NOE enhancements and T1 relaxation times of phosphorylated metabolites in human calf muscle at 1.5 Tesla

Phosphorus metabolism in the brain of cognitively normal midlife individuals at risk for Alzheimer's disease

BACKGROUND

Neurometabolic abnormalities and amyloid-beta plaque deposition are important early pathophysiologic changes in Alzheimer's disease (AD). This study investigated the relationship between high-energy phosphorus-containing metabolites, glucose uptake, and amyloid plaque using phosphorus magnetic resonance spectroscopy (³¹P-MRS) and positron emission tomography (PET).

METHODS

We measured ³¹P-MRS, fluorodeoxyglucose (FDG)-PET, and Pittsburgh Compound B (PiB)-PET in a cohort of 20 cognitively normal middle-aged adults at risk for AD. We assessed ³¹P-MRS reliability by scanning a separate cohort of 13 healthy volunteers twice each. We calculated the coefficient-of-variation (CV) of metabolite ratios phosphocreatine-to-adenosine triphosphate (PCr/α-ATP), inorganic phosphate (Pi)-to-α-ATP, and phosphomonoesters-to-phosphodiesters (PME/PDE), and pH in pre-defined brain regions. We performed linear regression analysis to determine the relationship between ³¹P measurements and tracer uptake, and Dunn's multiple comparison tests to investigate regional differences in phosphorus metabolism. Finally, we performed linear regression analysis on ³¹P-MRS measurements in both cohorts to investigate the relationship of phosphorus metabolism with age.

RESULTS

Most regional ³¹P metabolite ratio and pH inter- and intra-day CVs were well below 10%. There was an inverse relationship between FDG-SUV levels and metabolite ratios PCr/α-ATP, Pi/α-ATP, and PME/PDE in several brain regions in the AD risk group. There were also several regional differences among ³¹P metabolites and pH in the AD risk group including elevated PCr/α-ATP, depressed PME/PDE, and elevated pH in the temporal cortices. Increased PCr/α-ATP throughout the brain was associated with aging.

CONCLUSIONS

Phosphorus spectroscopy in the brain can be performed with high repeatability. Phosphorus metabolism varies with region and age, and is related to glucose uptake in adults at risk for AD. Phosphorus spectroscopy may be a valuable approach to study early changes in brain energetics in high-risk populations.

3D 31 P MR spectroscopic imaging of the human brain at 3 T with a 31 P receive array: An assessment of 1 H decoupling, T1 relaxation times, 1 H-31 P nuclear Overhauser effects and NAD. NMR IN BIOMEDICINE 2021;34:e4169. [PMID: 31518036 PMCID: PMC8244063 DOI: 10.1002/nbm.4169]

³¹ P MR spectroscopic imaging (MRSI) is a versatile technique to study phospholipid precursors and energy metabolism in the healthy and diseased human brain. However, mainly due to its low sensitivity, ³¹ P MRSI is currently limited to research purposes. To obtain 3D ³¹ P MRSI spectra with improved signal-to-noise ratio on clinical 3 T MR systems, we used a coil combination consisting of a dual-tuned birdcage transmit coil and a ³¹ P eight-channel phased-array receive insert. To further increase resolution and sensitivity we applied WALTZ4 ¹ H decoupling and continuous wave nuclear Overhauser effect (NOE) enhancement and acquired high-quality MRSI spectra with nominal voxel volumes of ~ 17.6 cm³ (effective voxel volume ~ 51 cm³ ) in a clinically relevant measurement time of ~ 13 minutes, without exceeding SAR limits. Steady-state NOE enhancements ranged from 15 ± 9% (γ-ATP) and 33 ± 3% (phosphocreatine) to 48 ± 11% (phosphoethanolamine). Because of these improvements, we resolved and detected all ³¹ P signals of metabolites that have also been reported for ultrahigh field strengths, including resonances for NAD⁺ , NADH and extracellular inorganic phosphate. T₁ times of extracellular inorganic phosphate were longer than for intracellular inorganic phosphate (3.8 ± 1.4s vs 1.8 ± 0.65 seconds). A comparison of measured T₁ relaxation times and NOE enhancements at 3 T with published values between 1.5 and 9.4 T indicates that T₁ relaxation of ³¹ P metabolite spins in the human brain is dominated by dipolar relaxation for this field strength range. Even although intrinsic sensitivity is higher at ultrahigh fields, we demonstrate that at a clinical field strength of 3 T, similar ³¹ P MRSI information content can be obtained using a sophisticated coil design combined with ¹ H decoupling and NOE enhancement.

High-resolution 31 P echo-planar spectroscopic imaging in vivo at 7T

PURPOSE

Conventional ³¹ P chemical shift imaging is time-consuming and yields only limited spatial resolution. The purpose of this study was to demonstrate feasibility of ³¹ P echo-planar spectroscopic imaging (EPSI) in vivo at 7T.

METHODS

A 3D ³¹ P EPSI sequence with trapezoidal-shaped gradient pulses was implemented on a 7T MR scanner. To increase spectral width with reduced demand on gradient performance, a multishot approach was chosen. Acquisition weighting and ³¹ P-{¹ H} double resonance for nuclear Overhauser signal enhancement were applied to increase sensitivity.

RESULTS

3D ³¹ P-{¹ H} EPSI data from model solution and from human calf muscle and brain were obtained from voxels with effective sizes of 4.1 to 16.2 cm³ in measurement times of approximately 10 min. Individual spectra showed well-resolved resonances of endogenous ³¹ P-metabolites without artifacts. Volumetric high-resolution ³¹ P-metabolite maps in vivo showed metabolic heterogeneity of different tissues.

CONCLUSION

In vivo ³¹ P EPSI at 7T yields high-quality metabolic images. The proposed multishot EPSI technique reduces the measurement times for acquisition of volumetric high-resolution maps of ³¹ P-metabolites or intracellular pH in human studies. Magn Reson Med 79:1251-1259, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

In-vivo31P-MRS of skeletal muscle and liver: A way for non-invasive assessment of their metabolism

In addition to direct assessment of high energy phosphorus containing metabolite content within tissues, phosphorus magnetic resonance spectroscopy (³¹P-MRS) provides options to measure phospholipid metabolites and cellular pH, as well as the kinetics of chemical reactions of energy metabolism in vivo. Even though the great potential of ³¹P-MR was recognized over 30 years ago, modern MR systems, as well as new, dedicated hardware and measurement techniques provide further opportunities for research of human biochemistry. This paper presents a methodological overview of the ³¹P-MR techniques that can be used for basic, physiological, or clinical research of human skeletal muscle and liver in vivo. Practical issues of ³¹P-MRS experiments and examples of potential applications are also provided. As signal localization is essential for liver ³¹P-MRS and is important for dynamic muscle examinations as well, typical localization strategies for ³¹P-MR are also described.

Imaging human teeth by phosphorus magnetic resonance with nuclear Overhauser enhancement

Three-dimensional phosphorus MR images ((31)P MRI) of teeth are obtained at a nominal resolution of 0.5 mm in less than 15 minutes using acquisition pulse sequences sensitive to ultra-short transversal relaxation times. The images directly reflect the spatially resolved phosphorus content of mineral tissue in dentin and enamel; they show a lack of signal from pulp tissue and reduced signal from de-mineralized carious lesions. We demonstrate for the first time that the signal in (31)P MR images of mineralized tissue is enhanced by a (1)H-(31)P nuclear Overhauser effect (NOE). Using teeth as a model for imaging mineralized human tissue, graded differences in signal enhancement are observed that correlate well with known mineral content. From solid-state NMR experiments we conclude that the NOE is facilitated by spin diffusion and that the NOE difference can be assigned to a higher water content and a different micro-structure of dentin. Thus, a novel method for imaging mineral content without ionizing radiation is proposed. This method has potential use in the assessment of de-mineralization states in humans, such as caries of teeth and osteoporosis of bones.

Repeatability of (31) P MRSI in the human brain at 7 T with and without the nuclear Overhauser effect

An often-employed strategy to enhance signals in (31) P MRS is the generation of the nuclear Overhauser effect (NOE) by saturation of the water resonance. However, NOE allegedly increases the variability of the (31) P data, because variation is reported in NOE enhancements. This would negate the signal-to-noise (SNR) gain it generates. We hypothesized that the variation in NOE enhancement values is not caused by the variability in NOE itself, but is attributable to measurement uncertainties in the values used to calculate the enhancement. If true, the expected increase in SNR with NOE would improve the repeatability of (31) P MRS measurements. To verify this hypothesis, a repeatability study of native and NOE-enhanced (31) P MRSI was performed in the brains of seven healthy volunteers at 7 T. The repeatability coefficient (RC) and the coefficient of variation in repeated measurements (CoVrepeat ) were determined for each method, and the 95% limits of agreement (LoAs) between native and NOE-enhanced signals were calculated. The variation between the methods, defined by the LoA, is at least as great as that predicted by the RC of each method. The sources of variation in NOE enhancements were determined using variance component analysis. In the seven metabolites with a positive NOE enhancement (nine metabolite resonances assessed), CoVrepeat improved, on average, by 15%. The LoAs could be explained by the RCs of the individual methods for the majority of the metabolites, generally confirming our hypothesis. Variation in NOE enhancement was mainly attributable to the factor repeat, but between-voxel effects were also present for phosphoethanolamine and (glycero)phosphocholine. CoVrepeat and fitting error were strongly correlated and improved with positive NOE. Our findings generally indicate that NOE enhances the signal of metabolites, improving the repeatability of metabolite measurements. Additional variability as a result of NOE was minimal. These findings encourage the use of NOE-enhanced (31) P MRSI. Copyright © 2015 John Wiley & Sons, Ltd.

Nuclear-Overhauser-enhanced MR imaging of (31)P-containing metabolites: multipoint-Dixon vs. frequency-selective excitation

The purpose of this study is to develop nuclear-Overhauser-enhanced (NOE) [(1)H]-(31)P magnetic resonance imaging (MRI) based on 3D fully-balanced steady-state free precession (fbSSFP). Therefore, two implementations of a 3D fbSSFP sequence are compared using frequency-selective excitation (FreqSel) and multipoint-Dixon (MP-Dixon). (31)P-containing model solutions and four healthy volunteers were examined at field strengths of B0=3T and 7T. Maps of the distribution of phosphocreatine (PCr), inorganic phosphate (Pi), and adenosine 5´-triphosphate (ATP) in the human calf were obtained with an isotropic resolution of 1.5cm (1.0cm) in an acquisition time of 5min (10min). NOE-pulses had the highest impact on the PCr acquisitions enhancing the signal up to (82 ± 13) % at 3T and up to (37 ± 9) % at 7T. An estimation of the level of PCr in muscle tissue from [(1)H]-(31)P MRI data yielded a mean value of (33 ± 8) mM. In conclusion, direct [(1)H]-(31)P imaging using FreqSel as well as MP-Dixon is possible in clinically feasible acquisition times. FreqSel should be preferred for measurements where only a single metabolite resonance is considered. MP-Dixon performs better in terms of SNR if a larger spectral width is of interest.

Exchange kinetics by inversion transfer: integrated analysis of the phosphorus metabolite kinetic exchanges in resting human skeletal muscle at 7 T

PURPOSE

To develop an inversion pulse-based, chemical exchange saturation transfer-like method for detection of (31) P magnetization exchanges among all nuclear magnetic resonance visible metabolites suitable for providing an integrated kinetic analysis of phosphorus exchange reactions in vivo.

METHODS

The exchange kinetics by inversion transfer (EKIT) sequence includes application of a frequency-selective inversion pulse arrayed over the range of relevant (31) P frequencies, followed by a constant delay and a hard readout pulse. A series of EKIT spectra, each given by a plot of Z-magnetization for each metabolite of interest versus frequency of the inversion pulse, can be generated from this single data set.

RESULTS

EKIT spectra reflect chemical exchange due to known biochemical reactions, cross-relaxation effects, and relayed magnetization transfers due to both processes. The rate constants derived from EKIT data collected on resting human skeletal muscle were: ATP synthesis via ATP synthase (0.050 ± 0.016 s(-1) ), ATP synthesis via creatine kinase (0.264 ± 0.023 s(-1) ), and cross-relaxation between neighboring spin pairs within ATP (0.164 ± 0.022 s(-1) ).

CONCLUSION

EKIT provides a simple, alternative method to detect chemical exchange, cross relaxation, and relayed magnetization transfer effects in human skeletal muscle at 7 T.

(31) P MR spectroscopic imaging of the human prostate at 7 T: T1 relaxation times, Nuclear Overhauser Effect, and spectral characterization

PURPOSE

Optimization of phosphorus ((31) P) MR spectroscopic imaging (MRSI) of the human prostate at 7 T by the evaluation of T1 relaxation times and the Nuclear Overhauser Effect (NOE) of phosphorus-containing metabolites.

METHODS

Twelve patients with prostate cancer and one healthy volunteer were scanned on a 7 T whole-body system using a (31) P endorectal coil combined with an eight-channel (1) H body array coil. T1 relaxation times were measured using progressive saturation in a two-dimensional localization sequence. (31) P MRSI was performed twice: once without NOE and once with NOE using low-power continuous wave (1) H irradiation to determine NOE enhancements.

RESULTS

T1 relaxation times of (31) P metabolites in the human prostate at 7 T varied between 3.0 and 8.3 s. Positive but variable NOE enhancements were measured for most metabolites. Remarkably, the (31) P MR spectra showed two peaks in chemical shift range of inorganic phosphate.

CONCLUSION

Knowledge of T1 relaxation times and NOE enhancements enables protocol optimization for (31) P MRSI of the prostate at 7 T. With a strongly reduced (31) P flip angle (≤ 45°), a (31) P MRSI dataset with optimal signal-to-noise ratio per unit time can be obtained within 15 minutes. The NOE enhancement can improve fitting accuracy, but its variability requires further investigation.

31P MR spectroscopy and computational modeling identify a direct relation between Pi content of an alkaline compartment in resting muscle and phosphocreatine resynthesis kinetics in active muscle in humans

The assessment of mitochondrial properties in skeletal muscle is important in clinical research, for instance in the study of diabetes. The gold standard to measure mitochondrial capacity non-invasively is the phosphocreatine (PCr) recovery rate after exercise, measured by (31)P Magnetic Resonance spectroscopy ((31)P MRS). Here, we sought to expand the evidence base for an alternative method to assess mitochondrial properties which uses (31)P MRS measurement of the Pi content of an alkaline compartment attributed to mitochondria (Pi2; as opposed to cytosolic Pi (Pi1)) in resting muscle at high magnetic field. Specifically, the PCr recovery rate in human quadriceps muscle was compared with the signal intensity of the Pi2 peak in subjects with varying mitochondrial content of the quadriceps muscle as a result of athletic training, and the results were entered into a mechanistic computational model of mitochondrial metabolism in muscle to test if the empirical relation between Pi2/Pi1 ratio and the PCr recovery was consistent with theory. Localized (31)P spectra were obtained at 7T from resting vastus lateralis muscle to measure the intensity of the Pi2 peak. In the endurance trained athletes a Pi2/Pi1 ratio of 0.07 ± 0.01 was found, compared to a significantly lower (p<0.05) Pi2/Pi1 ratio of 0.03 ± 0.01 in the normally active group. Next, PCr recovery kinetics after in magnet bicycle exercise were measured at 1.5T. For the endurance trained athletes, a time constant τPCr 12 ± 3 s was found, compared to 24 ± 5s in normally active subjects. Without any parameter optimization the computational model prediction matched the experimental data well (r(2) of 0.75). Taken together, these results suggest that the Pi2 resonance in resting human skeletal muscle observed at 7T provides a quantitative MR-based functional measure of mitochondrial density.

Comparative determination of energy production rates and mitochondrial function using different 31P MRS quantitative methods in sedentary and trained subjects

Muscle energetics has been largely and quantitatively investigated using (31)P MRS. Various methods have been used to estimate the corresponding rate of oxidative ATP synthesis (ATP(ox)); however, potential differences among methods have not been investigated. In this study, we aimed to compare the rates of ATP production and energy cost in two groups of subjects with different training status using four different methods: indirect method (method 1), ADP control model (method 2) and phosphate potential control model (method 3). Method 4 was a modified version of method 3 with the introduction of a correction factor allowing for similar values to be obtained for the end-exercise oxidative ATP synthesis rate inferred from exercise measurements and the initial recovery phosphocreatine resynthesis rate. Seven sedentary and seven endurance-trained subjects performed a dynamic standardised rest-exercise-recovery protocol. We quantified the rates of ATP(ox) and anaerobic ATP synthesis (ATP(ana)) using (31)P MRS data recorded at 1.5 T. The rates of ATP(ox) over the entire exercise session were independent of the method used, except for method 4 which provided significantly higher values in both groups (p < 0.01). In addition, methods 1-3 were cross-correlated, thereby confirming their statistical agreement. The rate of ATP(ana) was significantly higher with method 1 (p < 0.01) and lower with method 4 (p < 0.01). As a result of the higher rate of ATP(ox), EC (method 4) calculated over the entire exercise session was higher and initial EC (method 1) was lower in both groups compared with the other methods. We showed in this study that the rate of ATP(ox) was independent of the calculation method, as long as no corrections (method 4) were performed. In contrast, results related to the rates of ATP(ana) were strongly affected by the calculation method and, more exactly, by the estimation of protons generated by ATP(ox). Although the absolute EC values differed between the methods, within- or between-subject comparisons are still valid given the tight relationships between them.

31P magnetic resonance spectroscopic imaging with polarisation transfer of phosphomono- and diesters at 3 T in the human brain: relation with age and spatial differences

Tissue levels of the compounds phosphocholine (PC), phosphoethanolamine (PE), glycerophosphocholine (GPC) and glycerophosphoethanolamine (GPE) can be studied by in vivo 31P MRS. However, the detection of the signals of these compounds suffers from low sensitivity and contamination by underlying broad resonances of other phosphorylated compounds. Improved sensitivity without this contamination can be achieved with a method for optimal polarisation transfer of 1H to 31P spins in these molecules, called selective refocused insensitive nuclei-enhanced polarisation transfer (sRINEPT). The aim of this study was to implement a three-dimensional magnetic resonance spectroscopic imaging (MRSI) version of sRINEPT on a clinical 3 T magnetic resonance system to obtain spatially resolved relative levels of PC, PE, GPC and GPE in the human brain as a function of age, which could be used as a reference dataset for clinical applications. Good signal-to-noise ratios were obtained from voxels of 17 cm(3) of the parietal and occipital lobes of the brain within a clinically acceptable measurement time of 17 min. Eighteen healthy subjects of different ages (16-70 years) were examined with this method. A strong inverse relation of the PE/GPE and PC/GPC ratios with age was found. Spatial resolution was sufficient to detect differences in metabolite ratios between white and grey matter. Moreover, we showed the feasibility of this method for clinical use in a pilot study of patients with brain tumours. The sRINEPT MRSI technique enables the exploration of phospholipid metabolism in brain diseases with a better sensitivity than was possible with earlier 31P MRS methods.

In vivo 31P MRS detection of an alkaline inorganic phosphate pool with short T1 in human resting skeletal muscle

Non-invasive determination of mitochondrial content is an important objective in clinical and sports medicine. 31P MRS approaches to obtain information on this parameter at low field strength typically require in-magnet exercise. Direct observation of the intra-mitochondrial inorganic phosphate (Pi) pool in resting muscle would constitute an alternative, simpler method. In this study, we exploited the higher spectral resolution and signal-to-noise at 7T to investigate the MR visibility of this metabolite pool. 31P in vivo MR spectra of the resting soleus (SOL) muscle were obtained with 1H MR image-guided surface coil localization (six volunteers) and of the SOL and tibialis anterior (TA) muscle using 2D CSI (five volunteers). A resonance at a frequency 0.38 ppm downfield from the cytosolic Pi resonance (Pi(1); pH 7.0 ± 0.04) was reproducibly detected in the SOL muscle in all subjects and conditionally attributed to the intra-mitochondrial Pi pool (Pi(2); pH 7.3 ± 0.07). In the SOL muscle, the Pi(2)/Pi(1) ratio was 1.6 times higher compared to the TA muscle in the same individual. Localized 3D CSI results showed that the Pi(2) peak was present in voxels well away from blood vessels. Determination of the T1 of the two Pi pools in a single individual using adiabatic excitation of the spectral region around 5 ppm yielded estimates of 4.3 ± 0.4 s vs 1.4 ± 0.5 s for Pi(1) and Pi(2), respectively. Together, these results suggest that the intra-mitochondrial Pi pool in resting human skeletal muscle may be visible with 31P MRS at high field.

Assessment of (31)P relaxation times in the human calf muscle: a comparison between 3 T and 7 T in vivo

Phosphorus ((31)P) T(1) and T(2) relaxation times in the resting human calf muscle were assessed by interleaved, surface coil localized inversion recovery and frequency-selective spin-echo at 3 and 7 T. The obtained T(1) (mean +/- SD) decreased significantly (P < 0.05) from 3 to 7 T for phosphomonoesters (PME) (8.1 +/- 1.7 s to 3.1 +/- 0.9 s), phosphodiesters (PDE) (8.6 +/- 1.2 s to 6.0 +/- 1.1 s), phosphocreatine (PCr) (6.7 +/- 0.4 s to 4.0 +/- 0.2 s), gamma-NTP (nucleotide triphosphate) (5.5 +/- 0.4 s to 3.3 +/- 0.2 s), alpha-NTP (3.4 +/- 0.3 s to 1.8 +/- 0.1 s), and beta-NTP (3.9 +/- 0.4 s to 1.8 +/- 0.1 s), but not for inorganic phosphate (Pi) (6.9 +/- 0.6 s to 6.3 +/- 1.0 s). The decrease in T(2) was significant for Pi (153 +/- 9 ms to 109 +/- 17 ms), PDE (414 +/- 128 ms to 314 +/- 35 ms), PCr (354 +/- 16 ms to 217 +/- 14 ms), and gamma-NTP (61.9 +/- 8.6 ms to 29.0 +/- 3.3 ms). This decrease in T(1) with increasing field strength of up to 62% can be explained by the increasing influence of chemical shift anisotropy on relaxation mechanisms and may allow shorter measurements at higher field strengths or up to 62% additional signal-to-noise ratio (SNR) per unit time. The fully relaxed SNR increased by +96%, while the linewidth increased from 6.5 +/- 1.2 Hz to 11.2 +/- 1.9 Hz or +72%. At 7 T (31)P-MRS in the human calf muscle offers more than twice as much SNR per unit time in reduced measurement time compared to 3 T. This will facilitate in vivo (31)P-MRS of the human muscle at 7 T.

Does oxidative capacity affect energy cost? An in vivo MR investigation of skeletal muscle energetics

Investigations of training effects on exercise energy cost have yielded conflicting results. The purpose of the present study was to compare quadriceps energy cost and oxidative capacity between endurance-trained and sedentary subjects during a heavy dynamic knee extension exercise. We quantified the rates of ATP turnover from oxidative and anaerobic pathways with (31)P-MRS, and we measured simultaneously pulmonary oxygen uptake in order to assess both total ATP production [i.e., energy cost (EC)] and O(2) consumption (O(2) cost) scaled to power output. Seven sedentary (SED) and seven endurance-trained (TRA) subjects performed a dynamic standardized rest-exercise-recovery protocol at an exercise intensity corresponding to 35% of maximal voluntary contraction. We showed that during a dynamic heavy exercise, the O(2) cost and EC were similar in the SED and endurance-trained groups. For a given EC, endurance-trained subjects exhibited a higher relative mitochondrial contribution to ATP production at the muscle level (84 +/- 12% in TRA and 57 +/- 12% in SED; P < 0.01) whereas the anaerobic contribution was reduced (18 +/- 12% in TRA and 44 +/- 11% in SED; P < 0.01). Our results obtained in vivo illustrate that on the one hand the beneficial effects of endurance training are not related to any reduction in EC or O(2) cost and on the other hand that this similar EC was linked to a change regarding the contribution of anaerobic and oxidative processes to energy production, i.e., a greater aerobic energy contribution associated with a concomitant reduction of the anaerobic energy supply.

Efficient 1H to 31P polarization transfer on a clinical 3T MR system

31P MR spectroscopy (MRS) in the detection of phosphocholine (PC), glycerolphosphocholine (GPC), phosphorylelthanolamine (PE), and glycerolphosphoethanolamine (GPE) compounds has shown clinical potential at 1.5T for several human diseases. The use of (1)H to (31)P polarization transfer can improve the sensitivity using a refocused INEPT method with a potential enhancement of 2.4 (gamma(1H)/gamma(31P)). However, in this method the (31)P signals of PE, PC, GPE, and GPC are strongly attenuated (50% or more) due to J-coupling between (31)P and (1)H that have similar magnitudes for homonuclear J-coupling constants in those metabolites. A method to cancel the homonuclear J-coupling effects in polarization transfer experiments is to apply frequency-selective refocusing pulses, which becomes feasible at 3T due to the increased chemical shift dispersion as compared to 1.5T. In this study, full (1)H to (31)P polarization transfer was realized using chemical shift selective refocusing pulses at 3T. T(1) and T(2) values for (1)H and (31)P spins of PE, PC, GPE, and GPC were measured in the human brain. A more than 2-fold signal-to-noise ratio (SNR) improvement was obtained compared to an optimized direct (31)P MRS method. As shifted RF pulses were used, this method can be applied on a broadband clinical MR system with a single RF system.

Musculoskeletal spectroscopy

Magnetic resonance spectroscopy (MRS) of skeletal muscle has been successfully applied by physiologists over several decades, particularly for studies of high-energy phosphates (by (31)P-MRS) and glycogen (by (13)C-MRS). Unfortunately, the observation of these heteronuclei requires equipment that is typically not available on clinical MR scanners, such as broadband capability and a second channel for decoupling and nuclear Overhauser enhancement (NOE). On the other hand, (1)H-MR spectra of skeletal muscle can be acquired on many routine MR systems and also provide a wealth of physiological information. In particular, studies of intramyocellular lipids (IMCL) attract physiologists and endocrinologists because IMCL levels are related to insulin resistance and thus can lead to a better understanding of major health problems in industrial countries. The combination of (1)H-, (13)C-, and (31)P-MRS gives access to the major long- and short-term energy sources of skeletal muscle. This review summarizes the technical aspects and unique MR-methodological features of the different nuclei. It reviews clinical studies that employed MRS of one or more nuclei, or combinations of MRS with other MR modalities. It also illustrates that MR spectra contain additional physiological information that is not yet used in routine clinical applications.

Dynamic MRS and MRI of skeletal muscle function and biomechanics

MR is a powerful technique for studying the biomechanical and functional properties of skeletal muscle in vivo in health and disease. This review focuses on 31P, 1H and 13C MR spectroscopy for assessment of the dynamics of muscle metabolism and on dynamic 1H MRI methods for non-invasive measurement of the biomechanical and functional properties of skeletal muscle. The information thus obtained ranges from the microscopic level of the metabolism of the myocyte to the macroscopic level of the contractile function of muscle complexes. The MR technology presented plays a vital role in achieving a better understanding of many basic aspects of muscle function, including the regulation of mitochondrial activity and the intricate interplay between muscle fiber organization and contractile function. In addition, these tools are increasingly being employed to establish novel diagnostic procedures as well as to monitor the effects of therapeutic and lifestyle interventions for muscle disorders that have an increasing impact in modern society.

T(1) measurement of (31)P metabolites at rest and during steady-state dynamic exercise using a clinical nuclear magnetic resonance scanner

This article illustrates some problems and possible solutions to determine the apparent spin-lattice relaxation time (T(1)) of the muscular (31)P metabolites at rest and during dynamic steady-state exercise using a clinical 1.5 T NMR scanner and a surface coil. T(1) was first estimated on a phosphates solution (phantom) using four different acquisition protocols, all based on the multiple-point "progressive saturation" method, and by fitting each data set with two different mathematical models. Subsequently, two of the four protocols and both models were used to estimate T(1) both at rest and during exercise on the calf muscles of 10 healthy volunteers. Experimental results obtained on the phantom showed that T(1) is greatly affected by the longest nominal explored repetition time (P<0.001) and by the mathematical model (P<0.001), ranging from 0.65+/-0.10 to 8.4+/-0.8 s. The two acquisition protocols applied on volunteers yielded significantly different T(1) (P<0.001), which were also rather different from the literature values for the same metabolites. Nevertheless, independently of the acquisition protocol and/or the fitting procedure, T(1) of all muscular phosphagens did not change statistically from rest to steady-state aerobic exercise.

In vivo 31P MR spectral patterns and reproducibility in cancer patients studied in a multi-institutional trial

The standardization and reproducibility of techniques required to acquire anatomically localized 31P MR spectra non-invasively while studying tumors in cancer patients in a multi-institutional group at 1.5 T are reported. This initial group of patients was studied from 1995 to 2000 to test the feasibility of acquiring in vivo localized 31P MRS in clinical MR spectrometers. The cancers tested were non-Hodgkin's lymphomas, sarcomas of soft tissue and bone, breast carcinomas and head and neck carcinomas. The best accrual and spectral quality were achieved with the non-Hodgkin's lymphomas. The initial analysis of the spectral values of the sum of phosphoethanolamine plus phosphocholine normalized by the content of nucleotide triphosphates in a homogeneous sample of 32 NHL patients studied by in vivo (31)P MRS showed good reproducibility among different institutions. No statistical differences were found between the institution with the largest number of cases accrued and the rest of the multi-institutional NHL data (2.28 +/- 0.64, mean +/- standard error; n = 17, vs 2.08 +/- 0.14, n = 15). The preliminary data reported demonstrate that the institutions involved in this trial are obtaining reproducible 31P MR spectroscopic data non-invasively from human tumors. This is a fundamental prerequisite for the international cooperative group to be able to demonstrate the clinical value of the normalized determination of phosphoethanolamine plus phosphocholine by 31P MRS as predictor for treatment response in cancer patients.

Sex differences in glycolysis during brief, intense isometric contractions

We have previously observed less muscle fatigue in women than men under conditions of intact circulation, but similar fatigue across the sexes during local ischemia. Thus, we hypothesized that women utilize their aerobic metabolic pathways to a greater extent than do men. To test this hypothesis, we examined the extent to which different pathways of intramuscular adenosine triphosphate (ATP) production were utilized by men and women during maximal voluntary isometric contractions. Force production during 15-s and 60-s contractions were recorded in parallel sessions. In one session, central activation was assessed with electrical stimulation. In the other, phosphorus magnetic resonance spectroscopy was used to quantify muscle oxidative capacity, and the contributions of glycolysis and oxidative phosphorylation to ATP synthesis during the 60-s contraction. Fatigue and central activation were similar in men and women during both the 15-s and 60-s contractions. The rate constants of phosphocreatine recovery following the 15-s contraction were similar in men and women, indicating similar oxidative capacities. Men exhibited greater acidosis and peak glycolytic rates compared with women during the 60-s contraction, with no differences observed in creatine kinase flux or the percent of oxidative capacity utilized. We conclude that men exhibit greater in vivo glycolysis during brief, intense isometric contractions. Although this metabolic difference did not contribute to any observable differences in fatigue in the present study, these results highlight a potentially important mechanism to explain sex-related differences in muscle function.

Dynamic interleaved 1H/31P STEAM MRS at 3 Tesla using a pneumatic force-controlled plantar flexion exercise rig

OBJECTIVE

To develop a measurement method for interleaved acquisition of 1H and 31 STEAM localised spectra of exercising human calf muscle.

MATERIALS AND METHODS

A non-magnetic exercise rig with a pneumatic piston and sensors for force and pedal angle was constructed to enable plantar flexion measured in the 3 T MR scanner, which holds the dual tuned (1H ,31P) surface coil used for signal transmission and reception.

RESULTS

(31) spectra acquired in interleaved mode benefit from higher Signal to noise ratio (factor of 1.34 +/-0.06 for PCr) compared to standard acquisition due to the Nuclear Overhauser effect and substantial PCr/P(i) changes during exercise can be observed in 31P spectra. 1H spectral quality is equal to that in single mode experiments and allows Cr2 changes to be monitored.

CONCLUSION

The feasibility of dynamic interleaved localised 1H and 31P spectroscopy during plantar flexion exercise has been demonstrated using a custom-built pneumatic system for muscle activation. This opens the possibility of studying the dynamics of metabolism with multi nuclear MRS in a single run.

Neural and metabolic mechanisms of excessive muscle fatigue in maintenance hemodialysis patients

Dialysis patients have severe exercise limitations related to metabolic disturbances, but muscle fatigue has not been well studied in this population. We investigated the magnitude and mechanisms of fatigue of the ankle dorsiflexor muscles in patients on maintenance hemodialysis. Thirty-three dialysis patients and twelve healthy control subjects performed incremental isometric dorsiflexion exercise, beginning at 10% of their maximal voluntary contraction (MVC) and increasing by 10% every 2 min. Muscle fatigue (fall of MVC), completeness of voluntary activation, and metabolic responses to exercise were measured. Before exercise, dialysis subjects exhibited reduced strength and impaired peripheral activation (lower compound muscle activation potential amplitude) but no metabolic perturbation. During exercise, dialysis subjects demonstrated threefold greater fatigue than controls with evidence of central activation failure but no change in peripheral activation. All metabolic parameters were significantly more perturbed at end exercise in dialysis subjects than in controls, including lower phosphocreatine (PCr) and pH, and higher Pi, Pi/PCr, and H2PO4−. Oxidative potential was markedly lower in patients than in controls [62.5 (SD 27.2) vs. 134.6 (SD 31.7), P < 0.0001]. Muscle fatigue was negatively correlated with oxidative potential among dialysis subjects ( r = −0.52, P = 0.04) but not controls. Changes in central activation ratio were also correlated with muscle fatigue in the dialysis subjects ( r = 0.59, P = 0.001) but not the controls. This study provides new information regarding the excessive muscular fatigue of dialysis patients and demonstrates that the mechanisms of this fatigue include both intramuscular energy metabolism and central activation failure.

Optimized detection of changes in glucose-6-phosphate levels in human skeletal muscle by31P MR spectroscopy

As glucose-6-phosphate (G6P) plays a central role in muscle energy metabolism, the possibility to observe changes in the tissue level of this compound in vivo is very relevant. G6P can be detected noninvasively by (31)P MR spectroscopy, but its visibility in vivo is severely hampered due to low tissue levels and spectral overlap with other, stronger phosphomonoester signals. To optimize the observation of changes in G6P levels in human calf muscle by (31)P MR spectroscopy at 1.5 T, we implemented an approach involving a new RF probe and a postacquisition correction method. An anatomically shaped circularly polarized (31)P coil was designed for high intrinsic sensitivity. Together with an additional (1)H coil and (1)H blocking circuits this allowed the application of NOE and (1)H decoupling to further enhance sensitivity. A hyperglycemic hyperinsulinemic clamp was used to increase G6P levels. The spectra were corrected for frequency and phase drift due to scanner instability and leg movements using an automated phase and frequency correction method. Difference (31)P spectroscopy was applied to detect changes of the G6P signal. The result, in five healthy subjects, demonstrated that the combination of sensitivity optimization with automated drift correction enabled a robust detection of G6P changes in time series experiments down to a resolution of 10 min.

Caffeine impairs intramuscular energy balance in patients susceptible to malignant hyperthermia

Malignant hyperthermia (MH) is a metabolic myopathy with an abnormal release of calcium by the sarcoplasmic reticulum (SR), triggered by volatile anesthetics and succinylcholine. Similarly, caffeine enhances Ca(2+)release by the SR in vitro. In a prospective, randomized study, high-energy phosphates were studied by intramuscular 31-phosphorus magnetic resonance spectroscopy ((31)P-MRS) in 10 MH-susceptible (MHS) and 7 MH-nonsusceptible (MHN) subjects before and after injection of 0.5 ml caffeine (20 mM). Intramuscular energy balance, measured by the ratios of P(i)/PCr and P(i)/gamma-ATP, did not differ between MHS and MHN patients before and after intramuscular caffeine injection. However, within each group, P(i)/PCr and P(i)/gamma-ATP increased significantly only in the MHS group. Intramuscular caffeine injection seemed to impair the metabolic balance in MHS individuals. This may reflect a local calcium overload leading to consumption of high-energy phosphates and increase of inorganic phosphate. Intramuscular stimulation by caffeine and (31)P-MRS may provide a valuable tool to investigate MH-related metabolic disturbances.

Relaxation times of 31P-metabolites in human calf muscle at 3 T

Localized (31)P-STEAM experiments were performed at 3 T to estimate relaxation times of phosphorus-containing metabolites in the human calf muscle in vivo. T(1) and T(2) times of PCr, P(i), and NTPs were measured in the resting calf muscle of healthy subjects by varying TR and TE. The localization performance of the (31)P-STEAM sequence was evaluated on a test object, resulting in a relative selection efficiency of 78 +/- 1% and contamination from outside the voxel of 0 +/- 2% under fully relaxed conditions. T(1) relaxation times (+/-SD, n = 5) of P(i), PCr, gamma-NTP, alpha-NTP, and beta-NTP obtained at 3 T are 5.2 +/- 1.0 s, 6.4 +/- 0.2 s, 4.5 +/- 0.3 s, 2.6 +/- 0.9 s, and 3.5 +/- 1.1 s, respectively. T(2) relaxation times (+/-SD, n = 6) of these metabolites are 148 +/- 17 ms, 334 +/- 30 ms, 78 +/- 13 ms, 55 +/- 7 ms, and 55 +/- 10 ms, respectively. Spin-lattice relaxation times established at 3 T are consistent with literature data at lower field strengths, whereas spin-spin relaxation times are lower. Several methodological considerations are discussed which may help improve quantification of metabolite concentrations in the human (calf) muscle in vivo by using localized noninvasive (31)P-MRS at 3 T, which is currently being tested for routine clinical applications.

Human skeletal muscle responses vary with age and gender during fatigue due to incremental isometric exercise

The purpose of this study was to compare the magnitude and mechanisms of ankle dorsiflexor muscle fatigue in 20 young (33 +/- 6 yr, mean +/- SD) and 21 older (75 +/- 6 yr) healthy men and women of similar physical activity status. Noninvasive measures of central and peripheral (neuromuscular junction, sarcolemma) muscle activation, muscle contractile function, and intramuscular energy metabolism were made before, during, and after incremental isometric exercise. Older subjects fatigued less than young (P < 0.01); there was no effect of gender on fatigue (P = 0.24). For all subjects combined, fatigue was modestly related to preexercise strength (r = 0.49, P < 0.01). Neither central (central activation ratio) nor peripheral (compound muscle action potential) activation played a significant role in fatigue in any group. During exercise, intracellular concentrations of P(i) and H(2)PO increased more and pH fell more in young compared with older subjects (P < 0.01) and in men compared with women (P < 0.01). These varied metabolic responses to exercise suggest a greater reliance on nonoxidative sources of ATP in young compared with older subjects and in men compared with women. These results suggest that the mechanisms of fatigue vary with age and gender, regardless of whether differences in the magnitude of fatigue are observed.

An additional phase in PCr use during sustained isometric exercise at 30% MVC in the tibialis anterior muscle

The occurrence of an abrupt acceleration in phosphocreatine hydrolysis in the tibial anterior muscle during the last part of a sustained isometric exercise at 30% maximal voluntary contraction until fatigue is demonstrated in seven out of eight healthy subjects by applying in vivo 31P NMR spectroscopy at 1.5 T field strength. This additional third phase in PCr hydrolysis, is preceded by a common biphasic pattern (first fast then slow) in PCr use. The NMR spectra, as localized by a surface coil and improved by proton irradiation, were collected at a time resolution of 16 s. Mean rates of PCr hydrolysis during exercise were -0.44 +/- 0.19% s(-1), -0.07 +/- 0.04% s(-1), and -0.29 +/- 0.10% s(-1) for the three successive phases. The increased rate of PCr hydrolysis, and also the loss of fine force control evident in the force records are consistent with increased involvement of large, fast-fatiguable units later in the contraction.

pH heterogeneity in tibial anterior muscle during isometric activity studied by (31)P-NMR spectroscopy

The occurrence of pH heterogeneity in human tibial anterior muscle during sustained isometric exercise is demonstrated by applying (31)P-nuclear magnetic resonance (NMR) spectroscopy in a study of seven healthy subjects. Exercise was performed at 30 and 60% of maximal voluntary contraction (MVC) until fatigue. The NMR spectra, as localized by a surface coil and improved by proton irradiation, were obtained at a high time resolution (16 s). They revealed the simultaneous presence of two pH pools during most experiments. Maximum difference in the two pH levels during exercise was 0.40 +/- 0.07 (30% MVC, n = 7) and 0.41 +/- 0.03 (60% MVC, n = 3). Complementary two-dimensional (31)P spectroscopic imaging experiments in one subject supported the supposition that the distinct pH pools reflect the metabolic status of the main muscle fiber types. The relative size of the P(i) peak in the spectrum attributed to the type II fiber pool increases with decreasing pH levels. This phenomenon is discussed in the context of the size principle stating that the smaller (type I) motor units are recruited first.

31P magnetic resonance spectroscopy in fibromyalgic muscle

OBJECTIVE

To measure inorganic phosphate (Pi), phosphocreatine (PCr), ATP and phosphodiesters (PDE) in fibromyalgic muscle tissue by (31)P magnetic resonance spectroscopy.

METHODS

A 1.5 Tesla scanner with a P 100 surface coil was used to examine 15 patients (mean age 49.9+/-14.3 yr) with fibromyalgia, according to the American College of Rheumatology criteria, and 17 healthy controls (mean age 30.2+/-5.8 yr).

RESULTS

Compared with the controls, there were increases in the levels of PDE (+22%, P = 0.032) and Pi (+19%, P = 0.019) in the spectra of fibromyalgia patients, but there was no difference in pH.

CONCLUSION

The metabolic differences we found may have been related to weakness and fatigue in the fibromyalgia patients, but they do not fully explain the fibromyalgia symptoms.

Introduction to in vivo 31P magnetic resonance spectroscopy of (human) skeletal muscle

31P magnetic resonance spectroscopy (MRS) offers a unique non-invasive window on energy metabolism in skeletal muscle, with possibilities for longitudinal studies and of obtaining important bioenergetic data continuously and with sufficient time resolution during muscle exercise. The present paper provides an introductory overview of the current status of in vivo 31P MRS of skeletal muscle, focusing on human applications, but with some illustrative examples from studies on transgenic mice. Topics which are described in the present paper are the information content of the 31P magnetic resonance spectrum of skeletal muscle, some practical issues in the performance of this MRS methodology, related muscle biochemistry and the validity of interpreting results in terms of biochemical processes, the possibility of investigating reaction kinetics in vivo and some indications for fibre-type heterogeneity as seen in spectra obtained during exercise.

Developmental changes in choline- and ethanolamine-containing compounds measured with proton-decoupled (31)P MRS in in vivo human brain

Cerebral phosphorylated metabolites, possibly involved in membrane and myelin sheath metabolism, were measured and quantified using proton-decoupled (31)P ({(1)H}-(31)P) MRS in 32 children and 28 adults. Age-dependent changes were determined for phosphorylethanolamine (PE), phosphorylcholine (PC), glycerophosphorylethanolamine (GPE), glycerophosphorylcholine (GPC), and phosphocreatine (PCr) concentrations. In the neonate, PE dominates the spectrum and decreases with age along with PC, whereas GPE, GPC, and PCr increase in concentration with postnatal age. PE (1.23 +/- 0.13 mM) and GPE (0.57 +/- 0.08 mM) co-resonate with choline in (1)H MRS. Together with PC (0.57 +/- 0.12 mM) and GPC (0. 94 +/- 0.13 mM) these four metabolites accounted for all of the visible (1)H MRS choline in normal adult brain. Children with diseases that affect myelination were found to have abnormal ¿(1)H¿-(31)P MRS. The new quantitative assay may provide novel insights in determining and monitoring normal and abnormal brain maturation noninvasively. Magn Reson Med 42:643-654, 1999.

A new method for spectral decomposition using a bilinear Bayesian approach

A frequent problem in analysis is the need to find two matrices, closely related to the underlying measurement process, which when multiplied together reproduce the matrix of data points. Such problems arise throughout science, for example, in imaging where both the calibration of the sensor and the true scene may be unknown and in localized spectroscopy where multiple components may be present in varying amounts in any spectrum. Since both matrices are unknown, such a decomposition is a bilinear problem. We report here a solution to this problem for the case in which the decomposition results in matrices with elements drawn from positive additive distributions. We demonstrate the power of the methodology on chemical shift images (CSI). The new method, Bayesian spectral decomposition (BSD), reduces the CSI data to a small number of basis spectra together with their localized amplitudes. We apply this new algorithm to a 19F nonlocalized study of the catabolism of 5-fluorouracil in human liver, 31P CSI studies of a human head and calf muscle, and simulations which show its strengths and limitations. In all cases, the dataset, viewed as a matrix with rows containing the individual NMR spectra, results from the multiplication of a matrix of generally nonorthogonal basis spectra (the spectral matrix) by a matrix of the amplitudes of each basis spectrum in the the individual voxels (the amplitude matrix). The results show that BSD can simultaneously determine both the basis spectra and their distribution. In principle, BSD should solve this bilinear problem for any dataset which results from multiplication of matrices representing positive additive distributions if the data overdetermine the solutions.

Quantification of phosphorus metabolites from chemical shift imaging spectra with corrections for point spread effects and B1 inhomogeneity

A method is described for quantifying phosphorus metabolites in tissue using spectra localized with surface coils and chemical shift imaging (CSI) and assuming that metabolites are uniformly distributed within a well-defined volume. An analytical expression is developed that yields a single numerical correction factor that takes into account the excitation and receiver profiles of the coil, T1 saturation, and point spread effects associated with Fourier transformation of CSI data. An external phosphorus standard is used to calibrate instrument gain and the B1 profile of the coil. For spherical samples, point spread effects can modulate the signal intensities of three-dimensional CSI spectra from -32% to +54%, depending on the voxel size. Measurements of phantoms of known concentrations showed systematic variations of +/- 10% and random errors of +/- 5%. We have used this method to measure the concentration of phosphocreatine in the thigh muscle of normal volunteers.

Decoupling: theory and practice. II. State of the art: in vivo applications of decoupling

Current methods for broadband heteronuclear decoupling are reviewed from a historical perspective. The principal concern is that decoupling should be effective over a wide range of chemical shifts without undue radiofrequency heating of the sample, particularly when human patients are involved. Continuous-wave methods are the least efficient in this respect, followed by noise decoupling. Composite pulse schemes offer a more effective use of radiofrequency power, while adiabatic passage methods are the most efficient of all. Bi-level decoupling employs a low level of radiofrequency irradiation during the relaxation delay to maintain the nuclear Overhauser effect, with a higher level during signal acquisition in order to decouple over a wide frequency band. All decoupling sequences introduce cycling sidebands into the observed spectrum, and schemes are described to minimize the intensity of these artifacts. In part II, practical applications of decoupling methods are examined in the context of in vivo spectroscopy, where the improvements in sensitivity and resolution through broadband decoupling can be critical for solving clinical problems. Attention is focused on the regulatory limits on power deposition in these experiments. A tabulation of the existing work on decoupling in biological tissue is presented, mainly involving 31P and 13C spectroscopy in vivo or in vitro.

Proton-decoupled 19F spectroscopy of 5-FU catabolites in human liver

An RF network and a dual-tuned surface coil are described for obtaining proton-decoupled, NOE enhanced 19F spectra from a whole body clinical imager operating at 1.5 Tesia. The network removes 19F frequency noise from the decoupler transmitter, and prevents preamplifier saturation from high-level decoupling signals. Proton decoupling of 19F spectra was optimized using a sample of urine containing 5-fluorouracil (5-FU) and its catabolite fluoro-beta-alanine (FBAL). Proton-decoupled 19F spectroscopy in vivo is demonstrated by obtaining both nonlocalized spectra and spectra localized with three-dimensional chemical shift imaging from the liver of patients undergoing 5-FU chemotherapy.

Molar quantitation of hepatic metabolites in vivo in proton-decoupled, nuclear Overhauser effect enhanced 31P NMR spectra localized by three-dimensional chemical shift imaging

Proton decoupling and nuclear Overhauser effect (NOE) enhancement significantly improve the signal-to-noise ratio and enhance resolution of metabolites in in vivo 31P MRS. We obtained proton-decoupled, NOE-enhanced, phospholipid-saturated 31P spectra localized to defined regions within the normal liver using three-dimensional chemical shift imaging. Proton-decoupling resulted in the resolution of two major peaks in the phosphomonoester (PME) region, three peaks in the phosphodiester (PDE) region and a diphosphodiester peak. In order to obtain molar quantitation, we measured the NOE of all hepatic phosphorus resonances, and we corrected for saturation effects by measuring hepatic metabolite T1 using the variable nutation angle method with phase-cycled, B1-independent rotation, adiabatic pulses. After corrections for saturation effects, NOE enhancement, B1 variations and point spread effects, the following mean concentrations (mmol/l of liver) (+/-SD) were obtained: [PME1] = 1.2 +/- 0.4, [PME2 + 2,3-DPG] = 1.1 +/- 0.1, [Pi + 2,3-DPG] = 2.8 +/- 0.5, [GPEth] = 2.8 +/- 0.7, [GPChol] = 3.5 +/- 0.6 and [beta-NTP] = 3.8 +/- 0.3. T1 and NOE enhancement were strongly correlated (r = 90), and indicated that the fractional contribution of 1H-31P dipolar relaxation to total 31P relaxation is minimal for NTPs, moderate for PMEs and high for PDEs in liver. Proton-decoupling and NOE enhancement permit one to obtain more information about in vivo metabolism of liver than previously available and should enhance the utility of 31P MRS for the study of hepatic disorders.

Simultaneous 3D NMR spectroscopy of fluorine and phosphorus in human liver during 5-fluorouracil chemotherapy

Simultaneous multivoxel 31P and 19F 3D localized NMR spectroscopy is demonstrated on a phantom and in the liver of patients undergoing bolus-infusion 5-fluorouracil chemotherapy. The 19F and 31P spectra were localized with 8 x 8 x 8 3D chemical-shift imaging, with both nuclei sharing the same field of view and voxel size (27 and 64 ml in phantom and liver, respectively) using a 1.5-Tesla clinical imager with two RF channels and a dual-tuned surface coil. The repetition time (TR = 0.26 s) and Ernst nutation angles (theta E = 32 degrees for 19F, 28 degrees for 31P) were chosen to optimize the signal-to-noise ratio (SNR) per-unit time for the 0.5- to 2-s T1 range of the 19F and 31P metabolites of interest. The overall examination time, including tuning, imaging, shimming and dual-nuclear spectroscopy, was under 90 min. Simultaneous acquisition of 31P and 19F spectra will permit the study of the influence of hepatic and/or tumor metabolism on the uptake and catabolism of fluoropyrimidine drugs with no extra measurement time.

Increased NOE enhancement in 1H decoupled 31P MRS

1H decoupling using the WALTZ-4 decoupling scheme is a popular means of improving spectral resolution in 31P NMR spectroscopy. At the same time, sensitivity in the proton decoupled 31P spectra is enhanced by the nuclear Overhauser effect. The authors show that when using WALTZ-4 decoupling in a uniform decoupler RF field, the degree of sensitivity enhancement is critically dependent on whether the decoupling interval contains an odd or an even number of WALTZ decoupling elements. This effect is demonstrated both in phantoms and in vivo.