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Yancey JR, Ma J, Subramaniam P, Carson CN, McGlade EC, Yurgelun-Todd DA, Renshaw PF. Creatine concentration in the anterior cingulate cortex is associated with greater stress recovery from traumatic events: Preliminary evidence from a US Veteran sample. J Affect Disord 2024; 355:115-121. [PMID: 38548194 DOI: 10.1016/j.jad.2024.03.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/08/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a psychiatric condition characterized by a prolonged stress response to potentially life-threatening events long after the event has passed. Understanding factors related to recovery from traumatic life events may inform novel targets for intervention. There is emerging preclinical evidence that creatine (Cr), a molecule critical to brain bioenergetics, may be a neurobiological marker of stress reactivity and recovery. METHOD 25 US Veterans (8 female) completed the Life Events Checklist for DSM-5, which assessed different types of traumatic events. Veterans were also asked to rate the subjective stress of each traumatic event on a 1-10 scale currently (Current Stress) and at the time the event occurred (Past Stress). Stress recovery was quantified as the difference between Current and Past Stress. Current PTSD symptoms were also assessed using the PTSD Checklist for DSM-5. Cr concentrations in the anterior cingulate cortex (ACC) were measured in the anterior cingulate cortex using proton magnetic resonance spectroscopy (1H-MRS). RESULTS Higher levels of Cr were associated with self-reported stress recovery from participants' most traumatic life event. Cr was not related to number of different types of traumatic life events or current PTSD symptoms. LIMITATIONS The sample size was relatively small. Stress recovery was measured via retrospective self-report. Future experimental work in humans should clarify the protective role of Cr in recovery from trauma. CONCLUSIONS ACC concentrations of Cr may be an important neurochemical factor related to stress recovery. Future work should investigate Cr as a possible protective factor against the effects of traumatic stress.
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Affiliation(s)
- James R Yancey
- Rocky Mountain Mental Illness Research Education and Clinical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Department of Veterans Affairs, Salt Lake City, UT, United States of America; Hunstman Mental Health Institute, Department of Psychiatry, University of Utah School of Medicine, United States of America.
| | - Jiyoung Ma
- Hunstman Mental Health Institute, Department of Psychiatry, University of Utah School of Medicine, United States of America
| | - Punitha Subramaniam
- Hunstman Mental Health Institute, Department of Psychiatry, University of Utah School of Medicine, United States of America
| | - Chelsea N Carson
- Rocky Mountain Mental Illness Research Education and Clinical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Department of Veterans Affairs, Salt Lake City, UT, United States of America; Hunstman Mental Health Institute, Department of Psychiatry, University of Utah School of Medicine, United States of America
| | - Erin C McGlade
- Rocky Mountain Mental Illness Research Education and Clinical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Department of Veterans Affairs, Salt Lake City, UT, United States of America; Hunstman Mental Health Institute, Department of Psychiatry, University of Utah School of Medicine, United States of America
| | - Deborah A Yurgelun-Todd
- Rocky Mountain Mental Illness Research Education and Clinical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Department of Veterans Affairs, Salt Lake City, UT, United States of America; Hunstman Mental Health Institute, Department of Psychiatry, University of Utah School of Medicine, United States of America
| | - Perry F Renshaw
- Rocky Mountain Mental Illness Research Education and Clinical Center, George E. Wahlen Department of Veterans Affairs Medical Center, Department of Veterans Affairs, Salt Lake City, UT, United States of America; Hunstman Mental Health Institute, Department of Psychiatry, University of Utah School of Medicine, United States of America
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Hatay GH, Ozturk-Isik E. Optimized multi-voxel TE-averaged PRESS for glutamate detection in the human brain at 3T. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2023; 356:107574. [PMID: 37922677 DOI: 10.1016/j.jmr.2023.107574] [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: 12/06/2022] [Revised: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE To optimize possible combinations of echo times (TE) for multi-voxel TE-averaged Point RESolved Spectroscopy (PRESS) while reducing the total number of TEs required to separate glutamate (Glu) and glutamine (Gln) within a clinically feasible scan time. METHODS General Approach to Magnetic resonance Mathematical Analysis (GAMMA) was used to implement 2D J-resolved PRESS technique, and the spectra of 14 individual brain metabolites were simulated at 64 different TEs. Monte Carlo simulations were used for selecting the best TE combinations to separate Glu and Gln using TE-averaged PRESS with a total number of two, three, four and five TEs. Single-voxel 1H-MRS data were acquired using 64 different TEs from a healthy volunteer on a clinical 3T MR scanner to validate the echo time combinations selected with simulations. Additionally, 2D 1H-MRSI data of eight healthy volunteers were acquired on a clinical 3T MR scanner using four different TEs that were determined by Monte Carlo simulations. Optimized TE-averaged PRESS spectra were created by averaging the spectra acquired at selected TEs. LCModel was used for spectral quantification. A Wilcoxon signed-rank test was used to detect statistically significant differences in Glu/Gln ratios between 35 ms PRESS and optimized TE-averaged PRESS data. RESULTS Glu could be clearly separated from Gln at 2.35 ppm, using optimized TE-averaged PRESS with only four TEs (35, 37, 40, and 42 ms) that were selected through Monte Carlo simulations. Glu/Gln ratios were significantly higher in the optimized TE-averaged PRESS data of healthy volunteers than in the 35 ms PRESS data (P = 0.008). CONCLUSION Optimized multi-voxel TE-averaged PRESS enabled faster and unobstructed quantification of Glu at multiple voxels in the human brain in vivo at 3T.
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Affiliation(s)
- Gokce Hale Hatay
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey.
| | - Esin Ozturk-Isik
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey.
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Bottino F, Lucignani M, Napolitano A, Dellepiane F, Visconti E, Rossi Espagnet MC, Pasquini L. In Vivo Brain GSH: MRS Methods and Clinical Applications. Antioxidants (Basel) 2021; 10:antiox10091407. [PMID: 34573039 PMCID: PMC8468877 DOI: 10.3390/antiox10091407] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/22/2021] [Accepted: 08/30/2021] [Indexed: 01/31/2023] Open
Abstract
Glutathione (GSH) is an important antioxidant implicated in several physiological functions, including the oxidation−reduction reaction balance and brain antioxidant defense against endogenous and exogenous toxic agents. Altered brain GSH levels may reflect inflammatory processes associated with several neurologic disorders. An accurate and reliable estimation of cerebral GSH concentrations could give a clear and thorough understanding of its metabolism within the brain, thus providing a valuable benchmark for clinical applications. In this context, we aimed to provide an overview of the different magnetic resonance spectroscopy (MRS) technologies introduced for in vivo human brain GSH quantification both in healthy control (HC) volunteers and in subjects affected by different neurological disorders (e.g., brain tumors, and psychiatric and degenerative disorders). Additionally, we aimed to provide an exhaustive list of normal GSH concentrations within different brain areas. The definition of standard reference values for different brain areas could lead to a better interpretation of the altered GSH levels recorded in subjects with neurological disorders, with insights into the possible role of GSH as a biomarker and therapeutic target.
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Affiliation(s)
- Francesca Bottino
- Medical Physics Department, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (F.B.); (M.L.)
| | - Martina Lucignani
- Medical Physics Department, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (F.B.); (M.L.)
| | - Antonio Napolitano
- Medical Physics Department, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (F.B.); (M.L.)
- Correspondence: ; Tel.: +39-333-3214614
| | - Francesco Dellepiane
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, 00189 Rome, Italy; (F.D.); (M.C.R.E.); (L.P.)
| | - Emiliano Visconti
- Neuroradiology Unit, Surgery and Trauma Department, Maurizio Bufalini Hospital, 47521 Cesena, Italy;
| | - Maria Camilla Rossi Espagnet
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, 00189 Rome, Italy; (F.D.); (M.C.R.E.); (L.P.)
- Neuroradiology Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Luca Pasquini
- Neuroradiology Unit, NESMOS Department, Sant’Andrea Hospital, La Sapienza University, 00189 Rome, Italy; (F.D.); (M.C.R.E.); (L.P.)
- Neuroradiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Mastaloudis A, Sheth C, Hester SN, Wood SM, Prescot A, McGlade E, Renshaw PF, Yurgelun-Todd DA. Supplementation with a putative calorie restriction mimetic micronutrient blend increases glutathione concentrations and improves neuroenergetics in brain of healthy middle-aged men and women. Free Radic Biol Med 2020; 153:112-121. [PMID: 32335159 DOI: 10.1016/j.freeradbiomed.2020.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/17/2020] [Accepted: 04/19/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Caloric restriction (CR) without micronutrient deficiency has been shown to increase both lifespan and healthspan. In animals, CR has been demonstrated to increase glutathione (GSH), a neuroprotective antioxidant, in the brain and preserve brain mitochondrial function by altering neuroenergetics. In humans it has been associated with improvements in mood states and cognitive function. However, most CR studies have employed a 30-60% reduction in calories which is likely too stringent for most people to adhere to long-term. Thus, there is an unmet need for nutritional supplements which can mimic the biological effects of CR, without the need for calorie limitations. AIM The purpose of the present randomized, placebo-controlled clinical trial was to use Proton (1H) Magnetic Resonance Spectroscopic (MRS) measurements to determine non-invasively whether a blend of micronutrients, a putative CR mimetic, positively modulates metabolites related to neuroprotection and neuroenergetics in the brain. METHODS Healthy middle-aged men and women (N = 63 [33 women]; age: 40-60 years) were randomized in a double-blind manner to 6 weeks supplementation with either the putative CR mimetic or placebo. At baseline and 6 weeks, subjects underwent MRS at 3 T to investigate changes in brain chemistry, including the neurometabolites: GSH, Glutamate (Glu), Glutamine (Gln) and N-Acetylaspartate (NAA). RESULTS GSH, a marker of antioxidant and cellular redox status, increased in the brain of participants in the supplement group. The supplement group also showed an increase in the Glu/Gln ratio, a marker of excitatory neurotransmission and bioenergetics. A trend for an increase in NAA/H2O, a marker of neuronal integrity, was observed in females in the supplement group. CONCLUSIONS The present study reveals that 6-weeks daily supplementation with a micronutrient blend elicits positive changes in brain neurochemistry. This is the first study to demonstrate that a putative CR mimetic increases brain GSH concentrations and improves neuroprotection and neuroenergetics in the brain of healthy humans. This study was registered at www.clinicaltrials.gov as NCT02439983.
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Affiliation(s)
| | - Chandni Sheth
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA.
| | | | - Steven M Wood
- Pharmanex Research, NSE Products, Inc., Provo, UT, USA
| | - Andrew Prescot
- Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Erin McGlade
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRREC), Salt Lake City, UT, USA
| | - Perry F Renshaw
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRREC), Salt Lake City, UT, USA
| | - Deborah A Yurgelun-Todd
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRREC), Salt Lake City, UT, USA
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Sheth C, Prescot AP, Legarreta M, Renshaw PF, McGlade E, Yurgelun-Todd D. Increased myoinositol in the anterior cingulate cortex of veterans with a history of traumatic brain injury: a proton magnetic resonance spectroscopy study. J Neurophysiol 2020; 123:1619-1629. [DOI: 10.1152/jn.00765.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In this study of veterans, we used a state-of-the-art neuroimaging tool to probe the neurometabolic profile of the anterior cingulate cortex in veterans with traumatic brain injury (TBI). We report significantly elevated myoinositol levels in veterans with TBI compared with those without TBI.
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Affiliation(s)
- Chandni Sheth
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, Utah
| | - Andrew P. Prescot
- Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Margaret Legarreta
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, Utah
- George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, Utah
| | - Perry F. Renshaw
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, Utah
- George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, Utah
| | - Erin McGlade
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, Utah
- George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, Utah
| | - Deborah Yurgelun-Todd
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, Utah
- George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), Salt Lake City, Utah
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Frank D, Kuts R, Tsenter P, Gruenbaum BF, Grinshpun Y, Zvenigorodsky V, Shelef I, Natanel D, Brotfain E, Zlotnik A, Boyko M. The effect of pyruvate on the development and progression of post-stroke depression: A new therapeutic approach. Neuropharmacology 2019; 155:173-184. [PMID: 31153808 DOI: 10.1016/j.neuropharm.2019.05.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/26/2019] [Accepted: 05/30/2019] [Indexed: 12/27/2022]
Abstract
Post-stroke depression (PSD) is a common and serious complication following stroke. Both stroke and depression have independently been associated with pathologically elevated glutamate levels in the brain's extra-cerebral fluid (ECF). Here we evaluate an alternative therapeutic approach to PSD with pyruvate. Rats were randomly assigned into one of 3 groups: Middle Cerebral Artery Occlusion (MCAO) plus pyruvate treatment, MCAO plus placebo treatment, and sham operated rats. Post-MCAO depressive and anxiety-like behavior was assessed, along with neurological status, brain infarct zone, brain edema, blood brain barrier (BBB) breakdown, cerebrospinal fluid and blood glutamate levels. Anxiety-like behavior and levels of blood alanine and α-ketoglutarate were measured in naïve rats treated with pyruvate, as a control. Post-stroke neurological deficit with concurrent elevation in glutamate levels were demonstrated, with peak glutamate levels 24 h after MCAO. Treatment with pyruvate led to reduced glutamate levels 24 h after MCAO and improved neurologic recovery. Pyruvate treatment reduced lesion volume, brain edema and the extent of BBB permeability 24 h post-MCAO. Naïve rats treated with pyruvate showed increased levels of α-ketoglutarate. Rats demonstrated post-stroke depressive behavior that was improved by the administration of pyruvate. There was less anxiety-like behavior in post-stroke rats treated with placebo in comparison to the post-stroke rats treated with pyruvate or sham operated rats. Glutamate scavenging with pyruvate appears to be an effective as a method in providing neuroprotection following stroke and as a therapeutic option for the treatment of PSD by reducing the consequent elevations in CNS glutamate levels.
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Affiliation(s)
- Dmitry Frank
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruslan Kuts
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Philip Tsenter
- Division of Internal Medicine, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Benjamin F Gruenbaum
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Yulia Grinshpun
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Vladislav Zvenigorodsky
- Department of Radiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ilan Shelef
- Department of Radiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dmitry Natanel
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Evgeny Brotfain
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alexander Zlotnik
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Matthew Boyko
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Dhamala E, Abdelkefi I, Nguyen M, Hennessy TJ, Nadeau H, Near J. Validation of in vivo MRS measures of metabolite concentrations in the human brain. NMR IN BIOMEDICINE 2019; 32:e4058. [PMID: 30663818 DOI: 10.1002/nbm.4058] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 11/15/2018] [Accepted: 11/17/2018] [Indexed: 05/05/2023]
Abstract
PURPOSE In vivo magnetic resonance spectroscopy (MRS) is the only technique capable of non-invasively assessing metabolite concentrations in the brain. The lack of alternative methods makes validation of MRS measures challenging. The aim of this study is to assess the validity of MRS measures of human brain metabolite concentrations by comparing multiple MRS measures acquired using different MRS acquisition sequences. METHODS Single-voxel SPECIAL and MEGA-PRESS MR spectra were acquired from both the dorsolateral prefrontal cortex and primary motor cortices in 15 healthy subjects. The SPECIAL spectrum, as well as both the edit-off and difference spectra of MEGA-PRESS were each analyzed in LCModel to obtain estimates of the absolute concentrations of total choline (TCh; glycerophosphocholine + phosphocholine), total creatine (TCr; creatine + phosphocreatine), N-acetylaspartate (NAA), N-acetylaspartylglutamate (NAAG), NAA + NAAG, glutamate (Glu), glutamine (Gln), Glu + Gln, scyllo-inositol (Scyllo), myo-inositol (Ins), glutathione (GSH), γ-aminobutyric acid (GABA), lactate (Lac) and aspartate (Asp). Then, having obtained up to three independent measures of each metabolite per brain region per subject, correlations between the different measures were assessed. RESULTS The degree of correlation between measures varied greatly across both the metabolites and sequences tested. As expected, metabolites with the most prominent spectral peaks (TCh, TCr, NAA + NAAG, Ins and Glu) had the most well-correlated measures between methods, while metabolites with less prominent spectral peaks (Lac, Gln, GABA, Asp, and NAAG) tended to have poorly-correlated measures between methods. Some metabolites with relatively less prominent spectral peaks (GSH, Scyllo) had fairly well-correlated measures between some methods. Combining metabolites improved the agreement between methods for measures of NAA + NAAG, but not for Glu + Gln. CONCLUSIONS Given that the ground truth for in vivo MRS measures is never known, the method proposed here provides a promising means to assess the validity of in vivo MRS measures, which has not yet been explored widely.
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Affiliation(s)
- Elvisha Dhamala
- Centre d'Imagerie Cérébrale, Douglas Mental Health University Institute, Montreal, Canada
| | | | - Mavesa Nguyen
- Department of Physics, Dawson College, Montreal, Canada
- Department of Mechanical Engineering, McGill University, Montreal, Canada
| | - T Jay Hennessy
- Centre d'Imagerie Cérébrale, Douglas Mental Health University Institute, Montreal, Canada
- Department of Biomedical Engineering, McGill University, Montreal, Canada
| | - Hélène Nadeau
- Department of Physics, Dawson College, Montreal, Canada
| | - Jamie Near
- Centre d'Imagerie Cérébrale, Douglas Mental Health University Institute, Montreal, Canada
- Department of Biomedical Engineering, McGill University, Montreal, Canada
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Sheth C, Prescot A, Bueler E, DiMuzio J, Legarreta M, Renshaw PF, Yurgelun-Todd D, McGlade E. Alterations in anterior cingulate cortex myoinositol and aggression in veterans with suicidal behavior: A proton magnetic resonance spectroscopy study. Psychiatry Res Neuroimaging 2018; 276:24-32. [PMID: 29723775 DOI: 10.1016/j.pscychresns.2018.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/21/2018] [Accepted: 04/23/2018] [Indexed: 11/28/2022]
Abstract
Studies investigating the neurochemical changes that correspond with suicidal behavior (SB) have not yielded conclusive results. Suicide correlates such as aggression have been used to explore risk factors for SB. Yet the neurobiological basis for the association between aggression and SB is unclear. Aggression and SB are both prevalent in veterans relative to civilian populations. The current study evaluated the relationship between brain chemistry in the anterior (ACC) and the posterior cingulate cortex (POC), as well as the relationship between aggression and SB in a veteran population using proton magnetic resonance spectroscopy (1H-MRS). Single-voxel MRS data at 3 Tesla (T) were acquired from the ACC and POC voxels using a 2-dimensional J-resolved point spectroscopy sequence and quantified using the ProFit algorithm. Participants also completed a structured diagnostic interview and a clinical battery. Our results showed that the myoinositol (mI)/H2O ratio in the ACC and POC was significantly higher in veterans who reported SB when compared to veterans who did not. The two groups did not differ significantly with regard to other metabolites. Second, verbal aggression and SB measures positively correlated with mI/H2O in the ACC. Finally, verbal aggression mediated the relationship between mI/H2O in the ACC and SB.
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Affiliation(s)
- Chandni Sheth
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA.
| | - Andrew Prescot
- Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Elliott Bueler
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRREC), Salt Lake City, UT, USA
| | - Jennifer DiMuzio
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRREC), Salt Lake City, UT, USA
| | - Margaret Legarreta
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRREC), Salt Lake City, UT, USA
| | - Perry F Renshaw
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRREC), Salt Lake City, UT, USA
| | - Deborah Yurgelun-Todd
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRREC), Salt Lake City, UT, USA
| | - Erin McGlade
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRREC), Salt Lake City, UT, USA
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9
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Kim SY, Kaufman MJ, Cohen BM, Jensen JE, Coyle JT, Du F, Öngür D. In Vivo Brain Glycine and Glutamate Concentrations in Patients With First-Episode Psychosis Measured by Echo Time-Averaged Proton Magnetic Resonance Spectroscopy at 4T. Biol Psychiatry 2018; 83:484-491. [PMID: 29031411 PMCID: PMC5809251 DOI: 10.1016/j.biopsych.2017.08.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 08/26/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Accumulating evidence suggests the involvement of abnormal glutamateric neurotransmission and N-methyl-D-aspartate receptor hypofunction in the pathophysiology of psychotic disorders. The purpose of this study was to quantify in vivo glutamate (Glu) and glycine (Gly) levels in patients with first-episode psychosis as well as age-matched healthy control subjects with magnetic resonance spectroscopy (MRS). METHODS The subjects were 46 patients with first-episode psychosis (20 with a schizophrenia spectrum disorder, 26 with bipolar disorder) and 50 age-matched healthy control subjects. Glu and Gly levels were measured in vivo in the anterior cingulate cortex and posterior cingulate cortex of the subjects by using the echo time-averaged proton MRS technique at 4T (i.e., modified point resolved spectroscopy sequence: 24 echo time steps with 20-ms increments). Metabolite levels were quantified using LCModel with simulated basis sets. RESULTS Significantly higher Glu and Gly levels were found in both the anterior cingulate cortex and posterior cingulate cortex of patients with first-episode psychosis as compared with healthy control subjects. Glu and Gly levels were positively correlated in patients. Patients with a schizophrenia spectrum disorder and bipolar disorder showed similar abnormalities. CONCLUSIONS Our findings demonstrate abnormally elevated brain Glu and Gly levels in patients with first-episode psychosis by means of echo time-averaged proton MRS at 4T. The findings implicate dysfunction of N-methyl-D-aspartate receptor and glutamatergic neurotransmission in the pathophysiology of the acute early phase of psychotic illnesses.
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Affiliation(s)
- Sang-Young Kim
- McLean Imaging Center, McLean Hospital; Harvard Medical School, Belmont, MA, 02478, USA,Psychotic Disorders Division, McLean Hospital; Harvard Medical School, Belmont, MA, 02478, USA
| | - Marc J. Kaufman
- McLean Imaging Center, McLean Hospital; Harvard Medical School, Belmont, MA, 02478, USA,Translational Imaging Laboratory, McLean Hospital; Harvard Medical School, Belmont, MA, 02478, USA
| | - Bruce M. Cohen
- Program for Neuropsychiatric Research, McLean Hospital; Harvard Medical School, Belmont MA, 02478, USA
| | - J. Eric Jensen
- McLean Imaging Center, McLean Hospital; Harvard Medical School, Belmont, MA, 02478, USA
| | - Joseph T. Coyle
- Laboratory for Psychiatric and Molecular Neuroscience, McLean Hospital; Harvard Medical School, Belmont, MA, 02478, USA
| | - Fei Du
- McLean Imaging Center, McLean Hospital; Harvard Medical School, Belmont, MA, 02478, USA,Psychotic Disorders Division, McLean Hospital; Harvard Medical School, Belmont, MA, 02478, USA
| | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital, Harvard Medical School, Belmont, Massachusetts.
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10
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Prescot A, Sheth C, Legarreta M, Renshaw PF, McGlade E, Yurgelun-Todd D. Altered Cortical GABA in Female Veterans with Suicidal Behavior: Sex Differences and Clinical Correlates. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2018; 2:2470547018768771. [PMID: 29756082 PMCID: PMC5947869 DOI: 10.1177/2470547018768771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/14/2018] [Indexed: 11/21/2022]
Abstract
Background Suicide is a public health concern in the civilian and veteran populations. Stressful life events are precipitating factors for suicide. The neurochemical underpinnings of the association between stress/trauma and suicide risk are unclear, especially in regards to sex differences. We hypothesized that gamma-amino butyric acid (GABA), the major inhibitory neurotransmitter may be a neurochemical candidate that is critical in the association between stress and suicide risk in veterans. Methods Proton magnetic resonance spectroscopy (1H MRS) at 3.0 Tesla was used to measure in vivo neurochemistry in the anterior cingulate cortex (ACC; predominantly the dorsal ACC) of 81 veterans (16 females), including 57 (11 females) who endorsed past suicidal ideation (SI) and/or suicide attempt (SA) and 24 (5 females) with no history of SI and/or SA. Suicidal behavior (SB) was defined as the presence of SI and/or SA. Results We observed no significant differences in GABA/ Creatine+phosphocreatine (Cr+PCr) between veterans with SB (SB+) and without SB (SB-). However, the female SB+ group showed significantly reduced GABA/Cr+PCr vs. the female SB- group. We observed a trend-level significant negative correlation between GABA/Cr+PCr and the defensive avoidance (DA) subscale on the Trauma Symptom Inventory (TSI) in the SB+ group. In contrast, the SB- group exhibited a positive relationship between the two variables. Furthermore, we found significant negative correlations between GABA/Cr+PCr and Hamilton Rating Scale for Depression (HAM-D) scores as well as between GABA/Cr+PCr and several subscales of the TSI in female veterans. Conclusions This study suggests that reduced GABA/Cr+ PCr ratio in the ACC, which may be related to altered inhibitory capacity, may underlie suicide risk in female veterans. Further, the negative association between GABA/Cr+PCr and stress symptomatology and depression scores suggests that MRS studies may shed light on intermediate phenotypes of SB.
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Affiliation(s)
- Andrew Prescot
- Department of Radiology, University of Utah School of
Medicine, Salt Lake City, UT, USA
| | - Chandni Sheth
- Department of Psychiatry, University of Utah School of
Medicine, Salt Lake City, UT, USA
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA
| | - Margaret Legarreta
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA
- George E. Wahlen Department of Veterans
Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical
Center, Salt Lake City, UT, USA
| | - Perry F. Renshaw
- Department of Psychiatry, University of Utah School of
Medicine, Salt Lake City, UT, USA
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA
- George E. Wahlen Department of Veterans
Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical
Center, Salt Lake City, UT, USA
| | - Erin McGlade
- Department of Psychiatry, University of Utah School of
Medicine, Salt Lake City, UT, USA
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA
- George E. Wahlen Department of Veterans
Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical
Center, Salt Lake City, UT, USA
| | - Deborah Yurgelun-Todd
- Department of Psychiatry, University of Utah School of
Medicine, Salt Lake City, UT, USA
- Diagnostic Neuroimaging, University of Utah, Salt Lake City, UT, USA
- George E. Wahlen Department of Veterans
Affairs Medical Center, VA VISN 19 Mental Illness Research, Education and Clinical
Center, Salt Lake City, UT, USA
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11
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Jensen JE, Auerbach RP, Pisoni A, Pizzagalli DA. Localized MRS reliability of in vivo glutamate at 3 T in shortened scan times: a feasibility study. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3771. [PMID: 28731544 PMCID: PMC5774335 DOI: 10.1002/nbm.3771] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 05/22/2023]
Abstract
Glutamate is the prime excitatory neurotransmitter in the mammalian brain and has been implicated in a wide range of psychiatric conditions. To improve the applicability and clinical reach of magnetic resonance spectroscopy (MRS), research is needed to develop shortened, yet reliable, MRS scanning procedures for standard 1.5-3-T clinical magnetic resonance imaging (MRI) systems, particularly with young or vulnerable populations unable to tolerate longer protocols. To this end, we evaluated the test-retest reliability of a shortened J-resolved MRS sequence in healthy adolescents (n = 22) aged 12-14 years. Participants underwent a series of sequential 6-min MRS scans, with the participants remaining in situ between successive scans. Glutamate and other metabolites were acquired from the rostral anterior cingulate cortex, as glutamatergic function in this region has been implicated in a number of psychiatric illnesses. Thirteen neurochemicals were quantified as ratios to total creatine, and reliability scores were expressed as the percentage difference between the two scans for each metabolite. Test-retest assessment of glutamate was reliable, as scores were less than 10% different (7.1 ± 4.2%), and glutamate values across scans were significantly correlated (Pearson r = 0.680, p < 10-4 ). Several other neurochemicals demonstrated satisfactory reliability, including choline (Cho) (7.4 ± 5.6%), glutathione (GSH) (8.6 ± 4.1%), myo-inositol (mI) (6.5 ± 7.1%) and N-acetylaspartate (NAA) (3.5 ± 3.6%), with test-retest correlations ranging from 0.747 to 0.953. A number of metabolites, however, did not demonstrate acceptable test-retest reliability using the current J-resolved MRS sequence, ranging from 13.8 ± 13.7% (aspartate, Asp) to 45.9 ± 38.3% (glycine, Gly). Collectively, test-retest analyses suggest that clinically viable quantitative data can be obtained on standard MRI systems for glutamate, as well as the other metabolites, during short scan times in a traditionally challenging brain region.
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Affiliation(s)
- J. Eric Jensen
- McLean Imaging Center, McLean Hospital
- Harvard Medical School
| | - Randy P. Auerbach
- Center for Anxiety and Stress Research, McLean Hospital
- Harvard Medical School
| | - Angela Pisoni
- Center for Anxiety and Stress Research, McLean Hospital
- Harvard Medical School
| | - Diego A. Pizzagalli
- McLean Imaging Center, McLean Hospital
- Center for Anxiety and Stress Research, McLean Hospital
- Harvard Medical School
- Address correspondence to: Diego A. Pizzagalli, Ph.D., McLean Hospital/Harvard Medical School, Mailstop 331, 115 Mill Street, Belmont, MA 02478-9106;
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12
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Iqbal Z, Wilson NE, Thomas MA. 3D spatially encoded and accelerated TE-averaged echo planar spectroscopic imaging in healthy human brain. NMR IN BIOMEDICINE 2016; 29:329-339. [PMID: 26748673 DOI: 10.1002/nbm.3469] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 11/17/2015] [Accepted: 11/23/2015] [Indexed: 06/05/2023]
Abstract
Several different pathologies, including many neurodegenerative disorders, affect the energy metabolism of the brain. Glutamate, a neurotransmitter in the brain, can be used as a biomarker to monitor these metabolic processes. One method that is capable of quantifying glutamate concentration reliably in several regions of the brain is TE-averaged (1) H spectroscopic imaging. However, this type of method requires the acquisition of multiple TE lines, resulting in long scan durations. The goal of this experiment was to use non-uniform sampling, compressed sensing reconstruction and an echo planar readout gradient to reduce the scan time by a factor of eight to acquire TE-averaged spectra in three spatial dimensions. Simulation of glutamate and glutamine showed that the 2.2-2.4 ppm spectral region contained 95% glutamate signal using the TE-averaged method. Peak integration of this spectral range and home-developed, prior-knowledge-based fitting were used for quantitation. Gray matter brain phantom measurements were acquired on a Siemens 3 T Trio scanner. Non-uniform sampling was applied retrospectively to these phantom measurements and quantitative results of glutamate with respect to creatine 3.0 (Glu/Cr) ratios showed a coefficient of variance of 16% for peak integration and 9% for peak fitting using eight-fold acceleration. In vivo scans of the human brain were acquired as well and five different brain regions were quantified using the prior-knowledge-based algorithm. Glu/Cr ratios from these regions agreed with previously reported results in the literature. The method described here, called accelerated TE-averaged echo planar spectroscopic imaging (TEA-EPSI), is a significant methodological advancement and may be a useful tool for categorizing glutamate changes in pathologies where affected brain regions are not known a priori. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Zohaib Iqbal
- Department of Radiological Sciences, University of California Los Angeles, USA
| | - Neil E Wilson
- Department of Radiological Sciences, University of California Los Angeles, USA
| | - M Albert Thomas
- Department of Radiological Sciences, University of California Los Angeles, USA
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13
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Zhang Y, Shen J. Simultaneous quantification of glutamate and glutamine by J-modulated spectroscopy at 3 Tesla. Magn Reson Med 2015; 76:725-32. [PMID: 26361892 DOI: 10.1002/mrm.25922] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 08/05/2015] [Accepted: 08/13/2015] [Indexed: 11/08/2022]
Abstract
PURPOSE The echo time (TE) averaged spectrum is the one-dimensional (1D) cross-section of the J-resolved spectrum at J = 0. In multiecho TE-averaged spectroscopy, glutamate (Glu) is differentiated from glutamine (Gln) at 3 Tesla (T). This method, however, almost entirely suppresses Gln resonance lines around 2.35 ppm, leaving Gln undetermined. This study presents a novel method for quantifying both Glu and Gln using multi-echo spectral data. METHODS A 1D cross-section of J-resolved spectroscopy at J = 7.5 Hz-referred to as J-modulated spectroscopy-was developed to simultaneously quantify Glu and Gln levels in the human brain. The transverse relaxation times (T2 s) of metabolites were first determined using conventional TE-averaged spectroscopy with different starting echo time and then incorporated into the spectral model for fitting J-modulated data. RESULTS Simulation and in vivo data showed that the resonance signals of Glu and Gln were clearly separated around 2.35 ppm in J-modulated spectroscopy. In the anterior cingulate cortex, both Glu and Gln levels were found to be significantly higher in gray matter than in white matter in healthy subjects (P < 10(-10) and < 10(-5) , respectively). CONCLUSION Gln resonances can be clearly separated from Glu and N-acetyl-aspartate around 2.35 ppm using J-modulated spectroscopy. This method can be used to quantitatively measure Glu and Gln simultaneously at 3T. Magn Reson Med 76:725-732, 2016. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Yan Zhang
- MR Spectroscopy Core Facility, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Jun Shen
- MR Spectroscopy Core Facility, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA.,Molecular Imaging Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
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14
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Craveiro M, Cudalbu C, Mlynárik V, Gruetter R. Optimized MEGA-SPECIAL for in vivo glutamine detection in the rat brain at 14.1 T. NMR IN BIOMEDICINE 2014; 27:1151-1158. [PMID: 25070114 DOI: 10.1002/nbm.3168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 04/04/2014] [Accepted: 06/22/2014] [Indexed: 06/03/2023]
Abstract
Glutamine has multiple roles in brain metabolism and its concentration can be altered in various pathological conditions. An accurate knowledge of its concentration is therefore highly desirable to monitor and study several brain disorders in vivo. However, in recent years, several MRS studies have reported conflicting glutamine concentrations in the human brain. A recent hypothesis for explaining these discrepancies is that a short T2 component of the glutamine signal may impact on its quantification at long echo times. The present study therefore aimed to investigate the impact of acquisition parameters on the quantified glutamine concentration using two different acquisition techniques, SPECIAL at ultra-short echo time and MEGA-SPECIAL at moderate echo time. For this purpose, MEGA-SPECIAL was optimized for the first time for glutamine detection. Based on the very good agreement of the glutamine concentration obtained between the two measurements, it was concluded that no impact of a short T2 component of the glutamine signal was detected.
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Affiliation(s)
- Mélanie Craveiro
- Laboratory for Functional and Metabolic Imaging, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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15
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Prescot AP, Shi X, Choi C, Renshaw PF. In vivo T(2) relaxation time measurement with echo-time averaging. NMR IN BIOMEDICINE 2014; 27:863-869. [PMID: 24865447 PMCID: PMC4572890 DOI: 10.1002/nbm.3115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 02/04/2014] [Accepted: 03/11/2014] [Indexed: 05/29/2023]
Abstract
The accuracy of metabolite concentrations measured using in vivo proton ((1) H) MRS is enhanced following correction for spin-spin (T2 ) relaxation effects. In addition, metabolite proton T2 relaxation times provide unique information regarding cellular environment and molecular mobility. Echo-time (TE) averaging (1) H MRS involves the collection and averaging of multiple TE steps, which greatly simplifies resulting spectra due to the attenuation of spin-coupled and macromolecule resonances. Given the simplified spectral appearance and inherent metabolite T2 relaxation information, the aim of the present proof-of-concept study was to develop a novel data processing scheme to estimate metabolite T2 relaxation times from TE-averaged (1) H MRS data. Spectral simulations are used to validate the proposed TE-averaging methods for estimating methyl proton T2 relaxation times for N-acetyl aspartate, total creatine, and choline-containing compounds. The utility of the technique and its reproducibility are demonstrated using data obtained in vivo from the posterior-occipital cortex of 10 healthy control subjects. Compared with standard methods, distinct advantages of this approach include built-in macromolecule resonance attenuation, in vivo T2 estimates closer to reported values when maximum TE ≈ T2 , and the potential for T2 calculation of metabolite resonances otherwise inseparable in standard (1) H MRS spectra recorded in vivo.
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Affiliation(s)
- Andrew P. Prescot
- Brain Institute, University of Utah, Salt Lake City, UT, USA
- Department of Radiology, University of Utah School of Medicine, Salt lake City, UT, USA
| | - Xianfeng Shi
- Brain Institute, University of Utah, Salt Lake City, UT, USA
- Department of Psychiatry, University of Utah School of Medicine, Salt lake City, UT, USA
| | - Changho Choi
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Perry. F. Renshaw
- Brain Institute, University of Utah, Salt Lake City, UT, USA
- Department of Psychiatry, University of Utah School of Medicine, Salt lake City, UT, USA
- VISN 19 MIRECC, Salt Lake City, UT, USA
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16
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Rae CD. A Guide to the Metabolic Pathways and Function of Metabolites Observed in Human Brain 1H Magnetic Resonance Spectra. Neurochem Res 2013; 39:1-36. [PMID: 24258018 DOI: 10.1007/s11064-013-1199-5] [Citation(s) in RCA: 324] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 11/08/2013] [Accepted: 11/11/2013] [Indexed: 12/20/2022]
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17
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Good P. Does infectious fever relieve autistic behavior by releasing glutamine from skeletal muscles as provisional fuel? Med Hypotheses 2013; 80:1-12. [DOI: 10.1016/j.mehy.2012.08.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 08/25/2012] [Accepted: 08/30/2012] [Indexed: 01/01/2023]
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