metabolite tissue levels were determined relative to a readily available standard. A repeatibility error of <5%, and a coefficient of variation (CV) of <10% were observed for brain Glu levels in a study of six normal volunteers.

In vivo 2D J-resolved magnetic resonance spectroscopy of rat brain with a 3-T clinical human scanner

A clinical 3-T scanner equipped with a custom-made transmit/receive birdcage coil was used to collect 2D J-resolved single-voxel spectroscopy in vivo of rat brain. Four adult Wistar rats were scanned twice each, with a 2-week interval. Voxel size was approximately 5 x 10 x 5 mm(3). Total spectroscopic acquisition time was 14 min for collection of two 4:20 min water-suppressed acquisitions and one 4:20 min acquisition acquired in the absence of water suppression. The unsuppressed water data were used in post-processing to reduce residual water side bands, as well as for metabolite signal normalization to account for variations in coil loading and voxel size. Peak areas were estimated for resonances from N-acetyl aspartate (NAA), creatine, choline, taurine, glutamate, and combined glutamate and glutamine. T(2)-relaxation times were estimated for NAA and creatine. The average deviation from the mean of repeated measures for glutamate, combined glutamate and glutamine, and taurine ranged from 7.6% to 18.3%, while for NAA, creatine, and choline, the deviation was less than 3%. The estimated T(2) values for NAA (mean +/- SD = 330 +/- 57 ms) and creatine (174 +/- 27 ms) were similar to those reported previously for rat brain and for human gray and white matter. These results indicate that reliable, small animal brain MR spectroscopy can be performed on a human clinical 3-T scanner.

In vivo 1H NMR spectroscopy of individual human brain metabolites at moderate field strengths

This article reviews spectral editing techniques for in vivo 1H NMR spectroscopy of human brain tissue at moderate field strengths of 1.5-3 Tesla. Various aspects of 1H NMR spectroscopy are discussed with regard to in vivo applications. The parameter set [delta, J, n] (delta being the relative chemical shift, J the scalar coupling constant and n the number of coupled spins) is used to characterize the spin systems under investigation and to classify the editing techniques that are used in in vivo 1H NMR spectroscopy.

Evaluation of two-dimensional L-COSY and JPRESS using a 3 T MRI scanner: from phantoms to human brain in vivo

Localized versions of two-dimensional (2D) magnetic resonance spectroscopic (MRS) sequences, namely JPRESS and L-COSY, have been implemented on a whole-body 3T MRI/MRS scanner. Volume selection was achieved using three slice-selective radio-frequency (RF) pulses: 90 degrees-180 degrees-180 degrees in JPRESS and 90 degrees-180 degrees-90 degrees in L-COSY with a CHESS sequence prior to voxel localization for global water suppression. The last 180 degrees RF pulse was used for resolving the J-coupled cross peaks in JPRESS, whereas the last 90 degrees RF pulse was used for coherence transfer between J-coupled metabolites in L-COSY. A head MRI coil for 'transmission' and a 4 inch receive surface coil for 'reception' or a head coil transmit/receive were used. A total of 16 healthy volunteers were investigated using these 2D MRS sequences. Voxel sizes of 18 and 27 ml were localized in the occipito-parietal gray and white matter regions and the total duration for each 2D signal acquisition was typically 35 min. Compared with 2D L-COSY, reduced spectral width along the second spectral dimension and shorter 2D spectral acquisition were the major advantages of 2D JPRESS. In contrast, increased spectral width along the new spectral dimension in L-COSY resulted in an improved spectral dispersion enabling the detection of several brain metabolites at low concentrations that have not been resolved using the conventional one-dimensional (1D) MRS techniques. Due to increased sampling rate, severe loss of metabolite signals due to T2 during t1 was a major drawback of 2D JPRESS in vivo.

In vivo measurement of brain metabolites using two-dimensional double-quantum MR spectroscopy--exploration of GABA levels in a ketogenic diet

A localized proton 2D double-quantum (DQ) spin-echo spectroscopy technique was implemented on 1.5 T clinical MRI scanners for the detection of gamma-aminobutyrate (GABA) in the brain. The 2D approach facilitates separation of peaks overlapping with GABA in 1D DQ-filtered (DQF) spectra. This technique was applied to four normal adult volunteers and four children with intractable epilepsy. The coefficient of variation of the level of GABA and overlapping macromolecules at F2 = 3.0 ppm and F1 = 4.8 ppm was 0.08 in normal subjects. Three patients received 2D MRS scans before and after initiation of the ketogenic diet (KD): one patient showed a trend of decreasing GABA throughout the study, and two patients showed low initial GABA levels that increased over time. In addition to major metabolites and GABA, low-level metabolites (valine, leucine, and glutathione) were also identified in the 2D spectra.

Rapid modulation of GABA in sensorimotor cortex induced by acute deafferentation

Recovery of function after acute injury to the central nervous system may be controlled by the availability of gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter in the cerebral cortex. Acute lesions as well as manipulation of sensory inputs can lead to rapid reorganization of the cerebral cortex, occurring within minutes to hours. Reduction of cortical inhibitory tone through a decrease in the availability of GABA has been suggested as a possible mechanism; however, the degree and temporal course of the changes in brain GABA are not known. A novel method using two-dimensional J-resolved magnetic resonance spectroscopy showed that GABA levels in the human sensorimotor cortex are quickly reduced within minutes of deafferentation. This finding strongly supports the view that the release of latent corticocortical projections from tonic inhibition through decreased GABA availability is a mechanism of rapid cortical plasticity. Reduction of brain GABA can play a pivotal role in regulating the extent of rapid cortical reorganization after lesions or changes in sensory input.

Reproducibility of localized 2D correlated MR spectroscopy

The test-retest reliability of two-dimensional (2D) correlated spectroscopy (COSY) was studied on a whole-body 1.5T MRI scanner. Single-voxel localized 2D proton spectra were recorded in vitro as well as in vivo using a recently implemented localized chemical shift correlated spectroscopic (L-COSY) sequence. A total of 40 in vitro and 40 human brain (10 volunteers, four times each) 2D L-COSY spectra were recorded. The coefficients of variation (CVs) of selected brain metabolites (raw volume integrals) recorded in 10 healthy volunteers were less than 9% for creatine, choline, and N-acetyl aspartate, and less than 17% for myo-inositol, glutamine/glutamate, aspartate, and threonine/lactate. The 2D metabolite ratios and the raw volume integrals of 2D diagonal and cross peaks in healthy human brain were very well reproduced. The intraclass correlation coefficients were greater than 0.4 (P < 0.05) for the major metabolites, indicating that the 2D peak volumes were stable enough within individuals to detect reliable differences between normal subjects.

2D JPRESS of human prostates using an endorectal receiver coil

A localized 2D J-resolved (JPRESS) MR spectroscopic sequence was evaluated in human prostates in vivo. Voxels of typically 2 ml were placed in the peripheral zone of the prostate. Eight healthy volunteers, three subjects with benign prostatic hyperplasia, and three patients with prostatic cancer were scanned on a 1.5T MR scanner, using a body coil for RF transmission and a pelvic phased-array coil combined with a disposable endorectal coil for signal reception. The total acquisition time for a 2D JPRESS spectrum was approximately 17 min. A major advantage of the endorectal 2D JPRESS was the ability to resolve the peaks of choline-containing compounds and those of spermine unequivocally. Spectral results clearly showed the biochemical changes in cancer and benign compared to healthy prostates, in conformity with ex vivo biochemical findings. The preliminary results suggest that the endorectal 2D JPRESS could be successfully implemented for the diagnostic examination of human prostates. .

The potential of proton magnetic resonance spectroscopy ((1)H-MRS) in the diagnosis and management of patients with brain tumors

Proton ((1)H) magnetic resonance spectroscopy (MRS) is a noninvasive method that can monitor the metabolic changes in most brain diseases. This technique is now available on current 1.5 Tesla magnetic resonance units and does not require sophisticated software or time-consuming post-processing techniques. Previous studies using single-voxel techniques showed the usefulness of MRS for the diagnosis of brain tumor despite some technical issues, including spatial resolution and volume coverage. Recent advances have been made through the use of multivoxel techniques and metabolite maps, which allow assessment of both the entire volume of the lesion and the surrounding normal-appearing brain tissue. Recent studies suggest the potential of this technique to guide biopsies, to define radiotherapy targets, and to monitor patients after treatment. Some persistent drawbacks, including measurement time and spectral resolution, will probably be overcome in the near future.

Clinical applications of proton MR spectroscopy in oncology

Proton magnetic resonance spectroscopy (H1-MRS) has been increasingly receiving more attention from radiologists, neurosurgeons, radiation and medical oncologists in the "in situ" clinical evaluation of human tumors. The utilization of H1-MRS, especially in human brain tumors, coupled to both routine magnetic resonance imaging (MRI) and functional MRI techniques provides greater information concerning tumor grading and extension and characterization of the normal surrounding tissue than what is possible with any other imaging technique alone. In this paper, we will review the current status of proton MR spectroscopy with emphasis on its clinical utility to diagnose tumors, its utility in planning surgical and radiation therapy interventions, and in its use in monitoring tumor treatment.