Variability of metabolite yield using STEAM or PRESS sequences in vivo at 3.0 T, illustrated with myo-inositol

In vivo Human MR Spectroscopy Using a Clinical Scanner: Development, Applications, and Future Prospects

MR spectroscopy (MRS) is a unique and useful method for noninvasively evaluating biochemical metabolism in human organs and tissues, but its clinical dissemination has been slow and often limited to specialized institutions or hospitals with experts in MRS technology. The number of 3-T clinical MR scanners is now increasing, representing a major opportunity to promote the use of clinical MRS. In this review, we summarize the theoretical background and basic knowledge required to understand the results obtained with MRS and introduce the general consensus on the clinical utility of proton MRS in routine clinical practice. In addition, we present updates to the consensus guidelines on proton MRS published by the members of a working committee of the Japan Society of Magnetic Resonance in Medicine in 2013. Recent research into multinuclear MRS equipped in clinical MR scanners is explained with an eye toward future development. This article seeks to provide an overview of the current status of clinical MRS and to promote the understanding of when it can be useful. In the coming years, MRS-mediated biochemical evaluation is expected to become available for even routine clinical practice.

Neurometabolite mapping highlights elevated myo-inositol profiles within the developing brain in down syndrome

The neurodevelopmental phenotype in Down Syndrome (DS), or Trisomy 21, is variable including a wide spectrum of cognitive impairment and a high risk of early-onset Alzheimer's disease (AD). A key metabolite of interest within the brain in DS is Myo-inositol (mIns). The NA+/mIns co-transporter is located on human chromosome 21 and is overexpressed in DS. In adults with DS, elevated brain mIns was previously associated with cognitive impairment and proposed as a risk marker for progression to AD. However, it is unknown if brain mIns is increased earlier in development. The aim of this study was to estimate mIns concentration levels and key brain metabolites [N-acetylaspartate (NAA), Choline (Cho) and Creatine (Cr)] in the developing brain in DS and aged-matched controls. We used in vivo magnetic resonance spectroscopy (MRS) in neonates with DS (n = 12) and age-matched controls (n = 26) scanned just after birth (36-45 weeks postmenstrual age). Moreover, we used Mass Spectrometry in early (10-20 weeks post conception) ex vivo fetal brain tissue samples from DS (n = 14) and control (n = 30) cases. Relative to [Cho] and [Cr], we report elevated ratios of [mIns] in vivo in the basal ganglia/thalamus, in neonates with DS, when compared to age-matched typically developing controls. Glycine concentration ratios [Gly]/[Cr] and [Cho]/[Cr] also appear elevated. We observed elevated [mIns] in the ex vivo fetal cortical brain tissue in DS compared with controls. In conclusion, a higher level of brain mIns was evident as early as 10 weeks post conception and was measurable in vivo from 36 weeks post-menstrual age. Future work will determine if this early difference in metabolites is linked to cognitive outcomes in childhood or has utility as a potential treatment biomarker for early intervention.

Magnetic Resonance Spectroscopy for Detection of 2-Hydroxyglutarate as a Biomarker for IDH Mutation in Gliomas

Mutations in the isocitrate dehydrogenase (IDH)1/2 genes are highly prevalent in gliomas and have been suggested to play an important role in the development and progression of the disease. Tumours harbouring these mutations exhibit a significant alteration in their metabolism resulting in the aberrant accumulation of the oncometabolite 2-hydroxygluarate (2-HG). As well as being suggested to play an important role in tumour progression, 2-HG may serve as a surrogate indicator of IDH status through non-invasive detection using magnetic resonance spectroscopy (MRS). In this review, we describe the recent efforts in developing MRS methods for detection and quantification of 2-HG in vivo and provide an assessment of the role of the 2-HG in gliomagenesis and patient prognosis.

In-Vivo Proton Magnetic Resonance Spectroscopy of 2-Hydroxyglutarate in Isocitrate Dehydrogenase-Mutated Gliomas: A Technical Review for Neuroradiologists

The diagnostic and prognostic potential of an onco-metabolite, 2-hydroxyglutarate (2HG) as a proton magnetic resonance spectroscopy (1H-MRS) detectable biomarker of the isocitrate dehydrogenase (IDH)-mutated (IDH-MT) gliomas has drawn attention of neuroradiologists recently. However, due to severe spectral overlap with background signals, quantification of 2HG can be very challenging. In this technical review for neuroradiologists, first, the biochemistry of 2HG and its significance in the diagnosis of IDH-MT gliomas are summarized. Secondly, various 1H-MRS methods used in the previous studies are outlined. Finally, wereview previous in vivo studies, and discuss the current status of 1H-MRS in the diagnosis of IDH-MT gliomas.

On the Utility of Short Echo Time (TE) Single Voxel 1H-MRS in Non-Invasive Detection of 2-Hydroxyglutarate (2HG); Challenges and Potential Improvement Illustrated with Animal Models Using MRUI and LCModel

Mutations in isocitrate dehydrogenase 1 and 2 (IDH1/2) are frequently found in brain tumors, and the resulting onco–metabolite, 2–hydroxyglutarate (2HG), has been suggested to be a potential diagnostic and prognostic biomarker of the diseases. Indeed, recent studies have demonstrated the feasibility of non–invasively detecting 2HG by using proton magnetic resonance spectroscopy (1H–MRS). Due to severe spectral overlaps of 2HG with its background metabolites and spectral baselines, however, the majority of those previous studies employed spectral editing methods with long echo times (TEs) instead of the most commonly used short TE approach with spectral fitting. Consequently, the results obtained with spectral editing methods may potentially be prone to errors resulting from substantial signal loss due to relaxation. Given that the spectral region where the main signal of 2HG resides is particularly sensitive to spectral baseline in metabolite quantification, we have investigated the impact of incorporating voxel–specifically measured baselines into the spectral basis set on the performance of the conventional short TE approach in 2HG detection in rodent models (Fisher 344 rats; n = 19) of IDH1/2 mutant–overexpressing F98 glioma at 9.4T. Metabolite spectra were acquired (SPECIAL sequence) for a tumor region and the contralateral normal region of the brain for each animal. For the estimation of spectral baselines metabolite–nulled spectra were obtained (double–inversion–recovery SPECIAL sequence) for each individual voxels. Data were post–processed with and without the measured baselines using MRUI and LCModel—the two most widely used data post–processing packages. Our results demonstrate that in–vivo detection of 2HG using the conventional short TE approach is challenging even at 9.4T. However, incorporation of voxel–specifically measured spectral baselines may potentially improve its performance. Upon more thorough validation in a larger number of animals and more importantly in human patients, the potential utility of the proposed short TE acquisition with voxel–specific baseline measurement approach in 2HG detection may need to be considered in the study design.

Enhancement of spectral editing efficacy of multiple quantum filters in in vivo proton magnetic resonance spectroscopy

The performance of multiple quantum filters (MQFs) can be disappointing when the background signal also arises from coupled spins. Moreover, at 3.0 T and even higher fields the majority of the spin systems of key brain metabolites fall into the strong-coupling regime. In this manuscript we address comprehensively, the importance of the phase of the multiple quantum coherence-generating pulse (MQ-pulse) in the design of MQFs, using both product operator and numerical analysis, in both zero and double quantum filter designs. The theoretical analyses were experimentally validated with the examples of myo-inositol editing and the separation of glutamate from glutamine. The results demonstrate that the phase of the MQ-pulse per se provides an additional spectral discrimination mechanism based on the degree of coupling beyond the conventional level-of-coherence approach of MQFs. To obtain the best spectral discrimination of strongly-coupled spin systems, therefore, the phase of the MQ-pulse must be included in the portfolio of the sequence parameters to be optimized.

In vivo (1)H-MRS hepatic lipid profiling in nonalcoholic fatty liver disease: an animal study at 9.4 T

The applicability of the in vivo proton magnetic resonance spectroscopy hepatic lipid profiling (MR-HLP) technique in nonalcoholic fatty liver disease was investigated. Using magnetic resonance spectroscopy, the relative fractions of diunsaturated (fdi), monounsaturated (fmono), and saturated (fsat) fatty acids as well as total hepatic lipid content were estimated in the livers of 8 control and 23 CCl4-treated rats at 9.4 T. The mean steatosis, necrosis, inflammation, and fibrosis scores of the treated group were all significantly higher than those of the control group (P < 0.01). There was a strong correlation between the histopathologic parameters and the MR-HLP parameters (r = 0.775, P < 0.01) where both steatosis and fibrosis are positively correlated with fmono and negatively correlated with fdi. Both necrosis and inflammation, however, were not correlated with any of the MR-HLP parameters. Hepatic lipid composition appears to be changed in association with the severity of steatosis and fibrosis in nonalcoholic fatty liver disease, and these changes can be depicted in vivo by using the MR-HLP method at 9.4 T. Thus, while it may not likely be that MR-HLP helps differentiate between steatohepatitis in its early stages and simple steatosis, these findings altogether are in support of potential applicability of in vivo MR-HLP at high field in nonalcoholic fatty liver disease.

Neurochemistry of drug action: insights from proton magnetic resonance spectroscopic imaging and their relevance to addiction

Proton magnetic resonance spectroscopy ((1)H MRS) is a noninvasive imaging technique that permits measurement of particular compounds or metabolites within the tissue of interest. In the brain, (1)H MRS provides a snapshot of the neurochemical environment within a defined volume of interest. A search of the literature demonstrates the widespread utility of this technique for characterizing tumors, tracking the progress of neurodegenerative disease, and for understanding the neurobiological basis of psychiatric disorders. As of relatively recently, (1)H MRS has found its way into substance abuse research, and it is beginning to become recognized as a valuable complement in the brain imaging toolbox that also contains positron emission tomography, single-photon-emission computed tomography, and functional magnetic resonance imaging. Drug abuse studies using (1)H MRS have identified several biochemical changes in the brain. The most consistent alterations across drug class were reductions in N-acetylaspartate and elevations in myo-inositol, whereas changes in choline, creatine, and amino acid transmitters also were abundant. Together, the studies discussed herein provide evidence that drugs of abuse may have a profound effect on neuronal health, energy metabolism and maintenance, inflammatory processes, cell membrane turnover, and neurotransmission, and these biochemical changes may underlie the neuropathology within brain tissue that subsequently gives rise to the cognitive and behavioral impairments associated with drug addiction.

Echo-time independent signal modulations for strongly coupled systems in triple echo localization schemes: an extension of S-PRESS editing

The double spin-echo point resolved spectroscopy sequence (PRESS) is a widely used method and standard in clinical MR spectroscopy. Existence of important J-modulations at constant echo times, depending on the temporal delays between the rf-pulses, have been demonstrated recently for strongly coupled spin systems and were exploited for difference editing, removing singlets from the spectrum (strong-coupling PRESS, S-PRESS). A drawback of this method for in vivo applications is that large signal modulations needed for difference editing occur only at relatively long echo times. In this work we demonstrate that, by simply adding a third refocusing pulse (3S-PRESS), difference editing becomes possible at substantially shorter echo times while, as applied to citrate, more favorable lineshapes can be obtained. For the example of an AB system an analytical description of the MR signal, obtained with this triple refocusing sequence (3S-PRESS), is provided.

Field strength dependence of PRESS timings for simultaneous detection of glutamate and glutamine from 1.5 to 7T

An optimization of the PRESS sequence for magnetic resonance spectroscopy is presented to simultaneously detect the important brain metabolites of glutamate (Glu) and glutamine (Gln) at field strengths of 1.5, 3, 4.7, and 7T. Standard, clinical examinations typically use short echo times which in general are not ideal for the separation of Glu and Gln. The optimization procedure is based on numerical product operator simulations to produce yield and overlap measurements for all possible practical choices of PRESS inter-echo timings. The simulations illustrate the substantial modulations in Glu and Gln with field strength. At all field strengths, the optimized timings demonstrate a significant reduction in overlap compared to short echo PRESS, while maintaining a high metabolite signal, with Glu and Gln yields >90% when excluding T2 relaxation losses. Minimal overlap was attained at 7T (0.3% Gln contamination in the Glu signal), and 4.7T (1.2%). The optimized timings were applied in vivo on healthy volunteers at field strengths of 1.5 and 4.7T.

Effect of PRESS and STEAM sequences on magnetic resonance spectroscopic liver fat quantification

PURPOSE

To compare PRESS and STEAM MR spectroscopy for assessment of liver fat in human subjects.

MATERIALS AND METHODS

Single-voxel (20 x 20 x 20 mm) PRESS and STEAM spectra were obtained at 1.5T in 49 human subjects with known or suspected fatty liver disease. PRESS and STEAM sequences were obtained with fixed TR (1500 msec) and different TE (five PRESS spectra between TE 30-70 msec, five STEAM spectra between TE 20-60 msec). Spectra were quantified and T2 and T2-corrected peak area were calculated by different techniques. The values were compared for PRESS and STEAM.

RESULTS

Water T2 values from PRESS and STEAM were not significantly different (P = 0.33). Fat peak T2s were 25%-50% shorter on PRESS than on STEAM (P < 0.02 for all comparisons) and there was no correlation between T2s of individual peaks. PRESS systematically overestimated the relative fat peak areas (by 7%-263%) compared to STEAM (P < 0.005 for all comparisons). The peak area given by PRESS was more dependent on the T2-correction technique than STEAM.

CONCLUSION

Measured liver fat depends on the MRS sequence used. Compared to STEAM, PRESS underestimates T2 values of fat, overestimates fat fraction, and provides a less consistent fat fraction estimate, probably due to J coupling effects.

Which pulse sequence is optimal for myo-inositol detection at 3T?

Optimized myo-inositol (mI) detection is important for diagnosing and monitoring a multitude of pathological conditions of the brain. Simulations are presented in this work, performed to decide which pulse sequence has the most significant advantage in terms of improving repeatability and accuracy of mI measurements at 3T over the pulse sequence used typically in the clinic, a TE = 35 ms PRESS sequence. Five classes of pulse sequences, four previously suggested for optimized mI detection (a short TE PRESS, a Carr-Purcell PRESS sequence, an optimized STEAM sequence, an optimized zero quantum filter), and one optimized for mI detection in this work (a single quantum filter) were compared to a standard, TE = 35 ms pulse sequence. While limiting the SNR of an acquisition to the equivalent SNR of a spectrum acquired in 5 min from an 8 cc voxel, it was found through simulations that the most repeatable mI measurements would be obtained with a Carr-Purcell sequence. This sequence was implemented in a clinical scanner, and improved mI measurements were demonstrated in vivo.

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.

Acute dextro-amphetamine administration does not alter brain myo-inositol levels in humans and animals: MRS investigations at 3 and 18.8 T

The pathophysiological underpinnings of bipolar disorder are not fully understood. However, they may be due in part to changes in the phosphatidylinositol second messenger system (PI-cycle) generally, or changes in myo-inositol concentrations more specifically. Dextro-amphetamine has been used as a model for mania in several human studies as it causes similar subjective and physiological symptoms. We wanted to determine if dextro-amphetamine altered myo-inositol concentrations in vivo as it would clearly define a mechanism linking putative changes in the PI-cycle to the subjective psychological changes seen with dextro-amphetamine administration. Fifteen healthy human volunteers received a baseline scan, followed by second scan 75 min after receiving a 25 mg oral dose of dextro-amphetamine. Stimulated echo proton magnetic resonance spectroscopy (MRS) scans were preformed at 3.0 Tesla (T) in the dorsal medial prefrontal cortex (DMPFC). Metabolite data were adjusted for tissue composition and analyzed using LCModel. Twelve adult male rats were treated acutely with a 5-mg/kg intraperitoneal dose of dextro-amphetamine. After 1 h rats were decapitated and the brains were rapidly removed and frozen until dissection. Rat brains were dissected into frontal, temporal, and occipital cortical areas, as well as hippocampus. Tissue was analyzed using a Varian 18.8 T spectrometer. Metabolites were identified and quantified using Chenomx Profiler software. The main finding in the present study was that myo-inositol concentrations in the DMPFC of human volunteers and in the four rat brain regions were not altered by acute dextro-amphetamine. While it remains possible that the PI-cycle may be involved in the pathophysiology of bipolar disorder, it is not likely that the subjective and physiological of dextro-amphetamine are mediated, directly or indirectly, via alternations in myo-inositol concentrations.

Exploiting the chemical shift displacement effect in the detection of glutamate and glutamine (Glx) with PRESS

A PRESS (Point RESolved Spectroscopy) sequence for the improved detection of the C2 protons of Glx (glutamate and glutamine) at approximately 3.75ppm is presented in this work. It is shown that for spins like the C2 protons of Glx which are involved solely in weak coupling interactions, the chemical shift displacement effect can be turned to advantage by exploiting PRESS refocusing pulses with bandwidths less than the chemical shift difference between the target spins and the spins to which they are weakly coupled. The narrow-bandwidth PRESS sequence allows refocusing of the J-coupling evolution of the target protons in the voxel of interest independently of echo time yielding signal equivalent to that which can be obtained with a one-pulse acquire sequence (assuming ideal pulses and ignoring T2 relaxation). The total echo time of PRESS was set long enough for the decay of macromolecule signal and the two echo times were empirically optimized so that the Glx signal at 3.75ppm suffered minimal contamination from myo-inositol. The efficacy of the method was verified on phantom solutions of Glx and on brain in vivo.

Effect of signal-to-noise ratio and spectral linewidth on metabolite quantification at 4 T

The accuracy and precision of measurements of metabolite concentrations from short echo-time spectra has previously been characterized at l.5 T as a function of signal-to-noise ratio (SNR) and peak linewidth. The purpose of this study was to characterize the systematic error in quantification of metabolite concentrations associated with linewidth and SNR for the major metabolites of interest in the short echo-time 1H-MR spectrum at 4 T. Simulated 4 T LASER localized spectra (TE = 46 ms) were generated with full width at half maximum (FWHM) over the range 4-14 Hz, and SNR over the range 5-500 by adding 100 Gaussian-distributed noise realizations at each combination of SNR and linewidth. Linewidth and SNR were treated as independent parameters, and therefore an increase in linewidth at a constant SNR resulted in increased metabolite areas. All spectra were fitted in the time domain using identical prior-knowledge and relative parameter starting values. Six metabolites (N-acetylaspartate, glutamate, creatine, myo-inositol, glycerophosphocholine, phosphocholine) were quantified with >90% accuracy and <10% standard deviation at SNR = 10 for linewidths ranging from 8 to 14 Hz FWHM. These simulations did not consider additional sources of variation, including eddy current artifacts, incomplete macromolecule baseline removal, and incomplete water suppression. Regardless, the results show that metabolite quantification from 4 T short echo-time 1H-MRS is sensitive to SNR and linewidth.

Simultaneous detection of resolved glutamate, glutamine, and gamma-aminobutyric acid at 4 T

A new approach is introduced to simultaneously detect resolved glutamate (Glu), glutamine (Gln), and gamma-aminobutyric acid (GABA) using a standard STEAM localization pulse sequence with the optimized sequence timing parameters. This approach exploits the dependence of the STEAM spectra of the strongly coupled spin systems of Glu, Gln, and GABA on the echo time TE and the mixing time TM at 4 T to find an optimized sequence parameter set, i.e., {TE, TM}, where the outer-wings of the Glu C4 multiplet resonances around 2.35 ppm, the Gln C4 multiplet resonances around 2.45 ppm, and the GABA C2 multiplet resonance around 2.28 ppm are significantly suppressed and the three resonances become virtual singlets simultaneously and thus resolved. Spectral simulation and optimization were conducted to find the optimized sequence parameters, and phantom and in vivo experiments (on normal human brains, one patient with traumatic brain injury, and one patient with brain tumor) were carried out for verification. The results have demonstrated that the Gln, Glu, and GABA signals at 2.2-2.5 ppm can be well resolved using a standard STEAM sequence with the optimized sequence timing parameters around {82 ms,48 ms} at 4 T, while the other main metabolites, such as N-acetyl aspartate (NAA), choline (tCho), and creatine (tCr), are still preserved in the same spectrum. The technique can be easily implemented and should prove to be a useful tool for the basic and clinical studies associated with metabolism of Glu, Gln, and/or GABA.

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.

Spatial localization in nuclear magnetic resonance spectroscopy

The ability to select a discrete region within the body for signal acquisition is a fundamental requirement of in vivo NMR spectroscopy. Ideally, it should be possible to tailor the selected volume to coincide exactly with the lesion or tissue of interest, without loss of signal from within this volume or contamination with extraneous signals. Many techniques have been developed over the past 25 years employing a combination of RF coil properties, static magnetic field gradients and pulse sequence design in an attempt to meet these goals. This review presents a comprehensive survey of these techniques, their various advantages and disadvantages, and implications for clinical applications. Particular emphasis is placed on the reliability of the techniques in terms of signal loss, contamination and the effect of nuclear relaxation and J-coupling. The survey includes techniques based on RF coil and pulse design alone, those using static magnetic field gradients, and magnetic resonance spectroscopic imaging. Although there is an emphasis on techniques currently in widespread use (PRESS, STEAM, ISIS and MRSI), the review also includes earlier techniques, in order to provide historical context, and techniques that are promising for future use in clinical and biomedical applications.

Detection of the myo-inositol 4.06-ppm resonance by selective J rewinding: application to human prefrontal cortex in vivo

A new proton NMR single-voxel spectral editing strategy for the rapid measurement of myo-inositol in human brain is proposed. The spectral editing detects the 4.06-ppm, weakly coupled resonance by means of selective J rewinding. An 84.6-ms-long quadruple-resonance selective 180 degrees radiofrequency pulse, implemented within an adiabatic-refocused localization sequence, induces an in-phase triplet at 4.06 ppm, while eliminating the contribution from creatine, phosphorylethanolamine, lactate, and serine in this spectral region. The myo-inositol concentration in human prefrontal cortex is estimated to be 5.7 +/- 0.9 mumol/g (mean +/- SD, n = 7), with reference to NAA at 10 micromol/g.