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Iqbal Z, Albuquerque K, Chan KL. Magnetic Resonance Spectroscopy for Cervical Cancer: Review and Potential Prognostic Applications. Cancers (Basel) 2024; 16:2141. [PMID: 38893260 PMCID: PMC11171343 DOI: 10.3390/cancers16112141] [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: 05/07/2024] [Revised: 05/28/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
This review article investigates the utilization of MRS in the setting of cervical cancer. A variety of different techniques have been used in this space including single-voxel techniques such as point-resolved spectroscopy (PRESS) and stimulated echo acquisition mode spectroscopy (STEAM). Furthermore, the experimental parameters for these acquisitions including field strength, repetition times (TR), and echo times (TE) vary greatly. This study critically examines eleven MRS studies that focus on cervical cancer. Out of the eleven studies, ten studies utilized PRESS acquisition, while the remaining study used STEAM acquisition. These studies generally showed that the choline signal is altered in cervical cancer (4/11 studies), the lipid signal is generally increased in cervical cancer or the lipid distribution is changed (5/11 studies), and that diffusion-weighted imaging (DWI) can quantitatively detect lower apparent diffusion coefficient (ADC) values in cervical cancer (2/11 studies). Two studies also investigated the role of MRS for monitoring treatment response and demonstrated mixed results regarding choline signal, and one of these studies showed increased lipid signal for non-responders. There are several new MRS technologies that have yet to be implemented for cervical cancer including advanced spectroscopic imaging and artificial intelligence, and those technologies are also discussed in the article.
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Affiliation(s)
- Zohaib Iqbal
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX 75235, USA;
| | - Kevin Albuquerque
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX 75235, USA;
| | - Kimberly L. Chan
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX 75235, USA;
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Honecker J, Prokopchuk O, Seeliger C, Hauner H, Junker D, Karampinos DC, Ruschke S. Feasibility of omega-3 fatty acid fraction mapping using chemical shift encoding-based imaging at 3 T. NMR IN BIOMEDICINE 2024:e5181. [PMID: 38830747 DOI: 10.1002/nbm.5181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/21/2024] [Accepted: 05/06/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE The aim of this work is to develop an ω-3 fatty acid fraction mapping method at 3 T based on a chemical shift encoding model, to assess its performance in a phantom and in vitro study, and to further demonstrate its feasibility in vivo. METHODS A signal model was heuristically derived based on spectral appearance and theoretical considerations of the corresponding molecular structures to differentiate between ω-3 and non-ω-3 fatty acid substituents in triacylglycerols in addition to the number of double bonds (ndb), the number of methylene-interrupted double bonds (nmidb), and the mean fatty acid chain length (CL). First, the signal model was validated using single-voxel spectroscopy and a time-interleaved multi-echo gradient-echo (TIMGRE) sequence in gas chromatography-mass spectrometry (GC-MS)-calibrated oil phantoms. Second, the TIMGRE-based method was validated in vitro in 21 adipose tissue samples with corresponding GC-MS measurements. Third, an in vivo feasibility study was performed for the TIMGRE-based method in the gluteal region of two healthy volunteers. Phantom and in vitro data was analyzed using a Bland-Altman analysis. RESULTS Compared with GC-MS, MRS showed in the phantom study significant correlations in estimating the ω-3 fraction (p < 0.001), ndb (p < 0.001), nmidb (p < 0.001), and CL (p = 0.001); MRI showed in the phantom study significant correlations (all p < 0.001) for the ω-3 fraction, ndb, and nmidb, but no correlation for CL. Also in the in vitro study, significant correlations (all p < 0.001) between MRI and GC-MS were observed for the ω-3 fraction, ndb, and nmidb, but not for CL. An exemplary ROI measurement in vivo in the gluteal subcutaneous adipose tissue yielded (mean ± standard deviation) 0.8% ± 1.9% ω-3 fraction. CONCLUSION The present study demonstrated strong correlations between gradient-echo imaging-based ω-3 fatty acid fraction mapping and GC-MS in the phantom and in vitro study. Furthermore, feasibility was demonstrated for characterizing adipose tissue in vivo.
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Affiliation(s)
- Julius Honecker
- Else Kröner Fresenius Center for Nutritional Medicine, ZIEL-Institute for Food and Health, Technical University of Munich, Freising, Germany
| | - Olga Prokopchuk
- Department of Surgery, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Claudine Seeliger
- Else Kröner Fresenius Center for Nutritional Medicine, ZIEL-Institute for Food and Health, Technical University of Munich, Freising, Germany
| | - Hans Hauner
- Else Kröner Fresenius Center for Nutritional Medicine, ZIEL-Institute for Food and Health, Technical University of Munich, Freising, Germany
- Institute of Nutritional Medicine, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Daniela Junker
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Stefan Ruschke
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich, Germany
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Lin D, Zhou J, Cao Y, Wang Z, Hsu YC, Zheng F, Li H, Sun S, Ren H, Deng L, Chen F, Wang M. Echo time optimization for in-vivo measurement of unsaturated lipid resonances using J-difference-edited MRS. Magn Reson Med 2023; 90:2217-2232. [PMID: 37496253 DOI: 10.1002/mrm.29807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Measuring lipid composition provides more information than just total lipid content. Hence, the non-invasive measurement of unsaturated lipid protons with both high efficiency and precision is of pressing need. This study was to optimize echo time (TE) for the best resolving of J-difference editing of unsaturated lipid resonances. METHODS The TE dependence of J-difference-edited (JDE) MRS was verified in the density-matrix simulation, soybean oil phantom, in-vivo experiments of white adipose tissue (WAT), and skeletal muscles using single-voxel MEGA-PRESS sequence at 3T. The peak SNRs and Cramér-Rao lower bounds (CRLBs) acquired at the proposed TE of 45 ms and previously published TE of 70 ms were compared (eight pairs) in WAT, extramyocelluar lipids (EMCLs), and intramyocellular lipids (IMCLs). The lipid composition in skeletal muscles was compared between healthy males (n = 7) and females (n = 7). RESULTS The optimal TE was suggested as 45 ms. Compared to 70 ms, the mean signal gains at TE of 45 ms were 151% in WAT, 168% in EMCL, 204% in IMCL for allylic resonance, and 52% in EMCL for diallylic resonance. CRLBs were significantly reduced at TE of 45 ms in WAT, EMCL, IMCL for allylic resonance and in EMCL for diallylic resonance. With TE of 45 ms, significant gender differences were found in the lipid composition in EMCL pools, while no difference in IMCL pools. CONCLUSION The JDE-MRS protocol with TE of 45 ms allows improved quantification of unsaturated lipid resonances in vivo and future lipid metabolism investigations.
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Affiliation(s)
- Dingyi Lin
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jiaqiang Zhou
- School of Medicine, Sir Run Run Shaw Hospital, Department of Endocrinology, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yang Cao
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ziyan Wang
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yi-Cheng Hsu
- MR Collaboration, Siemens Healthineers Itd, Shanghai, China
| | - Fenping Zheng
- School of Medicine, Sir Run Run Shaw Hospital, Department of Endocrinology, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hong Li
- School of Medicine, Sir Run Run Shaw Hospital, Department of Endocrinology, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shuiya Sun
- School of Medicine, Sir Run Run Shaw Hospital, Department of Endocrinology, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hong Ren
- School of Medicine, Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Liping Deng
- School of Medicine, Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Feng Chen
- School of Medicine, the First Affiliated Hospital, Department of Radiology, Zhejiang University, Hangzhou, Zhejiang, China
| | - Min Wang
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
- School of Medicine, Sir Run Run Shaw Hospital, Department of Endocrinology, Zhejiang University, Hangzhou, Zhejiang, China
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Buitinga M, Veeraiah P, Haans F, Schrauwen-Hinderling VB. Ectopic lipid deposition in muscle and liver, quantified by proton magnetic resonance spectroscopy. Obesity (Silver Spring) 2023; 31:2447-2459. [PMID: 37667838 DOI: 10.1002/oby.23865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 09/06/2023]
Abstract
Advances in the development of noninvasive imaging techniques have spurred investigations into ectopic lipid deposition in the liver and muscle and its implications in the development of metabolic diseases such as type 2 diabetes. Computed tomography and ultrasound have been applied in the past, though magnetic resonance-based methods are currently considered the gold standard as they allow more accurate quantitative detection of ectopic lipid stores. This review focuses on methodological considerations of magnetic resonance-based methods to image hepatic and muscle fat fractions, and it emphasizes anatomical and morphological aspects and how these may influence data acquisition, analysis, and interpretation.
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Affiliation(s)
- Mijke Buitinga
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Nutrition and Movement Sciences (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Pandichelvam Veeraiah
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- Scannexus (Ultra-High Field Imaging Center), Maastricht, The Netherlands
- Faculty of Health Medicine and Life Sciences (FHML), Maastricht, The Netherlands
| | - Florian Haans
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Vera B Schrauwen-Hinderling
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Nutrition and Movement Sciences (NUTRIM), Maastricht University, Maastricht, The Netherlands
- Institute for Clinical Diabetology, German Diabetes Center and Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
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Fallone CJ, Tessier AG, Field CJ, Yahya A. Resolving the omega-3 methyl resonance with long echo time magnetic resonance spectroscopy in mouse adipose tissue at 9.4 T. NMR IN BIOMEDICINE 2021; 34:e4455. [PMID: 33269481 DOI: 10.1002/nbm.4455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/27/2020] [Accepted: 11/11/2020] [Indexed: 06/12/2023]
Abstract
Tissue omega-3 (ω-3) content is biologically important to disease; however, its quantification with magnetic resonance spectroscopy in vivo is challenging due to its low concentration. In addition, the ω-3 methyl resonance (≈ 0.98 ppm) overlaps that of the non-ω-3 (≈ 0.90 ppm), even at 9.4 T. We demonstrate that a Point-RESolved Spectroscopy (PRESS) sequence with an echo time (TE) of 109 ms resolves the ω-3 and non-ω-3 methyl peaks at 9.4 T. Sequence efficacy was verified on five oils with differing ω-3 fat content; the ω-3 content obtained correlated with that measured using 16.5 T NMR (R2 = 0.97). The PRESS sequence was also applied to measure ω-3 content in visceral adipose tissue of three different groups (all n = 3) of mice, each of which were fed a different 20% w/w fat diet. The fat portion of the diet consisted of low (1.4%), medium (9.0%) or high (16.4%) ω-3 fat. The sequence was also applied to a control mouse fed a standard chow diet (5.6% w/w fat, which was 5.9% ω-3). Gas chromatography (GC) analysis of excised tissue was performed for each mouse. The ω-3 fat content obtained with the PRESS sequence correlated with the GC measures (R2 = 0.96). Apparent T2 times of methyl protons were assessed by obtaining spectra from the oils and another group of four mice (fed the high ω-3 diet) with TE values of 109 and 399 ms. Peak areas were fit to a mono-exponentially decaying function and the apparent T2 values of the ω-3 and non-ω-3 methyl protons were 906 ± 148 and 398 ± 78 ms, respectively, in the oils. In mice, the values were 410 ± 68 and 283 ± 57 ms for ω-3 and non-ω-3 fats, respectively.
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Affiliation(s)
- Clara J Fallone
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Anthony G Tessier
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
- Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Catherine J Field
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Atiyah Yahya
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
- Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada
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Gajdošík M, Hingerl L, Škoch A, Freudenthaler A, Krumpolec P, Ukropec J, Ukropcová B, Šedivý P, Hájek M, Itariu BK, Maier B, Baumgartner‐Parzer S, Krebs M, Trattnig S, Krššák M. Ultralong TE In Vivo 1 H MR Spectroscopy of Omega-3 Fatty Acids in Subcutaneous Adipose Tissue at 7 T. J Magn Reson Imaging 2019; 50:71-82. [PMID: 30578581 PMCID: PMC6618283 DOI: 10.1002/jmri.26605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Omega-3 (n-3) fatty acids (FA) play and important role in neural development and other metabolic diseases such as obesity and diabetes. The knowledge about the in vivo content and distribution of n-3 FA in human body tissues is not well established and the standard quantification of FA is invasive and costly. PURPOSE To detect omega-3 (n-3 CH3 ) and non-omega-3 (CH3 ) methyl group resonance lines with echo times up to 1200 msec, in oils, for the assessment of n-3 FA content, and the n-3 FA fraction in adipose tissue in vivo. STUDY TYPE Prospective technical development. POPULATION Three oils with different n-3 FA content and 24 healthy subjects. FIELD STRENGTH/SEQUENCE Single-voxel MR spectroscopy (SVS) with a point-resolved spectroscopy (PRESS) sequence with an echo time (TE) of 1000 msec at 7 T. ASSESSMENT Knowledge about the J-coupling evolution of both CH3 resonances was used for the optimal detection of the n-3 CH3 resonance line at a TE of 1000 msec. The accuracy of the method in oils and in vivo was validated from a biopsy sample with gas chromatography analysis. STATISTICAL TESTS SVS data were compared to gas chromatography with the Pearson correlation coefficient. RESULTS T2 relaxation times in oils were assessed as follows: CH2 , 65 ± 22 msec; CH3 , 325 ± 7 msec; and n-3 CH3 , 628 ± 34 msec. The n-3 FA fractions from oil phantom experiments (n = 3) were in agreement with chromatography analysis and the comparison of in vivo obtained data with the results of chromatography analysis (n = 5) yielded a significant correlation (P = 0.029). DATA CONCLUSION PRESS with ultralong-TE can detect and quantify the n-3 CH3 signal in vivo at 7 T. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:71-82.
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Affiliation(s)
- Martin Gajdošík
- High‐field MR Centre, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
- Division of Endocrinology and Metabolism, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of RadiologyNew York University School of MedicineNew YorkNew York
| | - Lukas Hingerl
- High‐field MR Centre, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
| | - Antonín Škoch
- National Institute of Mental HealthKlecanyCzech Republic
- MR Unit, Department of Diagnostic and Interventional RadiologyInstitute for Clinical and Experimental MedicinePragueCzech Republic
| | - Angelika Freudenthaler
- Division of Endocrinology and Metabolism, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Patrik Krumpolec
- High‐field MR Centre, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
- Institute of Experimental EndocrinologyBiomedical Research Center, Slovak Academy of SciencesBratislavaSlovakia
| | - Jozef Ukropec
- Institute of Experimental EndocrinologyBiomedical Research Center, Slovak Academy of SciencesBratislavaSlovakia
| | - Barbara Ukropcová
- Institute of Experimental EndocrinologyBiomedical Research Center, Slovak Academy of SciencesBratislavaSlovakia
| | - Petr Šedivý
- MR Unit, Department of Diagnostic and Interventional RadiologyInstitute for Clinical and Experimental MedicinePragueCzech Republic
| | - Milan Hájek
- MR Unit, Department of Diagnostic and Interventional RadiologyInstitute for Clinical and Experimental MedicinePragueCzech Republic
| | - Bianca K. Itariu
- Division of Endocrinology and Metabolism, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Bernhard Maier
- University Clinic for Trauma Surgery, Medical University of ViennaViennaAustria
| | - Sabina Baumgartner‐Parzer
- Division of Endocrinology and Metabolism, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Michael Krebs
- Division of Endocrinology and Metabolism, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Siegfried Trattnig
- High‐field MR Centre, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
- Christian Doppler Laboratory for Clinical Molecular MR ImagingViennaAustria
| | - Martin Krššák
- High‐field MR Centre, Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
- Division of Endocrinology and Metabolism, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
- Christian Doppler Laboratory for Clinical Molecular MR ImagingViennaAustria
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Thankamony A, Kemp GJ, Koulman A, Bokii V, Savage DB, Boesch C, Hodson L, Dunger DB, Sleigh A. Compositional marker in vivo reveals intramyocellular lipid turnover during fasting-induced lipolysis. Sci Rep 2018; 8:2750. [PMID: 29426847 PMCID: PMC5807358 DOI: 10.1038/s41598-018-21170-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/30/2018] [Indexed: 01/28/2023] Open
Abstract
Intramyocellular lipid (IMCL) is of particular metabolic interest, but despite many proton magnetic resonance spectroscopy (1H MRS) studies reporting IMCL content measured by the methylene (CH2) resonance signal, little is known about its composition. Here we validated IMCL CH3:CH2 ratio as a compositional marker using 1H MRS at short echo time, and investigated IMCL content and composition during a 28-hour fast in 24 healthy males. Increases in IMCL CH2 relative to the creatine and phosphocreatine resonance (Cr) at 3.0 ppm (an internal standard) correlated with circulating free fatty acid (FA) concentrations, supporting the concept of increased FA influx into IMCL. Significant decreases in IMCL CH3:CH2 ratio indicated a less unsaturated IMCL pool after fasting, and this compositional change related inversely to IMCL baseline composition, suggesting a selective efflux of unsaturated shorter-chain FA from the IMCL pool. This novel in vivo evidence reveals IMCL turnover during extended fasting, consistent with the concept of a flexible, responsive myocellular lipid store. There were also differences between soleus and tibialis anterior in basal IMCL composition and in response to fasting. We discuss the potential of this marker for providing insights into normal physiology and mechanisms of disease.
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Affiliation(s)
- Ajay Thankamony
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Graham J Kemp
- Department of Musculoskeletal Biology, University of Liverpool and MRC-Arthritis Research UK Centre for Integrated research into Musculoskeletal Ageing (CIMA), Liverpool, UK
| | - Albert Koulman
- National Institute for Health Research Biomedical Research Centre (NIHR BRC) Core Metabolomics and Lipidomics Laboratory, University of Cambridge, Cambridge, UK.,Wellcome Trust-MRC Institute of Metabolic Science, Cambridge, UK
| | - Vlada Bokii
- Wolfson Brain Imaging Centre, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - David B Savage
- Wellcome Trust-MRC Institute of Metabolic Science, Cambridge, UK
| | - Chris Boesch
- Department of Clinical Research and Radiology, AMSM, University Bern, Bern, Switzerland
| | - Leanne Hodson
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Cambridge, UK.,Wellcome Trust-MRC Institute of Metabolic Science, Cambridge, UK
| | - Alison Sleigh
- Wellcome Trust-MRC Institute of Metabolic Science, Cambridge, UK. .,Wolfson Brain Imaging Centre, University of Cambridge School of Clinical Medicine, Cambridge, UK. .,National Institute for Health Research/Wellcome Trust Clinical Research Facility, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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