1
|
Zhou M, Nie Z, Zhao J, Xiao Y, Hong X, Wang Y, Dong C, Lin AP, Lei Z. Optimization and validation of echo times of point-resolved spectroscopy for cystathionine detection in gliomas. Cancer Imaging 2024; 24:118. [PMID: 39223589 PMCID: PMC11367870 DOI: 10.1186/s40644-024-00764-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Cystathionine accumulates selectively in 1p/19q-codeleted gliomas, and can serve as a possible noninvasive biomarker. This study aims to optimize the echo time (TE) of point-resolved spectroscopy (PRESS) for cystathionine detection in gliomas, and evaluate the diagnostic accuracy of PRESS for 1p/19q-codeletion identification. METHODS The TE of PRESS was optimized with numerical and phantom analysis to better resolve cystathionine from the overlapping aspartate multiplets. The optimized and 97 ms TE PRESS were then applied to 84 prospectively enrolled patients suspected of glioma or glioma recurrence to examine the influence of aspartate on cystathionine quantification by fitting the spectra with and without aspartate. The diagnostic performance of PRESS for 1p/19q-codeleted gliomas were assessed. RESULTS The TE of PRESS was optimized as (TE1, TE2) = (17 ms, 28 ms). The spectral pattern of cystathionine and aspartate were consistent between calculation and phantom. The mean concentrations of cystathionine in vivo fitting without aspartate were significantly higher than those fitting with full basis-set for 97 ms TE PRESS (1.97 ± 2.01 mM vs. 1.55 ± 1.95 mM, p < 0.01), but not significantly different for 45 ms method (0.801 ± 1.217 mM and 0.796 ± 1.217 mM, p = 0.494). The cystathionine concentrations of 45 ms approach was better correlated with those of edited MRS than 97 ms counterparts (r = 0.68 vs. 0.49, both p < 0.01). The sensitivity and specificity for discriminating 1p/19q-codeleted gliomas were 66.7% and 73.7% for 45 ms method, and 44.4% and 52.5% for 97 ms method, respectively. CONCLUSION The 45 ms TE PRESS yields more precise cystathionine estimates than the 97 ms method, and is anticipated to facilitate noninvasive diagnosis of 1p/19q-codeleted gliomas, and treatment response monitoring in those patients. Medium diagnostic performance of PRESS for 1p/19q-codeleted gliomas were observed, and warrants further investigations.
Collapse
Affiliation(s)
- Min Zhou
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhuang Nie
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jie Zhao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yao Xiao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Center for Clinical Spectroscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Xiaohua Hong
- Tumor Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuhui Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chengjun Dong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Alexander P Lin
- Center for Clinical Spectroscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ziqiao Lei
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| |
Collapse
|
2
|
Armbruster R, Wilson N, Elliott MA, Liu F, Benyard B, Jacobs P, Swain A, Nanga RPR, Reddy R. Repeatability of Lac+ measurements in healthy human brain at 3 T. NMR IN BIOMEDICINE 2024; 37:e5158. [PMID: 38584133 DOI: 10.1002/nbm.5158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE In vivo quantification of lactate has numerous applications in studying the pathology of both cerebral and musculoskeletal systems. Due to its low concentration (~0.5-1 mM), and overlap with lipid signals, traditional 1H MR spectra acquired in vivo using a small voxel and short echo time often result in an inadequate signal to detect and resolve the lactate peak, especially in healthy human volunteers. METHODS In this study, using a semi-LASER acquisition with long echo time (TE = 288 ms) and large voxel size (80 × 70 × 20 mm3), we clearly visualize the combined signal of lactate and threonine. Therefore, we call the signal at 1.33 ppm Lac+ and quantify Lac+ concentration from water suppressed spectra in healthy human brains in vivo. Four participants (22-37 years old; mean age = 28 ± 5.4; three male, one female) were scanned on four separate days, and on each day four measurements were taken. Intra-day values are calculated for each participant by comparing the four measurements on a single day. Inter-day values were calculated using the mean intra-day measurements. RESULTS The mean intra-participant Lac+ concentration, standard deviation (SD), and coefficient of variation (CV) ranged from 0.49 to 0.61 mM, 0.02 to 0.07 mM, and 4% to 13%, respectively, across four volunteers. The inter-participant Lac+ concentration, SD, and CV was 0.53 mM, ±0.06 mM, and 11%. CONCLUSION Repeatability is shown in Lac+ measurement in healthy human brain using a long echo time semi-LASER sequence with a large voxel in about 3.5 min at 3 T.
Collapse
Affiliation(s)
- Ryan Armbruster
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Neil Wilson
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark A Elliott
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fang Liu
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Blake Benyard
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul Jacobs
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anshuman Swain
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ravi Prakash Reddy Nanga
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ravinder Reddy
- Center for Advanced Metabolic Imaging in Precision Medicine, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
3
|
Branzoli F, Liserre R, Deelchand DK, Poliani PL, Bielle F, Nichelli L, Sanson M, Lehéricy S, Marjańska M. Neurochemical Differences between 1p/19q Codeleted and Noncodeleted IDH-mutant Gliomas by in Vivo MR Spectroscopy. Radiology 2023; 308:e223255. [PMID: 37668523 PMCID: PMC10546286 DOI: 10.1148/radiol.223255] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 06/19/2023] [Accepted: 06/29/2023] [Indexed: 09/06/2023]
Abstract
Background Noninvasive identification of glioma subtypes is important for optimizing treatment strategies. Purpose To compare the in vivo neurochemical profiles between isocitrate dehydrogenase (IDH) 1-mutant 1p/19q codeleted gliomas and their noncodeleted counterparts measured by MR spectroscopy at 3.0 T with a point-resolved spectroscopy (PRESS) sequence optimized for D-2-hydroxyglutarate (2HG) detection. Materials and Methods Adults with IDH1-mutant gliomas were retrospectively included for this study from two university hospitals (inclusion period: January 2015 to July 2016 and September 2019 to June 2021, respectively) based on availability of 1p/19q codeletion status and a PRESS acquisition optimized for 2HG detection (echo time, 97 msec) at 3.0 T before any treatment. Spectral analysis was performed using LCModel and a simulated basis set. Metabolite quantification was performed using the water signal as a reference and correcting for water and metabolite longitudinal and transverse relaxation time constants. Concentration ratios were computed using total creatine (tCr) and total choline. A two-tailed unpaired t test was used to compare metabolite concentrations obtained in codeleted versus noncodeleted gliomas, accounting for multiple comparisons. Results Thirty-one adults (mean age, 39 years ± 8 [SD]; 19 male) were included, and 19 metabolites were quantified. Cystathionine concentration was higher in codeleted (n = 13) than noncodeleted (n = 18) gliomas when quantification was performed using the water signal or tCr as references (2.33 mM ± 0.98 vs 0.93 mM ± 0.94, and 0.34 mM ± 0.14 vs 0.14 mM ± 0.14, respectively; both P < .001). The sensitivity and specificity of PRESS to detect codeletion by means of cystathionine quantification were 92% and 61%, respectively. Other metabolites did not show evidence of a difference between groups (P > .05). Conclusion Higher cystathionine levels were detected in IDH1-mutant 1p/19q codeleted gliomas than in their noncodeleted counterparts with use of a PRESS sequence optimized for 2HG detection. Of 19 metabolites quantified, only cystathionine showed evidence of a difference in concentration between groups. Clinical trial registry no. NCT01703962 © RSNA, 2023 See also the editorial by Lin in this issue.
Collapse
Affiliation(s)
- Francesca Branzoli
- From the Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute–L’Institut du Cerveau et de la Moelle Épinière (ICM), 47 boulevard de l’Hôpital, 75013 Paris, France (F. Branzoli, L.N., M.S., S.L.); Center for Neuroimaging Research (CENIR), L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (F. Branzoli, S.L.); Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy (R.L.); Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minn (D.K.D., M.M.); Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy (P.L.P.); Laboratory R Escourolle (F. Bielle), Department of Neuroradiology (L.N., S.L.), and Department of Neurology 2 (M.S.), University Hospital La Pitié-Salpêtrière-Charles Foix, AP-HP, Paris, France; and Onconeurotek Tumor Bank, L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (M.S.)
| | - Roberto Liserre
- From the Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute–L’Institut du Cerveau et de la Moelle Épinière (ICM), 47 boulevard de l’Hôpital, 75013 Paris, France (F. Branzoli, L.N., M.S., S.L.); Center for Neuroimaging Research (CENIR), L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (F. Branzoli, S.L.); Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy (R.L.); Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minn (D.K.D., M.M.); Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy (P.L.P.); Laboratory R Escourolle (F. Bielle), Department of Neuroradiology (L.N., S.L.), and Department of Neurology 2 (M.S.), University Hospital La Pitié-Salpêtrière-Charles Foix, AP-HP, Paris, France; and Onconeurotek Tumor Bank, L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (M.S.)
| | - Dinesh K. Deelchand
- From the Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute–L’Institut du Cerveau et de la Moelle Épinière (ICM), 47 boulevard de l’Hôpital, 75013 Paris, France (F. Branzoli, L.N., M.S., S.L.); Center for Neuroimaging Research (CENIR), L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (F. Branzoli, S.L.); Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy (R.L.); Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minn (D.K.D., M.M.); Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy (P.L.P.); Laboratory R Escourolle (F. Bielle), Department of Neuroradiology (L.N., S.L.), and Department of Neurology 2 (M.S.), University Hospital La Pitié-Salpêtrière-Charles Foix, AP-HP, Paris, France; and Onconeurotek Tumor Bank, L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (M.S.)
| | - Pietro Luigi Poliani
- From the Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute–L’Institut du Cerveau et de la Moelle Épinière (ICM), 47 boulevard de l’Hôpital, 75013 Paris, France (F. Branzoli, L.N., M.S., S.L.); Center for Neuroimaging Research (CENIR), L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (F. Branzoli, S.L.); Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy (R.L.); Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minn (D.K.D., M.M.); Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy (P.L.P.); Laboratory R Escourolle (F. Bielle), Department of Neuroradiology (L.N., S.L.), and Department of Neurology 2 (M.S.), University Hospital La Pitié-Salpêtrière-Charles Foix, AP-HP, Paris, France; and Onconeurotek Tumor Bank, L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (M.S.)
| | - Franck Bielle
- From the Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute–L’Institut du Cerveau et de la Moelle Épinière (ICM), 47 boulevard de l’Hôpital, 75013 Paris, France (F. Branzoli, L.N., M.S., S.L.); Center for Neuroimaging Research (CENIR), L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (F. Branzoli, S.L.); Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy (R.L.); Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minn (D.K.D., M.M.); Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy (P.L.P.); Laboratory R Escourolle (F. Bielle), Department of Neuroradiology (L.N., S.L.), and Department of Neurology 2 (M.S.), University Hospital La Pitié-Salpêtrière-Charles Foix, AP-HP, Paris, France; and Onconeurotek Tumor Bank, L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (M.S.)
| | - Lucia Nichelli
- From the Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute–L’Institut du Cerveau et de la Moelle Épinière (ICM), 47 boulevard de l’Hôpital, 75013 Paris, France (F. Branzoli, L.N., M.S., S.L.); Center for Neuroimaging Research (CENIR), L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (F. Branzoli, S.L.); Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy (R.L.); Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minn (D.K.D., M.M.); Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy (P.L.P.); Laboratory R Escourolle (F. Bielle), Department of Neuroradiology (L.N., S.L.), and Department of Neurology 2 (M.S.), University Hospital La Pitié-Salpêtrière-Charles Foix, AP-HP, Paris, France; and Onconeurotek Tumor Bank, L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (M.S.)
| | - Marc Sanson
- From the Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute–L’Institut du Cerveau et de la Moelle Épinière (ICM), 47 boulevard de l’Hôpital, 75013 Paris, France (F. Branzoli, L.N., M.S., S.L.); Center for Neuroimaging Research (CENIR), L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (F. Branzoli, S.L.); Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy (R.L.); Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minn (D.K.D., M.M.); Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy (P.L.P.); Laboratory R Escourolle (F. Bielle), Department of Neuroradiology (L.N., S.L.), and Department of Neurology 2 (M.S.), University Hospital La Pitié-Salpêtrière-Charles Foix, AP-HP, Paris, France; and Onconeurotek Tumor Bank, L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (M.S.)
| | - Stéphane Lehéricy
- From the Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute–L’Institut du Cerveau et de la Moelle Épinière (ICM), 47 boulevard de l’Hôpital, 75013 Paris, France (F. Branzoli, L.N., M.S., S.L.); Center for Neuroimaging Research (CENIR), L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (F. Branzoli, S.L.); Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy (R.L.); Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minn (D.K.D., M.M.); Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy (P.L.P.); Laboratory R Escourolle (F. Bielle), Department of Neuroradiology (L.N., S.L.), and Department of Neurology 2 (M.S.), University Hospital La Pitié-Salpêtrière-Charles Foix, AP-HP, Paris, France; and Onconeurotek Tumor Bank, L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (M.S.)
| | - Małgorzata Marjańska
- From the Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute–L’Institut du Cerveau et de la Moelle Épinière (ICM), 47 boulevard de l’Hôpital, 75013 Paris, France (F. Branzoli, L.N., M.S., S.L.); Center for Neuroimaging Research (CENIR), L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (F. Branzoli, S.L.); Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy (R.L.); Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minn (D.K.D., M.M.); Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy (P.L.P.); Laboratory R Escourolle (F. Bielle), Department of Neuroradiology (L.N., S.L.), and Department of Neurology 2 (M.S.), University Hospital La Pitié-Salpêtrière-Charles Foix, AP-HP, Paris, France; and Onconeurotek Tumor Bank, L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (M.S.)
| |
Collapse
|
4
|
Gudmundson AT, Koo A, Virovka A, Amirault AL, Soo M, Cho JH, Oeltzschner G, Edden RAE, Stark CEL. Meta-analysis and open-source database for in vivo brain Magnetic Resonance spectroscopy in health and disease. Anal Biochem 2023; 676:115227. [PMID: 37423487 PMCID: PMC10561665 DOI: 10.1016/j.ab.2023.115227] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
Proton (1H) Magnetic Resonance Spectroscopy (MRS) is a non-invasive tool capable of quantifying brain metabolite concentrations in vivo. Prioritization of standardization and accessibility in the field has led to the development of universal pulse sequences, methodological consensus recommendations, and the development of open-source analysis software packages. One on-going challenge is methodological validation with ground-truth data. As ground-truths are rarely available for in vivo measurements, data simulations have become an important tool. The diverse literature of metabolite measurements has made it challenging to define ranges to be used within simulations. Especially for the development of deep learning and machine learning algorithms, simulations must be able to produce accurate spectra capturing all the nuances of in vivo data. Therefore, we sought to determine the physiological ranges and relaxation rates of brain metabolites which can be used both in data simulations and as reference estimates. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we've identified relevant MRS research articles and created an open-source database containing methods, results, and other article information as a resource. Using this database, expectation values and ranges for metabolite concentrations and T2 relaxation times are established based upon a meta-analyses of healthy and diseased brains.
Collapse
Affiliation(s)
- Aaron T Gudmundson
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Annie Koo
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Anna Virovka
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Alyssa L Amirault
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Madelene Soo
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Jocelyn H Cho
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Georg Oeltzschner
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Richard A E Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Craig E L Stark
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA.
| |
Collapse
|
5
|
Robison RK, Haynes JR, Ganji SK, Nockowski CP, Kovacs Z, Pham W, Morgan VL, Smith SA, Thompson RC, Omary RA, Gore JC, Choi C. J-Difference editing (MEGA) of lactate in the human brain at 3T. Magn Reson Med 2023; 90:852-862. [PMID: 37154389 PMCID: PMC10901256 DOI: 10.1002/mrm.29693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE The need to detect and quantify brain lactate accurately by MRS has stimulated the development of editing sequences based on J coupling effects. In J-difference editing of lactate, threonine can be co-edited and it contaminates lactate estimates due to the spectral proximity of the coupling partners of their methyl protons. We therefore implemented narrow-band editing 180° pulses (E180) in MEGA-PRESS acquisitions to resolve separately the 1.3-ppm resonances of lactate and threonine. METHODS Two 45.3-ms rectangular E180 pulses, which had negligible effects 0.15-ppm away from the carrier frequency, were implemented in a MEGA-PRESS sequence with TE 139 ms. Three acquisitions were designed to selectively edit lactate and threonine, in which the E180 pulses were tuned to 4.1 ppm, 4.25 ppm, and a frequency far off resonance. Editing performance was validated with numerical analyses and acquisitions from phantoms. The narrow-band E180 MEGA and another MEGA-PRESS sequence with broad-band E180 pulses were evaluated in six healthy subjects. RESULTS The 45.3-ms E180 MEGA offered a difference-edited lactate signal with lower intensity and reduced contamination from threonine compared to the broad-band E180 MEGA. The 45.3 ms E180 pulse had MEGA editing effects over a frequency range larger than seen in the singlet-resonance inversion profile. Lactate and threonine in healthy brain were both estimated to be 0.4 ± 0.1 mM, with reference to N-acetylaspartate at 12 mM. CONCLUSION Narrow-band E180 MEGA editing minimizes threonine contamination of lactate spectra and may improve the ability to detect modest changes in lactate levels.
Collapse
Affiliation(s)
- Ryan K Robison
- Philips, Nashville, Tennessee, USA
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin R Haynes
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sandeep K Ganji
- Philips, Rochester, Minnesota, USA
- Mayo Clinic, Rochester, Minnesota, USA
| | - Charles P Nockowski
- Philips, Nashville, Tennessee, USA
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Zoltan Kovacs
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Wellington Pham
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Victoria L Morgan
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Seth A Smith
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Reid C Thompson
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Reed A Omary
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John C Gore
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
- Department of Physics and Astronomy, Vanderbilt University, Nashville, Tennessee, USA
| | - Changho Choi
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
6
|
Gudmundson AT, Koo A, Virovka A, Amirault AL, Soo M, Cho JH, Oeltzschner G, Edden RA, Stark C. Meta-analysis and Open-source Database for In Vivo Brain Magnetic Resonance Spectroscopy in Health and Disease. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.10.528046. [PMID: 37205343 PMCID: PMC10187197 DOI: 10.1101/2023.02.10.528046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Proton ( 1 H) Magnetic Resonance Spectroscopy (MRS) is a non-invasive tool capable of quantifying brain metabolite concentrations in vivo . Prioritization of standardization and accessibility in the field has led to the development of universal pulse sequences, methodological consensus recommendations, and the development of open-source analysis software packages. One on-going challenge is methodological validation with ground-truth data. As ground-truths are rarely available for in vivo measurements, data simulations have become an important tool. The diverse literature of metabolite measurements has made it challenging to define ranges to be used within simulations. Especially for the development of deep learning and machine learning algorithms, simulations must be able to produce accurate spectra capturing all the nuances of in vivo data. Therefore, we sought to determine the physiological ranges and relaxation rates of brain metabolites which can be used both in data simulations and as reference estimates. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we've identified relevant MRS research articles and created an open-source database containing methods, results, and other article information as a resource. Using this database, expectation values and ranges for metabolite concentrations and T 2 relaxation times are established based upon a meta-analyses of healthy and diseased brains.
Collapse
Affiliation(s)
- Aaron T. Gudmundson
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD
| | - Annie Koo
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA
| | - Anna Virovka
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA
| | - Alyssa L. Amirault
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA
| | - Madelene Soo
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA
| | - Jocelyn H. Cho
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA
| | - Georg Oeltzschner
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD
| | - Richard A.E. Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD
| | - Craig Stark
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA
| |
Collapse
|
7
|
Beracha I, Seginer A, Tal A. Adaptive model-based Magnetic Resonance. Magn Reson Med 2023. [PMID: 37154407 DOI: 10.1002/mrm.29688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Conventional sequences are static in nature, fixing measurement parameters in advance in anticipation of a wide range of expected tissue parameter values. We set out to design and benchmark a new, personalized approach-termed adaptive MR-in which incoming subject data is used to update and fine-tune the pulse sequence parameters in real time. METHODS We implemented an adaptive, real-time multi-echo (MTE) experiment for estimating T2 s. Our approach combined a Bayesian framework with model-based reconstruction. It maintained and continuously updated a prior distribution of the desired tissue parameters, including T2 , which was used to guide the selection of sequence parameters in real time. RESULTS Computer simulations predicted accelerations between 1.7- and 3.3-fold for adaptive multi-echo sequences relative to static ones. These predictions were corroborated in phantom experiments. In healthy volunteers, our adaptive framework accelerated the measurement of T2 for n-acetyl-aspartate by a factor of 2.5. CONCLUSION Adaptive pulse sequences that alter their excitations in real time could provide substantial reductions in acquisition times. Given the generality of our proposed framework, our results motivate further research into other adaptive model-based approaches to MRI and MRS.
Collapse
Affiliation(s)
- Inbal Beracha
- Department of Chemical and Biological Physics, Weizmann Institute of Science, Rehovot, Israel
| | | | - Assaf Tal
- Department of Chemical and Biological Physics, Weizmann Institute of Science, Rehovot, Israel
| |
Collapse
|
8
|
Radke KL, Abrar DB, Frenken M, Wilms LM, Kamp B, Boschheidgen M, Liebig P, Ljimani A, Filler TJ, Antoch G, Nebelung S, Wittsack HJ, Müller-Lutz A. Chemical Exchange Saturation Transfer for Lactate-Weighted Imaging at 3 T MRI: Comprehensive In Silico, In Vitro, In Situ, and In Vivo Evaluations. Tomography 2022; 8:1277-1292. [PMID: 35645392 PMCID: PMC9149919 DOI: 10.3390/tomography8030106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 01/22/2023] Open
Abstract
Based on in silico, in vitro, in situ, and in vivo evaluations, this study aims to establish and optimize the chemical exchange saturation transfer (CEST) imaging of lactate (Lactate-CEST—LATEST). To this end, we optimized LATEST sequences using Bloch−McConnell simulations for optimal detection of lactate with a clinical 3 T MRI scanner. The optimized sequences were used to image variable lactate concentrations in vitro (using phantom measurements), in situ (using nine human cadaveric lower leg specimens), and in vivo (using four healthy volunteers after exertional exercise) that were then statistically analyzed using the non-parametric Friedman test and Kendall Tau-b rank correlation. Within the simulated Bloch−McConnell equations framework, the magnetization transfer ratio asymmetry (MTRasym) value was quantified as 0.4% in the lactate-specific range of 0.5−1 ppm, both in vitro and in situ, and served as the imaging surrogate of the lactate level. In situ, significant differences (p < 0.001) and strong correlations (τ = 0.67) were observed between the MTRasym values and standardized intra-muscular lactate concentrations. In vivo, a temporary increase in the MTRasym values was detected after exertional exercise. In this bench-to-bedside comprehensive feasibility study, different lactate concentrations were detected using an optimized LATEST imaging protocol in vitro, in situ, and in vivo at 3 T, which prospectively paves the way towards non-invasive quantification and monitoring of lactate levels across a broad spectrum of diseases.
Collapse
Affiliation(s)
- Karl Ludger Radke
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (K.L.R.); (M.F.); (L.M.W.); (B.K.); (M.B.); (A.L.); (G.A.); (S.N.); (H.-J.W.); (A.M.-L.)
| | - Daniel B. Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (K.L.R.); (M.F.); (L.M.W.); (B.K.); (M.B.); (A.L.); (G.A.); (S.N.); (H.-J.W.); (A.M.-L.)
| | - Miriam Frenken
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (K.L.R.); (M.F.); (L.M.W.); (B.K.); (M.B.); (A.L.); (G.A.); (S.N.); (H.-J.W.); (A.M.-L.)
| | - Lena Marie Wilms
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (K.L.R.); (M.F.); (L.M.W.); (B.K.); (M.B.); (A.L.); (G.A.); (S.N.); (H.-J.W.); (A.M.-L.)
| | - Benedikt Kamp
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (K.L.R.); (M.F.); (L.M.W.); (B.K.); (M.B.); (A.L.); (G.A.); (S.N.); (H.-J.W.); (A.M.-L.)
| | - Matthias Boschheidgen
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (K.L.R.); (M.F.); (L.M.W.); (B.K.); (M.B.); (A.L.); (G.A.); (S.N.); (H.-J.W.); (A.M.-L.)
| | | | - Alexandra Ljimani
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (K.L.R.); (M.F.); (L.M.W.); (B.K.); (M.B.); (A.L.); (G.A.); (S.N.); (H.-J.W.); (A.M.-L.)
| | - Timm Joachim Filler
- Institute of Anatomy I, Heinrich-Heine-University, D-40225 Dusseldorf, Germany;
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (K.L.R.); (M.F.); (L.M.W.); (B.K.); (M.B.); (A.L.); (G.A.); (S.N.); (H.-J.W.); (A.M.-L.)
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (K.L.R.); (M.F.); (L.M.W.); (B.K.); (M.B.); (A.L.); (G.A.); (S.N.); (H.-J.W.); (A.M.-L.)
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, D-52074 Aachen, Germany
| | - Hans-Jörg Wittsack
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (K.L.R.); (M.F.); (L.M.W.); (B.K.); (M.B.); (A.L.); (G.A.); (S.N.); (H.-J.W.); (A.M.-L.)
| | - Anja Müller-Lutz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (K.L.R.); (M.F.); (L.M.W.); (B.K.); (M.B.); (A.L.); (G.A.); (S.N.); (H.-J.W.); (A.M.-L.)
| |
Collapse
|
9
|
Branzoli F, Deelchand DK, Liserre R, Poliani PL, Nichelli L, Sanson M, Lehéricy S, Marjańska M. The influence of cystathionine on neurochemical quantification in brain tumor in vivo MR spectroscopy. Magn Reson Med 2022; 88:537-545. [PMID: 35381117 PMCID: PMC9232981 DOI: 10.1002/mrm.29252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/15/2022] [Accepted: 03/10/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE To evaluate the ability of the PRESS sequence (TE = 97 ms, optimized for 2-hydroxyglutarate detection) to detect cystathionine in gliomas and the effect of the omission of cystathionine on the quantification of the full neurochemical profile. METHODS Twenty-three subjects with a glioma were retrospectively included based on the availability of both MEGA-PRESS and PRESS acquisitions at 3T, and the presence of the cystathionine signal in the edited MR spectrum. In eight subjects, the PRESS acquisition was performed also in normal tissue. Metabolite quantification was performed using LCModel and simulated basis sets. The LCModel analysis for the PRESS data was performed with and without cystathionine. RESULTS All subjects with glioma had detectable cystathionine levels >1 mM with Cramér-Rao lower bounds (CRLB) <15%. The mean cystathionine concentrations were 3.49 ± 1.17 mM for MEGA-PRESS and 2.20 ± 0.80 mM for PRESS data. Cystathionine concentrations showed a significant correlation between the two MRS methods (r = 0.58, p = .004), and it was not detectable in normal tissue. Using PRESS, 19 metabolites were quantified with CRLB <50% for more than half of the subjects. The metabolites that were significantly (p < .0028) and mostly affected by the omission of cystathionine were aspartate, betaine, citrate, γ-aminobutyric acid (GABA), and serine. CONCLUSIONS Cystathionine was detectable by PRESS in all the selected gliomas, while it was not detectable in normal tissue. The omission from the spectral analysis of cystathionine led to severe biases in the quantification of other neurochemicals that may play key roles in cancer metabolism.
Collapse
Affiliation(s)
- Francesca Branzoli
- Paris Brain Institute-Institut du Cerveau (ICM), Center for Neuroimaging Research (CENIR), Paris, France.,Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France
| | - Dinesh K Deelchand
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Roberto Liserre
- Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy
| | - Pietro Luigi Poliani
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Lucia Nichelli
- Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France.,Department of Neuroradiology, Pitié Salpêtrière Hospital, Paris, France
| | - Marc Sanson
- Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France.,Department of Neurology 2, Pitié-Salpêtrière Hospital, Paris, France.,Onconeurotek Tumor Bank, Paris, France
| | - Stéphane Lehéricy
- Paris Brain Institute-Institut du Cerveau (ICM), Center for Neuroimaging Research (CENIR), Paris, France.,Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France.,Department of Neuroradiology, Pitié Salpêtrière Hospital, Paris, France
| | - Małgorzata Marjańska
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
10
|
Ganji SK, An Z, Tiwari V, Chang Y, Patel TR, Maher EA, Choi C. Optimization of spectrally selective 180° radiofrequency pulse timings in J-difference editing (MEGA) of lactate. Magn Reson Med 2022; 87:1150-1164. [PMID: 34657302 PMCID: PMC8776585 DOI: 10.1002/mrm.29051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE J-Difference editing (MEGA) provides an effective spectroscopic means of selectively measuring low-concentration metabolites having weakly coupled spins. The fractional inphase and antiphase coherences are determined by the radiofrequency (RF) pulses and inter-RF pulse intervals of the sequence. We examined the timings of the spectrally selective editing 180° pulses (E180) in MEGA-PRESS to maximize the edited signal amplitude in lactate at 3T. METHODS The time evolution of the lactate spin coherences was analytically and numerically calculated for non-volume localized and single-voxel localized MEGA sequences. Single-voxel localized MEGA-PRESS simulations and phantom experiments were conducted for echo time (TE) 60-160 ms and for all possible integer-millisecond timings of the E180 pulses. Optimized E180 timings of 144, 103, and 109 ms TEs, tailored with simulation and phantom data, were tested in brain tumor patients in vivo. Lactate signals, broadened to singlet linewidths (~6 Hz), were compared between simulation, phantom, and in vivo data. RESULTS Theoretical and experimental data indicated consistently that the MEGA-edited signal amplitude and width are sensitive to the E180 timings. In volume-localized MEGA, the lactate peak amplitudes in E180-on and difference spectra were maximized at specific E180 timings for individual TEs, largely due to the chemical-shift displacement effects. The E180 timings for maximum lactate peak amplitude were different from those of maximum inphase coherence in in vivo linewidth situations. CONCLUSION In in vivo MEGA editing, the E180 pulse timings can be effectively used for manipulating the inphase and antiphase coherences and increasing the edited signal amplitude, following TE optimization.
Collapse
Affiliation(s)
- Sandeep K. Ganji
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
- Philips Healthcare, Andover, Massachusetts, USA
| | - Zhongxu An
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Vivek Tiwari
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yongmin Chang
- Department of Molecular Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Toral R. Patel
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elizabeth A. Maher
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Annette G. Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Changho Choi
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
11
|
Tomiyasu M, Harada M. In vivo Human MR Spectroscopy Using a Clinical Scanner: Development, Applications, and Future Prospects. Magn Reson Med Sci 2022; 21:235-252. [PMID: 35173095 PMCID: PMC9199975 DOI: 10.2463/mrms.rev.2021-0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Moyoko Tomiyasu
- Department of Molecular Imaging and Theranostics, National Institutes for Quantum Science and Technology.,Department of Radiology, Kanagawa Children's Medical Center
| | - Masafumi Harada
- Department of Radiology and Radiation Oncology, Graduate School of Biomedical Sciences, Tokushima University
| |
Collapse
|
12
|
The relationship between diffusion heterogeneity and microstructural changes in high-grade gliomas using Monte Carlo simulations. Magn Reson Imaging 2021; 85:108-120. [PMID: 34653578 DOI: 10.1016/j.mri.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/17/2021] [Accepted: 10/07/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Diffusion-weighted imaging (DWI) may aid accurate tumor grading. Decreased diffusivity and increased diffusion heterogeneity measures have been observed in high-grade gliomas using the non-monoexponential models for DWI. However, DWI measures concerning tissue characteristics in terms of pathophysiological and structural changes are yet to be established. Thus, this study aims to investigate the relationship between the diffusion measurements and microstructural changes in the presence of high-grade gliomas using a three-dimensional Monte Carlo simulation with systematic changes of microstructural parameters. METHODS Water diffusion was simulated in a microenvironment along with changes associated with the presence of high-grade gliomas, including increases in cell density, nuclear volume, extracellular volume (VFex), and extracellular tortuosity (λex), and changes in membrane permeability (Pmem). DWI signals were simulated using a pulsed gradient spin-echo sequence. The sequence parameters, including the maximum gradient strength and diffusion time, were set to be comparable to those of clinical scanners and advanced human MRI systems. The DWI signals were fitted using the gamma distribution and diffusional kurtosis models with b-values up to 6000 and 2500 s/mm2, respectively. RESULTS The diffusivity measures (apparent diffusion coefficients (ADC), Dgamma of the gamma distribution model and Dapp of the diffusional kurtosis model) decreased with increases in cell density and λex, and a decrease in Pmem. These diffusivity measures increased with increases in nuclear volume and VFex. The diffusion heterogeneity measures (σgamma of the gamma distribution model and Kapp of the diffusional kurtosis model) increased with increases in cell density or nuclear volume at the low Pmem, and a decrease in Pmem. Increased σgamma was also associated with an increase in VFex. CONCLUSION Among simulated microstructural changes, only increases in cell density at low Pmem or decreases in Pmem corresponded to both the decreased diffusivity and increased diffusion heterogeneity measures. The results suggest that increases in cell density at low Pmem or decreases in Pmem may be associated with the diffusion changes observed in high-grade gliomas.
Collapse
|
13
|
Askari P, Dimitrov IE, Ganji SK, Tiwari V, Levy M, Patel TR, Pan E, Mickey BE, Malloy CR, Maher EA, Choi C. Spectral fitting strategy to overcome the overlap between 2-hydroxyglutarate and lipid resonances at 2.25 ppm. Magn Reson Med 2021; 86:1818-1828. [PMID: 33977579 PMCID: PMC8295210 DOI: 10.1002/mrm.28829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/07/2021] [Accepted: 04/15/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE 1 H MRS provides a noninvasive tool for identifying mutations in isocitrate dehydrogenase (IDH). Quantification of the prominent 2-hydroxyglutarate (2HG) resonance at 2.25 ppm is often confounded by the lipid resonance at the same frequency in tumors with elevated lipids. We propose a new spectral fitting approach to separate these overlapped signals, therefore, improving 2HG evaluation. METHODS TE 97 ms PRESS was acquired at 3T from 42 glioma patients. New lipid basis sets were created, in which the small lipid 2.25-ppm signal strength was preset with reference to the lipid signal at 0.9 ppm, incorporating published fat relaxation data. LCModel fitting using the new lipid bases (Fitting method 2) was conducted along with fitting using the LCModel built-in lipid basis set (Fitting method 1), in which the lipid 2.25-ppm signal is assessed with reference to the lipid 1.3-ppm signal. In-house basis spectra of low-molecular-weight metabolites were used in both fitting methods. RESULTS Fitting method 2 showed marked improvement in identifying IDH mutational status compared with Fitting method 1. 2HG estimates from Fitting method 2 were overall smaller than those from Fitting method 1, which was because of differential assignment of the signal at 2.25 ppm to lipids. In receiver operating characteristic analysis, Fitting method 2 provided a complete distinction between IDH mutation and wild-type whereas Fitting method 1 did not. CONCLUSION The data suggest that 1 H MR spectral fitting using the new lipid basis set provides a robust fitting strategy that improves 2HG evaluation in brain tumors with elevated lipids.
Collapse
Affiliation(s)
- Pegah Askari
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
- Joint Graduate Program in Biomedical Engineering at University of Texas Arlington and University of Texas Southwestern Medical Center, Texas
| | - Ivan E. Dimitrov
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
- Philips Healthcare, Gainesville, Florida
| | - Sandeep K. Ganji
- Philips Healthcare, Andover, Massachusetts
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Vivek Tiwari
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Levy
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Toral R. Patel
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Edward Pan
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bruce E. Mickey
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
- Annette G. Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Craig R. Malloy
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
- Veterans Affairs North Texas Health Care System, Dallas, Texas
| | - Elizabeth A. Maher
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
- Annette G. Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Changho Choi
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
14
|
Use of nuclear magnetic resonance spectroscopy in diagnosis of inborn errors of metabolism. Emerg Top Life Sci 2021; 5:39-48. [PMID: 33522566 DOI: 10.1042/etls20200259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 12/13/2022]
Abstract
Nuclear Magnetic Resonance (NMR) spectroscopy has been applied in many fields of science and is increasingly being considered as a tool in the clinical setting. This review examines its application for diagnosis of inborn errors of metabolism (IEMs). IEMs, whether involving deficiency in the synthesis and degradation of metabolites, or in lipoprotein metabolism, affect nearly 3% of the global population. NMR is a preferred method for comprehensive evaluation of complex biofluids such as blood or urine, as it can provide a relatively unbiased overview of all compounds that are present and does not destroy or otherwise chemically alter the sample. While current newborn screening programs take advantage of other more sensitive methods, such as mass spectrometry, NMR has advantages especially for urine analysis with respect to ease of sample preparation and the reproducibility of results. NMR spectroscopy is particularly compatible with analysis of lipoproteins because it provides information about their size and density, not easily attained by other methods, that can help the clinician to better manage patients with dyslipidemia. We believe that NMR holds great potential for expanding clinical diagnosis in the future, in the field of IEMs and beyond.
Collapse
|
15
|
Choi IY, Andronesi OC, Barker P, Bogner W, Edden RAE, Kaiser LG, Lee P, Marjańska M, Terpstra M, de Graaf RA. Spectral editing in 1 H magnetic resonance spectroscopy: Experts' consensus recommendations. NMR IN BIOMEDICINE 2021; 34:e4411. [PMID: 32946145 PMCID: PMC8557623 DOI: 10.1002/nbm.4411] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 05/08/2023]
Abstract
Spectral editing in in vivo 1 H-MRS provides an effective means to measure low-concentration metabolite signals that cannot be reliably measured by conventional MRS techniques due to signal overlap, for example, γ-aminobutyric acid, glutathione and D-2-hydroxyglutarate. Spectral editing strategies utilize known J-coupling relationships within the metabolite of interest to discriminate their resonances from overlying signals. This consensus recommendation paper provides a brief overview of commonly used homonuclear editing techniques and considerations for data acquisition, processing and quantification. Also, we have listed the experts' recommendations for minimum requirements to achieve adequate spectral editing and reliable quantification. These include selecting the right editing sequence, dealing with frequency drift, handling unwanted coedited resonances, spectral fitting of edited spectra, setting up multicenter clinical trials and recommending sequence parameters to be reported in publications.
Collapse
Affiliation(s)
- In-Young Choi
- Department of Neurology, Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, Kansas
| | - Ovidiu C Andronesi
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peter Barker
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, F. M. Kirby Center for Functional MRI, Kennedy Krieger Institute, Baltimore, Maryland
| | - Wolfgang Bogner
- High-field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Richard A E Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, F. M. Kirby Center for Functional MRI, Kennedy Krieger Institute, Baltimore, Maryland
| | - Lana G Kaiser
- Henry H. Wheeler, Jr. Brain Imaging Center, University of California, Berkeley, California
| | - Phil Lee
- Department of Radiology, Hoglund Biomedical Imaging Center, University of Kansas Medical Center, Kansas City, Kansas
| | - Małgorzata Marjańska
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Melissa Terpstra
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Robin A de Graaf
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| |
Collapse
|
16
|
Koush Y, de Graaf RA, Kupers R, Dricot L, Ptito M, Behar KL, Rothman DL, Hyder F. Metabolic underpinnings of activated and deactivated cortical areas in human brain. J Cereb Blood Flow Metab 2021; 41:986-1000. [PMID: 33472521 PMCID: PMC8054719 DOI: 10.1177/0271678x21989186] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/04/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022]
Abstract
Neuroimaging with functional MRI (fMRI) identifies activated and deactivated brain regions in task-based paradigms. These patterns of (de)activation are altered in diseases, motivating research to understand their underlying biochemical/biophysical mechanisms. Essentially, it remains unknown how aerobic metabolism of glucose to lactate (aerobic glycolysis) and excitatory-inhibitory balance of glutamatergic and GABAergic neuronal activities vary in these areas. In healthy volunteers, we investigated metabolic distinctions of activating visual cortex (VC, a task-positive area) using a visual task and deactivating posterior cingulate cortex (PCC, a task-negative area) using a cognitive task. We used fMRI-guided J-edited functional MRS (fMRS) to measure lactate, glutamate plus glutamine (Glx) and γ-aminobutyric acid (GABA), as indicators of aerobic glycolysis and excitatory-inhibitory balance, respectively. Both lactate and Glx increased upon activating VC, but did not change upon deactivating PCC. Basal GABA was negatively correlated with BOLD responses in both brain areas, but during functional tasks GABA decreased in VC upon activation and GABA increased in PCC upon deactivation, suggesting BOLD responses in relation to baseline are impacted oppositely by task-induced inhibition. In summary, opposite relations between BOLD response and GABAergic inhibition, and increases in aerobic glycolysis and glutamatergic activity distinguish the BOLD response in (de)activated areas.
Collapse
Affiliation(s)
- Yury Koush
- Magnetic Resonance Research Center, Department of Radiology & Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Robin A de Graaf
- Magnetic Resonance Research Center, Department of Radiology & Biomedical Imaging, Yale University, New Haven, CT, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Ron Kupers
- BRAINlab, Department of Neuroscience, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Laurence Dricot
- Institute of NeuroScience (IoNS), Université catholique de Louvain (UCLouvain), Belgium
| | - Maurice Ptito
- School of Optometry, Université de Montreal, Montreal, Canada
| | - Kevin L Behar
- Magnetic Resonance Research Center, Department of Radiology & Biomedical Imaging, Yale University, New Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Douglas L Rothman
- Magnetic Resonance Research Center, Department of Radiology & Biomedical Imaging, Yale University, New Haven, CT, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Fahmeed Hyder
- Magnetic Resonance Research Center, Department of Radiology & Biomedical Imaging, Yale University, New Haven, CT, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| |
Collapse
|
17
|
Dacko M, Lange T. Flexible MEGA editing scheme with asymmetric adiabatic pulses applied for T 2 measurement of lactate in human brain. Magn Reson Med 2020; 85:1160-1174. [PMID: 32975334 DOI: 10.1002/mrm.28500] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE A flexible MEGA editing scheme which decouples the editing efficiency from TE is proposed and the utility of asymmetric adiabatic pulses for this new technique is explored. It is demonstrated that the method enables robust T 2 measurement of lactate in healthy human brain. METHODS The proposed variation of the MEGA scheme applies editing pulses in both acquired spectra, ensuring that the difference in J-evolution of the target resonance leads to maximal signal yield in the difference spectrum for arbitrary TE. A MEGA-sLASER sequence is augmented with asymmetric adiabatic editing pulses for enhanced flexibility and immunity to B 1 + miscalibration and inhomogeneities. The technique is validated and optimized for flexible lactate editing via a simple analytical model, numerical simulations and in vitro experiments. The T 2 relaxation constant of lactate is determined in vivo via multiple-TE measurements with the proposed method and a dedicated postprocessing and quantification approach. RESULTS Asymmetric adiabatic editing pulses improve robustness and facilitate efficient J-editing in sequences or protocols with strong timing constraints. Single voxel measurements using the proposed MEGA scheme in the occipital cortex of six healthy subjects yield a relaxation constant of T 2 = 171 ± 19 ms for the methyl resonance of lactate at a field strength of 3T. CONCLUSIONS The proposed MEGA editing scheme allows for novel kinds of J-editing experiments and promises to be an asset to robust T 2 measurement of lactate and potentially other J-coupled metabolites in vivo.
Collapse
Affiliation(s)
- Michael Dacko
- Center for Diagnostic and Therapeutic Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Lange
- Center for Diagnostic and Therapeutic Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
18
|
Tiwari V, Mashimo T, An Z, Vemireddy V, Piccirillo S, Askari P, Hulsey KM, Zhang S, de Graaf RA, Patel TR, Pan E, Mickey BE, Maher EA, Bachoo RM, Choi C. In vivo MRS measurement of 2-hydroxyglutarate in patient-derived IDH-mutant xenograft mouse models versus glioma patients. Magn Reson Med 2020; 84:1152-1160. [PMID: 32003035 DOI: 10.1002/mrm.28183] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/09/2019] [Accepted: 01/03/2020] [Indexed: 11/10/2022]
Abstract
PURPOSE To generate a preclinical model of isocitrate dehydrogenase (IDH) mutant gliomas from glioma patients and design a MRS method to test the compatibility of 2-hydroxyglutarate (2HG) production between the preclinical model and patients. METHODS Five patient-derived xenograft (PDX) mice were generated from two glioma patients with IDH1 R132H mutation. A PRESS sequence was tailored at 9.4 T, with computer simulation and phantom analyses, for improving 2HG detection in mice. 2HG and other metabolites in the PDX mice were measured using the optimized MRS at 9.4 T and compared with 3 T MRS measurements of the metabolites in the parental-tumor patients. Spectral fitting was performed with LCModel using in-house basis spectra. Metabolite levels were quantified with reference to water. RESULTS The PRESS TE was optimized to be 96 ms, at which the 2HG 2.25 ppm signal was narrow and inverted, thereby leading to unequivocal separation of the 2HG resonance from adjacent signals from other metabolites. The optimized MRS provided precise detection of 2HG in mice compared to short-TE MRS at 9.4 T. The 2HG estimates in PDX mice were in excellent agreement with the 2HG measurements in the patients. CONCLUSION The similarity of 2HG production between PDX models and parental-tumor patients indicates that PDX tumors retain the parental IDH metabolic fingerprint and can serve as a preclinical model for improving our understanding of the IDH-mutation associated metabolic reprogramming.
Collapse
Affiliation(s)
- Vivek Tiwari
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tomoyuki Mashimo
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Annette G. Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Zhongxu An
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Vamsidhara Vemireddy
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sara Piccirillo
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Pegah Askari
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas.,Joint Graduate Program in Biomedical Engineering at University of Texas Arlington and University of Texas Southwestern Medical Center, Texas
| | - Keith M Hulsey
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Shanrong Zhang
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robin A de Graaf
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut.,Department of Biomedical Engineering, Yale University School of Medicine, New Haven, Connecticut
| | - Toral R Patel
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Edward Pan
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bruce E Mickey
- Annette G. Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elizabeth A Maher
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Annette G. Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert M Bachoo
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Annette G. Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Changho Choi
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
19
|
Kirov II, Tal A. Potential clinical impact of multiparametric quantitative MR spectroscopy in neurological disorders: A review and analysis. Magn Reson Med 2020; 83:22-44. [PMID: 31393032 PMCID: PMC6814297 DOI: 10.1002/mrm.27912] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/06/2019] [Accepted: 06/29/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Unlike conventional MR spectroscopy (MRS), which only measures metabolite concentrations, multiparametric MRS also quantifies their longitudinal (T1 ) and transverse (T2 ) relaxation times, as well as the radiofrequency transmitter inhomogeneity (B1+ ). To test whether knowledge of these additional parameters can improve the clinical utility of brain MRS, we compare the conventional and multiparametric approaches in terms of expected classification accuracy in differentiating controls from patients with neurological disorders. THEORY AND METHODS A literature review was conducted to compile metabolic concentrations and relaxation times in a wide range of neuropathologies and regions of interest. Simulations were performed to construct receiver operating characteristic curves and compute the associated areas (area under the curve) to examine the sensitivity and specificity of MRS for detecting each pathology in each region. Classification accuracy was assessed using metabolite concentrations corrected using population-averages for T1 , T2 , and B1+ (conventional MRS); using metabolite concentrations corrected using per-subject values (multiparametric MRS); and using an optimal linear multiparametric estimator comprised of the metabolites' concentrations and relaxation constants (multiparametric MRS). Additional simulations were conducted to find the minimal intra-subject precision needed for each parameter. RESULTS Compared with conventional MRS, multiparametric approaches yielded area under the curve improvements for almost all neuropathologies and regions of interest. The median area under the curve increased by 0.14 over the entire dataset, and by 0.24 over the 10 instances with the largest individual increases. CONCLUSIONS Multiparametric MRS can substantially improve the clinical utility of MRS in diagnosing and assessing brain pathology, motivating the design and use of novel multiparametric sequences.
Collapse
Affiliation(s)
- Ivan I. Kirov
- Center for Advanced Imaging Innovation and Research (CAIR), Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, Department of Radiology, 660 1 Avenue, New York, NY 10016, United States of America
| | - Assaf Tal
- Department of Chemical and Biological Physics, Weizmann Institute of Science, 234 Herzel St., Rehovot 7610001, Israel
| |
Collapse
|
20
|
Berrington A, Schreck KC, Barron BJ, Blair L, Lin DDM, Hartman AL, Kossoff E, Easter L, Whitlow CT, Jung Y, Hsu FC, Cervenka MC, Blakeley JO, Barker PB, Strowd RE. Cerebral Ketones Detected by 3T MR Spectroscopy in Patients with High-Grade Glioma on an Atkins-Based Diet. AJNR Am J Neuroradiol 2019; 40:1908-1915. [PMID: 31649157 DOI: 10.3174/ajnr.a6287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/04/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Ketogenic diets are being explored as a possible treatment for several neurological diseases, but the physiologic impact on the brain is unknown. The objective of this study was to evaluate the feasibility of 3T MR spectroscopy to monitor brain ketone levels in patients with high-grade gliomas who were on a ketogenic diet (a modified Atkins diet) for 8 weeks. MATERIALS AND METHODS Paired pre- and post-ketogenic diet MR spectroscopy data from both the lesion and contralateral hemisphere were analyzed using LCModel software in 10 patients. RESULTS At baseline, the ketone bodies acetone and β-hydroxybutyrate were nearly undetectable, but by week 8, they increased in the lesion for both acetone (0.06 ± 0.03 ≥ 0.27 ± 0.06 IU, P = .005) and β-hydroxybutyrate (0.07 ± 0.07 ≥ 0.79 ± 0.32 IU, P = .046). In the contralateral brain, acetone was also significantly increased (0.041 ± 0.01 ≥ 0.16 ± 0.04 IU, P = .004), but not β-hydroxybutyrate. Acetone was detected in 9/10 patients at week 8, and β-hydroxybutyrate, in 5/10. Acetone concentrations in the contralateral brain correlated strongly with higher urine ketones (r = 0.87, P = .001) and lower fasting glucose (r = -0.67, P = .03). Acetoacetate was largely undetectable. Small-but-statistically significant decreases in NAA were also observed in the contralateral hemisphere at 8 weeks. CONCLUSIONS This study suggests that 3T MR spectroscopy is feasible for detecting small cerebral metabolic changes associated with a ketogenic diet, provided that appropriate methodology is used.
Collapse
Affiliation(s)
- A Berrington
- From the Russell H. Morgan Departments of Radiology and Radiological Science (A.B., D.D.M.L., P.B.B.)
| | - K C Schreck
- Neurology (K.C.S., L.B., A.L.H., E.K., M.C.C., J.O.B., R.E.S.)
| | - B J Barron
- Institute of Clinical and Translational Research (B.J.B.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - L Blair
- Neurology (K.C.S., L.B., A.L.H., E.K., M.C.C., J.O.B., R.E.S.).,Pediatrics (L.B., A.L.H.)
| | - D D M Lin
- From the Russell H. Morgan Departments of Radiology and Radiological Science (A.B., D.D.M.L., P.B.B.)
| | - A L Hartman
- Neurology (K.C.S., L.B., A.L.H., E.K., M.C.C., J.O.B., R.E.S.).,Pediatrics (L.B., A.L.H.)
| | - E Kossoff
- Neurology (K.C.S., L.B., A.L.H., E.K., M.C.C., J.O.B., R.E.S.)
| | - L Easter
- Clinical and Translational Science Institute (L.E., R.E.S.)
| | | | - Y Jung
- Departments of Radiology (C.T.W., Y.J.)
| | - F-C Hsu
- Biostatistics and Data Science (F.-C.H.), Division of Public Health Sciences
| | - M C Cervenka
- Neurology (K.C.S., L.B., A.L.H., E.K., M.C.C., J.O.B., R.E.S.)
| | - J O Blakeley
- Neurology (K.C.S., L.B., A.L.H., E.K., M.C.C., J.O.B., R.E.S.)
| | - P B Barker
- From the Russell H. Morgan Departments of Radiology and Radiological Science (A.B., D.D.M.L., P.B.B.) .,F. M. Kirby Research Center for Functional Brain Imaging (P.B.B., R.E.S.), Kennedy Krieger Institute, Baltimore, Maryland
| | - R E Strowd
- Neurology (K.C.S., L.B., A.L.H., E.K., M.C.C., J.O.B., R.E.S.).,Clinical and Translational Science Institute (L.E., R.E.S.).,Departments of Neurology, Hematology and Oncology (R.E.S.), Wake Forest School of Medicine, Winston-Salem, North Carolina.,F. M. Kirby Research Center for Functional Brain Imaging (P.B.B., R.E.S.), Kennedy Krieger Institute, Baltimore, Maryland
| |
Collapse
|
21
|
Branzoli F, Di Stefano AL, Capelle L, Ottolenghi C, Valabrègue R, Deelchand DK, Bielle F, Villa C, Baussart B, Lehéricy S, Sanson M, Marjanska M. Highly specific determination of IDH status using edited in vivo magnetic resonance spectroscopy. Neuro Oncol 2019; 20:907-916. [PMID: 29126125 DOI: 10.1093/neuonc/nox214] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Mutations in the isocitrate dehydrogenase (IDH) enzyme affect 40% of gliomas and represent a major diagnostic and prognostic marker. The goals of this study were to evaluate the performance of noninvasive magnetic resonance spectroscopy (MRS) methods to determine the IDH status of patients with brain gliomas through detection of the oncometabolite 2-hydroxyglutarate (2HG) and to compare performance of these methods with DNA sequencing and tissue 2HG analysis. Methods Twenty-four subjects with suspected diagnosis of low-grade glioma were included prospectively in the study. For all subjects, MRS data were acquired at 3T using 2 MRS methods, edited MRS using Mescher-Garwood point-resolved spectroscopy (MEGA-PRESS) sequence and a PRESS sequence optimized for 2HG detection, using a volume of interest larger than 6 mL. IDH mutational status was determined by a combination of automated immunohistochemical analysis and Sanger sequencing. Levels of 2HG in tissue samples measured by gas chromatography-mass spectrometry were compared with those estimated by MRS. Results Edited MRS provided 100% specificity and 100% sensitivity in the detection of 2HG. The 2HG levels estimated by this technique were in line with those derived from tissue samples. Optimized PRESS provided lower performance, in agreement with previous findings. Conclusions Our results suggest that edited MRS is one of the most reliable tools to predict IDH mutation noninvasively, showing high sensitivity and specificity for 2HG detection. Integrating edited MRS in clinical practice may be highly beneficial for noninvasive diagnosis of glioma, prognostic assessment, and treatment planning.
Collapse
Affiliation(s)
- Francesca Branzoli
- Centre de NeuroImagerie de Recherche, Institut du Cerveau et de la Moelle épinère, Paris, France.,Sorbonne Universités, UPMC University of Paris, Paris, France
| | - Anna Luisa Di Stefano
- AP-HP, Hôpital de la Pitié-Salpêtrière, Service de Neurologie, Paris, France; Department of Neurology, Foch Hospital, Suresnes, Paris, France
| | - Laurent Capelle
- AP-HP, Hôpital de la Pitié-Salpêtrière, Service de Neurochirurgie, Paris, France
| | - Chris Ottolenghi
- Centre de Référence des Maladies Métaboliques, Service de Biochimie Métabolique, Hôpital Necker and Université Paris Descartes, Paris, France
| | - Romain Valabrègue
- Centre de NeuroImagerie de Recherche, Institut du Cerveau et de la Moelle épinère, Paris, France.,Sorbonne Universités, UPMC University of Paris, Paris, France
| | - Dinesh K Deelchand
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Franck Bielle
- AP-HP, Hôpital de la Pitié-Salpêtrière, Laboratoire R Escourolle, Paris, France; Department of Pathological Cytology and Anatomy, Foch Hospital, Suresnes, Paris, France
| | | | | | - Stéphane Lehéricy
- Centre de NeuroImagerie de Recherche, Institut du Cerveau et de la Moelle épinère, Paris, France.,Sorbonne Universités, UPMC University of Paris, Paris, France
| | - Marc Sanson
- Sorbonne Universités, UPMC University of Paris, Paris, France.,AP-HP, Hôpital de la Pitié-Salpêtrière, Service de Neurologie, Paris, France; Department of Neurology, Foch Hospital, Suresnes, Paris, France.,Onconeurotek Tumor Bank, Institut du Cerveau et de la Moelle épinère, Paris, France
| | - Malgorzata Marjanska
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
22
|
Wiegers EC, Rooijackers HM, Tack CJ, Philips BW, Heerschap A, van der Graaf M, de Galan BE. Effect of lactate administration on brain lactate levels during hypoglycemia in patients with type 1 diabetes. J Cereb Blood Flow Metab 2019; 39:1974-1982. [PMID: 29749805 PMCID: PMC6775588 DOI: 10.1177/0271678x18775884] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Administration of lactate during hypoglycemia suppresses symptoms and counterregulatory responses, as seen in patients with type 1 diabetes and impaired awareness of hypoglycemia (IAH), presumably because lactate can substitute for glucose as a brain fuel. Here, we examined whether lactate administration, in a dose sufficient to impair awareness of hypoglycemia, affects brain lactate levels in patients with normal awareness of hypoglycemia (NAH). Patients with NAH (n = 6) underwent two euglycemic-hypoglycemic clamps (2.8 mmol/L), once with sodium lactate infusion (NAH w|lac) and once with saline infusion (NAH w|placebo). Results were compared to those obtained during lactate administration in patients with IAH (n = 7) (IAH w|lac). Brain lactate levels were determined continuously with J-difference editing 1H-MRS. During lactate infusion, symptom and adrenaline responses to hypoglycemia were considerably suppressed in NAH. Infusion of lactate increased brain lactate levels modestly, but comparably, in both groups (mean increase in NAH w|lac: 0.12 ± 0.05 µmol/g and in IAH w|lac: 0.06 ± 0.04 µmol/g). The modest increase in brain lactate may suggest that the excess of lactate is immediately metabolized by the brain, which in turn may explain the suppressive effects of lactate on awareness of hypoglycemia observed in patients with NAH.
Collapse
Affiliation(s)
- Evita C Wiegers
- Department of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Hanne M Rooijackers
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Cees J Tack
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Bart Wj Philips
- Department of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Arend Heerschap
- Department of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Marinette van der Graaf
- Department of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen, The Netherlands.,Department of Pediatrics, Radboud university medical center, Nijmegen, The Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| |
Collapse
|
23
|
Landheer K, Schulte RF, Treacy MS, Swanberg KM, Juchem C. Theoretical description of modern1H in Vivo magnetic resonance spectroscopic pulse sequences. J Magn Reson Imaging 2019; 51:1008-1029. [DOI: 10.1002/jmri.26846] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 01/20/2023] Open
Affiliation(s)
- Karl Landheer
- Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science New York New York USA
| | | | - Michael S. Treacy
- Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science New York New York USA
| | - Kelley M. Swanberg
- Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science New York New York USA
| | - Christoph Juchem
- Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science New York New York USA
- Radiology, Columbia University College of Physicians and Surgeons New York New York USA
| |
Collapse
|
24
|
Dacko M, Lange T. Improved detection of lactate and β-hydroxybutyrate using MEGA-sLASER at 3 T. NMR IN BIOMEDICINE 2019; 32:e4100. [PMID: 31038254 DOI: 10.1002/nbm.4100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/28/2019] [Accepted: 03/12/2019] [Indexed: 06/09/2023]
Abstract
Lactate and β-hydroxybutyrate are important MRS-visible biomarkers for the energy metabolism of the human brain. A major obstacle for their unambiguous detection and quantification in vivo is their inherently low concentration and spectral overlap with resonances from lipids and macromolecules. In this work, we demonstrate the improved detectability of lactate and β-hydroxybutyrate with MEGA-sLASER compared to MEGA-PRESS at the clinical field strength of 3 T. The method is validated by numerical simulations, in vitro measurements and in vivo experiments on healthy subjects. It is demonstrated that MEGA-sLASER offers an SNR increase of approximately 70% for lactate and β-hydroxybutyrate detection compared to MEGA-PRESS in various brain regions. This increased SNR translates into reduced Cramér-Rao lower bounds for quantification and enables a more robust detection of subtle changes in the (brain) energy metabolism. The sensitivity of the method for detection of β-hydroxybutyrate concentration changes is demonstrated through measurements before and during a ketogenic diet while the sensitivity for detection of lactate concentration changes is shown by measurements before and after an intensive anaerobic exercise.
Collapse
Affiliation(s)
- Michael Dacko
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Lange
- Department of Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
25
|
Branzoli F, Deelchand DK, Sanson M, Lehéricy S, Marjańska M. In vivo 1 H MRS detection of cystathionine in human brain tumors. Magn Reson Med 2019; 82:1259-1265. [PMID: 31131476 DOI: 10.1002/mrm.27810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/29/2019] [Accepted: 04/22/2019] [Indexed: 11/09/2022]
Abstract
PURPOSE To report the technical aspects of noninvasive detection of cystathionine in human brain glioma with edited MRS, and to investigate possible further acquisition improvements for robust quantification of this metabolite. METHODS In vivo 1 H MR spectra were acquired at 3 T in 15 participants with an isocitrate dehydrogenase-mutated glioma using a MEGA-PRESS (MEscher GArwood point resolved spectroscopy) sequence previously employed for 2-hydroxyglutarate detection (TR = 2 s, TE = 68 ms). The editing pulse was applied at 1.9 ppm for the edit-on condition and at 7.5 ppm for the edit-off condition. To evaluate the editing efficiency, spectra were acquired in 1 participant by placing the editing pulse for the edit-on condition at 1.9, 2.03, and 2.16 ppm. Cystathionine concentration was quantified using LCModel and a simulated basis set. To confirm chemical shifts and J-coupling values of cystathionine, the 1 H NMR cystathionine spectrum was measured using a high-resolution 500 MHz spectrometer. RESULTS In 12 gliomas, cystathionine was observed in the in vivo edited MR spectra at 2.72 and 3.85 ppm and quantified. The signal intensity of the cystathionine resonance at 2.72 ppm increased 1.7 and 2.13 times when the editing pulse was moved to 2.03 and 2.16 ppm, respectively. Cystathionine was not detectable in normal brain tissue. CONCLUSION Cystathionine can be detected in vivo by edited MRS using the same protocol as for 2-hydroxyglutarate detection. This finding may enable a more accurate, noninvasive investigation of cellular metabolism in glioma.
Collapse
Affiliation(s)
- Francesca Branzoli
- Institut du Cerveau et de la Moelle épinère-ICM, Centre de NeuroImagerie de Recherche-CENIR, Paris, France.,Sorbonne Université, UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France
| | - Dinesh K Deelchand
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Marc Sanson
- Sorbonne Université, UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France.,AP-HP, Hôpital de la Pitié-Salpêtrière, Service de Neurologie 2, Paris, France.,Onconeurotek Tumor Bank, Institut du Cerveau et de la Moelle épinère-ICM, Paris, France
| | - Stéphane Lehéricy
- Institut du Cerveau et de la Moelle épinère-ICM, Centre de NeuroImagerie de Recherche-CENIR, Paris, France.,Sorbonne Université, UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France.,AP-HP, Hôpital de la Pitié-Salpêtrière, Service de Neuroradiologie, Paris, France
| | - Małgorzata Marjańska
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
26
|
An Z, Tiwari V, Baxter J, Levy M, Hatanpaa KJ, Pan E, Maher EA, Patel TR, Mickey BE, Choi C. 3D high-resolution imaging of 2-hydroxyglutarate in glioma patients using DRAG-EPSI at 3T in vivo. Magn Reson Med 2018; 81:795-802. [PMID: 30277274 DOI: 10.1002/mrm.27482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE To develop 3D high-resolution imaging of 2-hydroxyglutarate (2HG) at 3T in vivo. METHODS Echo-planar spectroscopic imaging with dual-readout alternated-gradients (DRAG-EPSI), which was recently reported for 2D imaging of 2HG at 7T, was tested for 3D imaging of 2HG at 3T. The frequency drifts and acoustic noise induced by DRAG-EPSI were investigated in comparison with conventional EPSI. Four patients with IDH-mutant gliomas were enrolled for 3D imaging of 2HG and other metabolites. A previously reported 2HG-tailored TE 97-ms PRESS sequence preceded the DRAG-EPSI readout gradients. Unsuppressed water, acquired with EPSI, was used as reference for multi-channel combination, eddy-current compensation, and metabolite quantification. Spectral fitting was conducted with the LCModel using in-house basis sets. RESULTS With gradient strength of 4 mT/m and slew rate of 20 mT/m/ms, DRAG-EPSI produced frequency drifts smaller by 5.5-fold and acoustic noise lower by 25 dB compared to conventional EPSI. In a 19-min scan, 3D DRAG-EPSI provided images of 2HG with precision (CRLB <10%) at a resolution of 10 × 10 × 10 mm3 for a field of view of 240 × 180 × 80 mm3 . 2HG was estimated to be 5 mM in a pre-treatment patient. In 3 post-surgery patients, 2HG estimates were 3-6 mM, and the 2HG distribution was different from the water-T2 image pattern or highly concentrated in the post-contrast enhancing region. CONCLUSION Together with 2HG-optimized PRESS, DRAG-EPSI provides an effective tool for reliable 3D high-resolution imaging of 2HG at 3T in vivo.
Collapse
Affiliation(s)
- Zhongxu An
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Vivek Tiwari
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeannie Baxter
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael Levy
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kimmo J Hatanpaa
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Edward Pan
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elizabeth A Maher
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.,Annette Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Toral R Patel
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bruce E Mickey
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.,Annette Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Changho Choi
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas.,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
27
|
Koush Y, de Graaf RA, Jiang L, Rothman DL, Hyder F. Functional MRS with J-edited lactate in human motor cortex at 4 T. Neuroimage 2018; 184:101-108. [PMID: 30201463 DOI: 10.1016/j.neuroimage.2018.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 08/31/2018] [Accepted: 09/04/2018] [Indexed: 01/08/2023] Open
Abstract
While functional MRI (fMRI) localizes regions of brain activation, functional MRS (fMRS) provides insights into metabolic underpinnings. Previous fMRS studies detected task-induced lactate increase using short echo-time non-edited 1H-MRS protocols, where lactate changes depended on accurate exclusion of overlapping lactate and lipid/macromolecule signals. Because long echo-time J-difference 1H-MRS detection of lactate is less susceptible to this shortcoming, we posited if J-edited fMRS protocol could reliably detect metabolic changes in the human motor cortex during a finger-tapping paradigm in relation to a reliable measure of basal lactate. Our J-edited fMRS protocol at 4T was guided by an fMRI pre-scan to determine the 1H-MRS voxel placement in the motor cortex. Because lactate and β-hydroxybutyrate (BHB) follow similar J-evolution profiles we observed both metabolites in all spectra, but only lactate showed reproducible task-induced modulation by 0.07 mM from a basal value of 0.82 mM. These J-edited fMRS results demonstrate good sensitivity and specificity for task-induced lactate modulation, suggesting that J-edited fMRS studies can be used to investigate the metabolic underpinning of human cognition by measuring lactate dynamics associated with activation and deactivation fMRI paradigms across brain regions at magnetic field lower than 7T.
Collapse
Affiliation(s)
- Yury Koush
- Magnetic Resonance Research Center, Yale University, New Haven, CT, USA; Department of Radiology & Biomedical Imaging, Yale University, New Haven, CT, USA.
| | - Robin A de Graaf
- Magnetic Resonance Research Center, Yale University, New Haven, CT, USA; Department of Radiology & Biomedical Imaging, Yale University, New Haven, CT, USA; Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Lihong Jiang
- Magnetic Resonance Research Center, Yale University, New Haven, CT, USA; Department of Radiology & Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Douglas L Rothman
- Magnetic Resonance Research Center, Yale University, New Haven, CT, USA; Department of Radiology & Biomedical Imaging, Yale University, New Haven, CT, USA; Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Fahmeed Hyder
- Magnetic Resonance Research Center, Yale University, New Haven, CT, USA; Department of Radiology & Biomedical Imaging, Yale University, New Haven, CT, USA; Department of Biomedical Engineering, Yale University, New Haven, CT, USA.
| |
Collapse
|
28
|
Lacroix R, Rozeman EA, Kreutz M, Renner K, Blank CU. Targeting tumor-associated acidity in cancer immunotherapy. Cancer Immunol Immunother 2018; 67:1331-1348. [PMID: 29974196 PMCID: PMC11028141 DOI: 10.1007/s00262-018-2195-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/29/2018] [Indexed: 12/21/2022]
Abstract
Checkpoint inhibitors, such as cytotoxic T-lymphocyte-associated protein-4 (CTLA-4) and programmed cell death-1 (PD-1) monoclonal antibodies have changed profoundly the treatment of melanoma, renal cell carcinoma, non-small cell lung cancer, Hodgkin lymphoma, and bladder cancer. Currently, they are tested in various tumor entities as monotherapy or in combination with chemotherapies or targeted therapies. However, only a subgroup of patients benefit from checkpoint blockade (combinations). This raises the question, which all mechanisms inhibit T cell function in the tumor environment, restricting the efficacy of these immunotherapeutic approaches. Serum activity of lactate dehydrogenase, likely reflecting the glycolytic activity of the tumor cells and thus acidity within the tumor microenvironment, turned out to be one of the strongest markers predicting response to checkpoint inhibition. In this review, we discuss the impact of tumor-associated acidity on the efficacy of T cell-mediated cancer immunotherapy and possible approaches to break this barrier.
Collapse
Affiliation(s)
- Ruben Lacroix
- Department of Molecular Oncology and Immunology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Elisa A Rozeman
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marina Kreutz
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Kathrin Renner
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Christian U Blank
- Department of Molecular Oncology and Immunology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
| |
Collapse
|
29
|
Carlin D, Babourina-Brooks B, Davies NP, Wilson M, Peet AC. Variation of T 2 relaxation times in pediatric brain tumors and their effect on metabolite quantification. J Magn Reson Imaging 2018; 49:195-203. [PMID: 29697883 PMCID: PMC6492201 DOI: 10.1002/jmri.26054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 12/24/2022] Open
Abstract
Background Metabolite concentrations are fundamental biomarkers of disease and prognosis. Magnetic resonance spectroscopy (MRS) is a noninvasive method for measuring metabolite concentrations; however, quantitation is affected by T2 relaxation. Purpose To estimate T2 relaxation times in pediatric brain tumors and assess how variation in T2 relaxation affects metabolite quantification. Study Type Retrospective. Population Twenty‐seven pediatric brain tumor patients (n = 17 pilocytic astrocytoma and n = 10 medulloblastoma) and 24 age‐matched normal controls. Field Strength/Sequence Short‐ (30 msec) and long‐echo (135 msec) single‐voxel MRS acquired at 1.5T. Assessment T2 relaxation times were estimated by fitting signal amplitudes at two echo times to a monoexponential decay function and were used to correct metabolite concentration estimates for relaxation effects. Statistical Tests One‐way analysis of variance (ANOVA) on ranks were used to analyze the mean T2 relaxation times and metabolite concentrations for each tissue group and paired Mann–Whitney U‐tests were performed. Results The mean T2 relaxation of water was measured as 181 msec, 123 msec, 90 msec, and 86 msec in pilocytic astrocytomas, medulloblastomas, basal ganglia, and white matter, respectively. The T2 of water was significantly longer in both tumor groups than normal brain (P < 0.001) and in pilocytic astrocytomas compared with medulloblastomas (P < 0.01). The choline T2 relaxation time was significantly longer in medulloblastomas compared with pilocytic astrocytomas (P < 0.05), while the T2 relaxation time of NAA was significantly shorter in pilocytic astrocytomas compared with normal brain (P < 0.001). Overall, the metabolite concentrations were underestimated by ∼22% when default T2 values were used compared with case‐specific T2 values at short echo time. The difference was reduced to 4% when individually measured water T2s were used. Data Conclusion Differences exist in water and metabolite T2 relaxation times for pediatric brain tumors, which lead to significant underestimation of metabolite concentrations when using default water T2 relaxation times. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:195–203.
Collapse
Affiliation(s)
- Dominic Carlin
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK.,Birmingham Children's Hospital NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Ben Babourina-Brooks
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK.,Birmingham Children's Hospital NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Nigel P Davies
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, West Midlands, UK.,Imaging and Medical Physics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Martin Wilson
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, West Midlands, UK.,Birmingham University Imaging Centre (BUIC), School of Psychology, University of Birmingham, West Midlands, UK
| | - Andrew C Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK.,Birmingham Children's Hospital NHS Foundation Trust, Birmingham, West Midlands, UK
| |
Collapse
|
30
|
Berrington A, Voets NL, Larkin SJ, de Pennington N, Mccullagh J, Stacey R, Schofield CJ, Jezzard P, Clare S, Cadoux-Hudson T, Plaha P, Ansorge O, Emir UE. A comparison of 2-hydroxyglutarate detection at 3 and 7 T with long-TE semi-LASER. NMR IN BIOMEDICINE 2018; 31. [PMID: 29315915 DOI: 10.1002/nbm.3886] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 06/07/2023]
Abstract
Abnormally high levels of the 'oncometabolite' 2-hydroxyglutarate (2-HG) occur in many grade II and III gliomas, and correlate with mutations in the genes of isocitrate dehydrogenase (IDH) isoforms. In vivo measurement of 2-HG in patients, using magnetic resonance spectroscopy (MRS), has largely been carried out at 3 T, yet signal overlap continues to pose a challenge for 2-HG detection. To combat this, several groups have proposed MRS methods at ultra-high field (≥7 T) where theoretical increases in signal-to-noise ratio and spectral resolution could improve 2-HG detection. Long echo time (long-TE) semi-localization by adiabatic selective refocusing (semi-LASER) (TE = 110 ms) is a promising method for improved 2-HG detection in vivo at either 3 or 7 T owing to the use of broad-band adiabatic localization. Using previously published semi-LASER methods at 3 and 7 T, this study directly compares the detectability of 2-HG in phantoms and in vivo across nine patients. Cramér-Rao lower bounds (CRLBs) of 2-HG fitting were found to be significantly lower at 7 T (6 ± 2%) relative to 3 T (15 ± 7%) (p = 0.0019), yet were larger at 7 T in an IDH wild-type patient. Although no increase in SNR was detected at 7 T (77 ± 26) relative to 3 T (77 ± 30), the detection of 2-HG was greatly enhanced through an improved spectral profile and increased resolution at 7 T. 7 T had a large effect on pairwise fitting correlations between γ-aminobutyric acid (GABA) and 2-HG (p = 0.004), and resulted in smaller coefficients. The increased sensitivity for 2-HG detection using long-TE acquisition at 7 T may allow for more rapid estimation of 2-HG (within a few spectral averages) together with other associated metabolic markers in glioma.
Collapse
Affiliation(s)
- Adam Berrington
- FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Natalie L Voets
- FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Sarah J Larkin
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Nick de Pennington
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Richard Stacey
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Peter Jezzard
- FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Stuart Clare
- FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Tom Cadoux-Hudson
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Puneet Plaha
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Olaf Ansorge
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Uzay E Emir
- FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
- School of Health Sciences, Purdue University, West Lafayette, IN, USA
| |
Collapse
|
31
|
Wyss PO, Bianchini C, Scheidegger M, Giapitzakis IA, Hock A, Fuchs A, Henning A. In vivo estimation of transverse relaxation time constant (T2
) of 17 human brain metabolites at 3T. Magn Reson Med 2018; 80:452-461. [DOI: 10.1002/mrm.27067] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/08/2017] [Accepted: 12/09/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Patrik O. Wyss
- Institute for Biomedical Engineering; University and ETH; Zurich Switzerland
- Max Planck Institute for Biological Cybernetics; Tuebingen Germany
| | - Claudio Bianchini
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Milan Scheidegger
- Institute for Biomedical Engineering; University and ETH; Zurich Switzerland
| | | | - Andreas Hock
- Institute for Biomedical Engineering; University and ETH; Zurich Switzerland
| | - Alexander Fuchs
- Institute for Biomedical Engineering; University and ETH; Zurich Switzerland
| | - Anke Henning
- Institute for Biomedical Engineering; University and ETH; Zurich Switzerland
- Max Planck Institute for Biological Cybernetics; Tuebingen Germany
- Institute of Physics; Ernst-Moritz-Arndt University Greifswald; Greifswald Germany
| |
Collapse
|
32
|
Tiwari V, An Z, Ganji SK, Baxter J, Patel TR, Pan E, Mickey BE, Maher EA, Pinho MC, Choi C. Measurement of glycine in healthy and tumorous brain by triple-refocusing MRS at 3 T in vivo. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3747. [PMID: 28548710 PMCID: PMC5557683 DOI: 10.1002/nbm.3747] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/10/2017] [Accepted: 04/11/2017] [Indexed: 05/21/2023]
Abstract
Glycine (Gly) has been implicated in several neurological disorders, including malignant brain tumors. The precise measurement of Gly is challenging largely as a result of the spectral overlap with myo-inositol (mI). We report a new triple-refocusing sequence for the reliable co-detection of Gly and mI at 3 T and for the evaluation of Gly in healthy and tumorous brain. The sequence parameters were optimized with density-matrix simulations and phantom validation. With a total TE of 134 ms, the sequence gave complete suppression of the mI signal between 3.5 and 3.6 ppm and, consequently, well-defined Gly (3.55 ppm) and mI (3.64 ppm) peaks. In vivo 1 H magnetic resonance spectroscopy (MRS) data were acquired from the gray matter (GM)-dominant medial occipital and white matter (WM)-dominant left parietal regions in six healthy subjects, and analyzed with LCModel using in-house-calculated basis spectra. Tissue segmentation was performed to obtain the GM and WM contents within the MRS voxels. Metabolites were quantified with reference to GM-rich medial occipital total creatine at 8 mM. The Gly and mI concentrations were estimated to be 0.63 ± 0.05 and 8.6 ± 0.6 mM for the medial occipital and 0.34 ± 0.05 and 5.3 ± 0.8 mM for the left parietal regions, respectively. From linear regression of the metabolite estimates versus fractional GM content, the concentration ratios between pure GM and pure WM were estimated to be 2.6 and 2.1 for Gly and mI, respectively. Clinical application of the optimized sequence was performed in four subjects with brain tumor. The Gly levels in tumors were higher than those of healthy brain. Gly elevation was more extensive in a post-contrast enhancing region than in a non-enhancing region. The data indicate that the optimized triple-refocusing sequence may provide reliable co-detection of Gly and mI, and alterations of Gly in brain tumors can be precisely evaluated.
Collapse
Affiliation(s)
- Vivek Tiwari
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Zhongxu An
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sandeep K. Ganji
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jeannie Baxter
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Toral R. Patel
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Edward Pan
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bruce E. Mickey
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Annette Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elizabeth A. Maher
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Annette Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Marco C. Pinho
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Changho Choi
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Correspondence to: Changho Choi, PhD, Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas 75390-8542,
| |
Collapse
|
33
|
Abstract
While many decades of scientific research studies have gone into harnessing the power of the immune system to fight cancer, only recently have cancer immunotherapeutic approaches begun to show robust clinical responses in patients with a variety of cancers. These treatments are adding to the current arsenal of cancer treatments; surgery, radiation and chemotherapy, and increasing the therapeutic options for cancer patients. Despite these advances, issues associated with these therapies include that not all patients respond to these therapies, and some patients who respond experience varying degrees of toxicities. One of the major issues affecting immunotherapy is the inability to evaluate trafficking of activated T-cells into sites of tumor. The current diagnostic imaging based on conventional anatomic imaging, which is the mainstay to monitor response to cytotoxic chemotherapy or radiation, is not adequate to assess initial response to immunotherapy or disease evolution. Patients’ prognosis by histological analysis has limited use in regards to immunotherapy. Thus, there is a crucial need for noninvasive biomarkers for screening patients that show long term response to therapy. Here, we provide a brief account of emerging molecular magnetic resonance imaging biomarkers that have potential to exploit the metabolism and metabolic products of activated T cells.
Collapse
|
34
|
Wang J, Kreis F, Wright AJ, Hesketh RL, Levitt MH, Brindle KM. Dynamic 1 H imaging of hyperpolarized [1- 13 C]lactate in vivo using a reverse INEPT experiment. Magn Reson Med 2017; 79:741-747. [PMID: 28474393 PMCID: PMC5811914 DOI: 10.1002/mrm.26725] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 03/24/2017] [Accepted: 03/29/2017] [Indexed: 01/08/2023]
Abstract
Purpose Dynamic magnetic resonance spectroscopic imaging of hyperpolarized 13C‐labeled cell substrates has enabled the investigation of tissue metabolism in vivo. Currently observation of these hyperpolarized substrates is limited mainly to 13C detection. We describe here an imaging pulse sequence that enables proton observation by using polarization transfer from the hyperpolarized 13C nucleus to spin‐coupled protons. Methods The pulse sequence transfers 13C hyperpolarization to 1H using a modified reverse insensitive nuclei enhanced by polarization transfer (INEPT) sequence that acquires a fully refocused echo. The resulting hyperpolarized 1H signal is acquired using a 2D echo‐planar trajectory. The efficiency of polarization transfer was investigated using simulations with and without T1 and T2 relaxation of both the 1H and 13C nuclei. Results Simulations showed that 1H detection of the hyperpolarized 13C nucleus in lactate should increase significantly the signal‐to‐noise ratio when compared with direct 13C detection at 3T. However the advantage of 1H detection is expected to disappear at higher fields. Dynamic 1H images of hyperpolarized [1‐13C]lactate, with a spatial resolution of 1.25 × 1.25 mm2, were acquired from a phantom injected with hyperpolarized [1‐13C]lactate and from tumors in vivo following injection of hyperpolarized [1‐13C]pyruvate. Conclusions The sequence allows 1H imaging of hyperpolarized 13C‐labeled substrates in vivo. Magn Reson Med 79:741–747, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Collapse
Affiliation(s)
- Jiazheng Wang
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Felix Kreis
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Alan J Wright
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Richard L Hesketh
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, United Kingdom
| | - Malcolm H Levitt
- School of Chemistry, University of Southampton, Southampton, United Kingdom
| | - Kevin M Brindle
- Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, United Kingdom.,Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
35
|
Lange T, Ko CW, Lai PH, Dacko M, Tsai SY, Buechert M. Simultaneous detection of valine and lactate using MEGA-PRESS editing in pyogenic brain abscess. NMR IN BIOMEDICINE 2016; 29:1739-1747. [PMID: 27779348 DOI: 10.1002/nbm.3660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/23/2016] [Accepted: 09/23/2016] [Indexed: 05/06/2023]
Abstract
Valine and lactate have been recognized as important metabolic markers to diagnose brain abscess by means of MRS. However, in vivo unambiguous detection and quantification is hampered by macromolecular contamination. In this work, MEGA-PRESS difference editing of valine and lactate is proposed. The method is validated in vitro and applied for quantitative in vivo experiments in one healthy subject and two brain abscess patients. It is demonstrated that with this technique the overlapping lipid signal can be reduced by more than an order of magnitude and thus the robustness of valine and lactate detection in vivo can be enhanced. Quantification of the two abscess MEGA-PRESS spectra yielded valine/lactate concentration ratios of 0.10 and 0.27. These ratios agreed with the concentration ratios determined from concomitantly acquired short-TE PRESS data and were in line with literature values. The quantification accuracy of lactate (as measured with Cramér-Rao lower bounds in LCModel processing) was better for MEGA-PRESS than for short-TE PRESS in all acquired in vivo datasets. The Cramér-Rao lower bounds of valine were only better for MEGA-PRESS in one of the two abscess cases, while in the other case coediting of isoleucine confounded the quantification in the MEGA-PRESS analysis. MEGA-PRESS and short-TE PRESS should be combined for unambiguous quantification of amino acids in abscess measurements. Simultaneous valine/lactate MEGA-PRESS editing might benefit the distinction of brain abscesses from tumors, and further categorization of bacteria with reasonable sensitivity and specificity.
Collapse
Affiliation(s)
- Thomas Lange
- Department of Radiology, Medical Physics, Medical Center-University of Freiburg, Freiburg, Germany
| | - Cheng-Wen Ko
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Ping-Hong Lai
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Michael Dacko
- Department of Radiology, Medical Physics, Medical Center-University of Freiburg, Freiburg, Germany
| | - Shang-Yueh Tsai
- Graduate Institute of Applied Physics, National Chengchi University, Taipei, Taiwan
- Research Center for Mind, Brain and Learning, National Chengchi University, Taipei, Taiwan
| | - Martin Buechert
- Department of Radiology, Medical Physics, Medical Center-University of Freiburg, Freiburg, Germany
| |
Collapse
|
36
|
Payne GS, Harris LM, Cairns GS, Messiou C, deSouza NM, Macdonald A, Saran F, Leach MO. Validating a robust double-quantum-filtered (1) H MRS lactate measurement method in high-grade brain tumours. NMR IN BIOMEDICINE 2016; 29:1420-6. [PMID: 27514007 PMCID: PMC5042032 DOI: 10.1002/nbm.3587] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 06/23/2016] [Accepted: 06/23/2016] [Indexed: 05/23/2023]
Abstract
(1) H MRS measurements of lactate are often confounded by overlapping lipid signals. Double-quantum (DQ) filtering eliminates lipid signals and permits single-shot measurements, which avoid subtraction artefacts in moving tissues. This study evaluated a single-voxel-localized DQ filtering method qualitatively and quantitatively for measuring lactate concentrations in the presence of lipid, using high-grade brain tumours in which the results could be compared with standard acquisition as a reference. Paired standard acquisition and DQ-filtered (1) H MR spectra were acquired at 3T from patients receiving treatment for glioblastoma, using fLASER (localization by adiabatic selective refocusing using frequency offset corrected inversion pulses) single-voxel localization. Data were acquired from 2 × 2 × 2 cm(3) voxels, with a repetition time of 1 s and 128 averages (standard acquisition) or 256 averages (DQ-filtered acquisition), requiring 2.15 and 4.3 min respectively. Of 37 evaluated data pairs, 20 cases (54%) had measureable lactate (fitted Cramér-Rao lower bounds ≤ 20%) in either the DQ-filtered or the standard acquisition spectra. The measured DQ-filtered lactate signal was consistently downfield of lipid (1.33 ± 0.03 ppm vs 1.22 ± 0.08 ppm; p = 0.002), showing that it was not caused by lipid breakthrough, and that it matched the lactate signal seen in standard measurements (1.36 ± 0.02 ppm). In the absence of lipid, similar lactate concentrations were measured by the two methods (mean ratio DQ filtered/standard acquisition = 1.10 ± 0.21). In 7/20 cases with measurable lactate, signal was not measureable in the standard acquisition owing to lipid overlap but was quantified in the DQ-filtered acquisition. Conversely, lactate was undetected in seven DQ-filtered acquisitions but visible using the standard acquisition. In conclusion, the DQ filtering method has proven robust in eliminating lipid and permits uncontaminated measurement of lactate. This is important validation prior to use in tissues outside the brain, which contain large amounts of lipid and which are often susceptible to motion.
Collapse
Affiliation(s)
- G S Payne
- MRI Unit, Royal Marsden Hospital, Sutton, Surrey, UK.
| | - L M Harris
- MRI Unit, Royal Marsden Hospital, Sutton, Surrey, UK
| | - G S Cairns
- MRI Unit, Royal Marsden Hospital, Sutton, Surrey, UK
| | - C Messiou
- MRI Unit, Royal Marsden Hospital, Sutton, Surrey, UK
| | - N M deSouza
- MRI Unit, Royal Marsden Hospital, Sutton, Surrey, UK
| | - A Macdonald
- MRI Unit, Royal Marsden Hospital, Sutton, Surrey, UK
| | - F Saran
- MRI Unit, Royal Marsden Hospital, Sutton, Surrey, UK
| | - M O Leach
- MRI Unit, Royal Marsden Hospital, Sutton, Surrey, UK
| |
Collapse
|
37
|
Landheer K, Sahgal A, Myrehaug S, Chen AP, Cunningham CH, Graham SJ. A rapid inversion technique for the measurement of longitudinal relaxation times of brain metabolites: application to lactate in high-grade gliomas at 3 T. NMR IN BIOMEDICINE 2016; 29:1381-1390. [PMID: 27455374 DOI: 10.1002/nbm.3580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/30/2016] [Accepted: 06/13/2016] [Indexed: 06/06/2023]
Abstract
The aim of this study was to develop a time-efficient inversion technique to measure the T1 relaxation time of the methyl group of lactate (Lac) in the presence of contaminating lipids and to measure T1 at 3 T in a cohort of primary high-grade gliomas. Three numerically optimized inversion times (TIs) were chosen to minimize the expected error in T1 estimates for a given input total scan duration (set to be 30 min). A two-cycle spectral editing scheme was used to suppress contaminating lipids. The T1 values were then estimated from least-squares fitting of signal measurements versus TI. Lac T1 was estimated as 2000 ± 280 ms. After correcting for T1 (and T2 from literature values), the mean absolute Lac concentration was estimated as 4.3 ± 2.6 mm. The technique developed agrees with the results obtained by standard inversion recovery and can be used to provide rapid T1 estimates of other spectral components as required. Lac T1 exhibits similar variations to other major metabolites observable by MRS in high-grade gliomas. The T1 estimate provided here will be useful for future MRS studies wishing to report relaxation-corrected estimates of Lac concentration as an objective tumor biomarker. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Karl Landheer
- Department of Medical Biophysics, University of Toronto, ON, Canada.
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada.
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, ON, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, ON, Canada
| | | | - Charles H Cunningham
- Department of Medical Biophysics, University of Toronto, ON, Canada
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Simon J Graham
- Department of Medical Biophysics, University of Toronto, ON, Canada
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| |
Collapse
|
38
|
An Z, Ganji SK, Tiwari V, Pinho MC, Patel T, Barnett S, Pan E, Mickey BE, Maher EA, Choi C. Detection of 2-hydroxyglutarate in brain tumors by triple-refocusing MR spectroscopy at 3T in vivo. Magn Reson Med 2016; 78:40-48. [PMID: 27454352 DOI: 10.1002/mrm.26347] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/26/2016] [Accepted: 06/27/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE To test the efficacy of triple-refocusing MR spectroscopy (MRS) for improved detection of 2-hydroxyglutarate (2HG) in brain tumors at 3T in vivo. METHODS The triple-refocusing sequence parameters were tailored at 3T, with density-matrix simulations and phantom validation, for enhancing the 2HG 2.25-ppm signal selectivity with respect to the adjacent resonances of glutamate (Glu), glutamine (Gln), and gamma-aminobutyric acid (GABA). In vivo MRS data were acquired from 15 glioma patients and analyzed with LCModel using calculated basis spectra. Metabolites were quantified with reference to water. RESULTS A triple-refocusing sequence (echo time = 137 ms) was obtained for 2HG detection. The 2HG 2.25-ppm signal was large and narrow while the Glu and Gln signals between 2.2 and 2.3 ppm were minimal. The optimized triple refocusing offered improved separation of 2HG from Glu, Gln and GABA when compared with published MRS methods. 2HG was detected in all 15 patients, the estimated 2HG concentrations ranging from 2.4 to 15.0 mM, with Cramer-Rao lower bounds of 2%-11%. The 2HG estimates did not show significant correlation with total choline. CONCLUSION The optimized triple refocusing provides excellent 2HG signal discrimination from adjacent resonances and may confer reliable in vivo measurement of 2HG at relatively low concentrations. Magn Reson Med 78:40-48, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
Collapse
Affiliation(s)
- Zhongxu An
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sandeep K Ganji
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Vivek Tiwari
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Marco C Pinho
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Toral Patel
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Samuel Barnett
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Edward Pan
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bruce E Mickey
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Annette Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elizabeth A Maher
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Annette Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Changho Choi
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
39
|
Berrington A, Voets NL, Plaha P, Larkin SJ, Mccullagh J, Stacey R, Yildirim M, Schofield CJ, Jezzard P, Cadoux-Hudson T, Ansorge O, Emir UE. Improved localisation for 2-hydroxyglutarate detection at 3T using long-TE semi-LASER. Tomography 2016; 2:94-105. [PMID: 27547821 PMCID: PMC4990123 DOI: 10.18383/j.tom.2016.00139] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
2-hydroxyglutarate (2-HG) has emerged as a biomarker of tumour cell IDH mutations that may enable the differential diagnosis of glioma patients. At 3 Tesla, detection of 2-HG with magnetic resonance spectroscopy is challenging because of metabolite signal overlap and a spectral pattern modulated by slice selection and chemical shift displacement. Using density matrix simulations and phantom experiments, an optimised semi-LASER scheme (TE = 110 ms) improves localisation of the 2-HG spin system considerably compared to an existing PRESS sequence. This results in a visible 2-HG peak in the in vivo spectra at 1.9 ppm in the majority of IDH mutated tumours. Detected concentrations of 2-HG were similar using both sequences, although the use of semi-LASER generated narrower confidence intervals. Signal overlap with glutamate and glutamine, as measured by pairwise fitting correlation was reduced. Lactate was readily detectable across glioma patients using the method presented here (mean CLRB: (10±2)%). Together with more robust 2-HG detection, long TE semi-LASER offers the potential to investigate tumour metabolism and stratify patients in vivo at 3T.
Collapse
Affiliation(s)
- Adam Berrington
- Nuffield Department of Clinical Neurosciences, FMRIB Centre, John Radcliffe Hospital, University of Oxford, Oxford
| | - Natalie L. Voets
- Nuffield Department of Clinical Neurosciences, FMRIB Centre, John Radcliffe Hospital, University of Oxford, Oxford
| | - Puneet Plaha
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford
| | - Sarah J. Larkin
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford
| | | | - Richard Stacey
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford
| | | | | | - Peter Jezzard
- Nuffield Department of Clinical Neurosciences, FMRIB Centre, John Radcliffe Hospital, University of Oxford, Oxford
| | - Tom Cadoux-Hudson
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford
| | - Olaf Ansorge
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford
| | - Uzay E. Emir
- Nuffield Department of Clinical Neurosciences, FMRIB Centre, John Radcliffe Hospital, University of Oxford, Oxford
| |
Collapse
|
40
|
Ganji SK, An Z, Tiwari V, McNeil S, Pinho MC, Pan E, Mickey BE, Maher EA, Choi C. In vivo detection of 2-hydroxyglutarate in brain tumors by optimized point-resolved spectroscopy (PRESS) at 7T. Magn Reson Med 2016; 77:936-944. [PMID: 26991680 DOI: 10.1002/mrm.26190] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 11/07/2022]
Abstract
PURPOSE To test the efficacy of 7T MRS for in vivo detection of 2-hydroxyglutarate (2HG) in brain tumors. METHODS The subecho times of point-resolved spectroscopy (PRESS) were optimized at 7T with density-matrix simulations and phantom validation to improve the 2HG signal selectivity with respect to the neighboring resonances of γ-aminobutyric acid (GABA), glutamate (Glu), and glutamine (Gln). MRS data were acquired from 12 subjects with gliomas in vivo and analyzed with LCModel using calculated basis spectra. Metabolite levels were quantified using unsuppressed short echo time (TE) water as a reference. RESULTS The PRESS TE was optimized as TE = 78 ms (TE1 = 58 ms and TE2 = 20 ms), at which the 2HG 2.25 ppm resonance appeared as a temporally maximum inverted narrow peak and the GABA, Glu, and Gln resonances between 2.2 and 2.5 ppm were all positive peaks. The PRESS TE = 78 ms method offered improved discrimination of 2HG from Glu, Gln, and GABA when compared with short-TE MRS. 2HG was detected in all patients enrolled in the study, the estimated 2HG concentrations ranging from 1.0 to 6.2 mM, with percentage standard deviation of 2%-7%. CONCLUSION Data indicate that the optimized MRS provides good selectivity of 2HG from other metabolite signals and may confer reliable in vivo detection of 2HG at relatively low concentrations. Magn Reson Med 77:936-944, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
Collapse
Affiliation(s)
- Sandeep K Ganji
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Zhongxu An
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Vivek Tiwari
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sarah McNeil
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Annette Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Marco C Pinho
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Edward Pan
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bruce E Mickey
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Annette Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elizabeth A Maher
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Annette Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Changho Choi
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|