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Emeliyanova P, Parkes LM, Williams SR, Lea-Carnall C. Evidence for biexponential glutamate T 2 relaxation in human visual cortex at 3T: A functional MRS study. NMR IN BIOMEDICINE 2024:e5240. [PMID: 39188210 DOI: 10.1002/nbm.5240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 04/30/2024] [Accepted: 08/02/2024] [Indexed: 08/28/2024]
Abstract
Functional magnetic resonance spectroscopy (fMRS) measures dynamic changes in metabolite concentration in response to neural stimulation. The biophysical basis of these changes remains unclear. One hypothesis suggests that an increase or decrease in the glutamate signal detected by fMRS could be due to neurotransmitter movements between cellular compartments with different T2 relaxation times. Previous studies reporting glutamate (Glu) T2 values have generally sampled at echo times (TEs) within the range of 30-450 ms, which is not adequate to observe a component with short T2 (<20 ms). Here, we acquire MRS measurements for Glu, (t) total creatine (tCr) and total N-acetylaspartate (tNAA) from the visual cortex in 14 healthy participants at a range of TE values between 9.3-280 ms during short blocks (64 s) of flickering checkerboards and rest to examine both the short- and long-T2 components of the curve. We fit monoexponential and biexponential Glu, tCr and tNAA T2 relaxation curves for rest and stimulation and use Akaike information criterion to assess best model fit. We also include power calculations for detection of a 2% shift of Glu between compartments for each TE. Using pooled data over all participants at rest, we observed a short Glu T2-component with T2 = 10 ms and volume fraction of 0.35, a short tCr T2-component with T2 = 26 ms and volume fraction of 0.25 and a short tNAA T2-component around 15 ms with volume fraction of 0.34. No statistically significant change in Glu, tCr and tNAA signal during stimulation was detected at any TE. The volume fractions of short-T2 component between rest and active conditions were not statistically different. This study provides evidence for a short T2-component for Glu, tCr and tNAA but no evidence to support the hypothesis of task-related changes in glutamate distribution between short and long T2 compartments.
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Affiliation(s)
- Polina Emeliyanova
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland
- Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Laura M Parkes
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland
- Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Stephen R Williams
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Caroline Lea-Carnall
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland
- Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom of Great Britain and Northern Ireland
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Collée M, Rajkumar R, Farrher E, Hagen J, Ramkiran S, Schnellbächer GJ, Khudeish N, Shah NJ, Veselinović T, Neuner I. Predicting performance in attention by measuring key metabolites in the PCC with 7T MRS. Sci Rep 2024; 14:17099. [PMID: 39048626 PMCID: PMC11269673 DOI: 10.1038/s41598-024-67866-1] [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: 12/01/2023] [Accepted: 07/16/2024] [Indexed: 07/27/2024] Open
Abstract
The posterior cingulate cortex (PCC) is a key hub of the default mode network and is known to play an important role in attention. Using ultra-high field 7 Tesla magnetic resonance spectroscopy (MRS) to quantify neurometabolite concentrations, this exploratory study investigated the effect of the concentrations of myo-inositol (Myo-Ins), glutamate (Glu), glutamine (Gln), aspartate or aspartic acid (Asp) and gamma-amino-butyric acid (GABA) in the PCC on attention in forty-six healthy participants. Each participant underwent an MRS scan and cognitive testing, consisting of a trail-making test (TMT A/B) and a test of attentional performance. After a multiple regression analysis and bootstrapping for correction, the findings show that Myo-Ins and Asp significantly influence (p < 0.05) attentional tasks. On one hand, Myo-Ins shows it can improve the completion times of both TMT A and TMT B. On the other hand, an increase in aspartate leads to more mistakes in Go/No-go tasks and shows a trend towards enhancing reaction time in Go/No-go tasks and stability of alertness without signal. No significant (p > 0.05) influence of Glu, Gln and GABA was observed.
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Affiliation(s)
- M Collée
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
| | - R Rajkumar
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
- JARA - BRAIN - Translational Medicine, Aachen, Germany
| | - E Farrher
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
| | - J Hagen
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
| | - S Ramkiran
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
| | - G J Schnellbächer
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
| | - N Khudeish
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
| | - N J Shah
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
- JARA - BRAIN - Translational Medicine, Aachen, Germany
- Institute of Neuroscience and Medicine 11, INM-11, Forschungszentrum Jülich, Jülich, Germany
- Department of Neurology, RWTH Aachen University, Aachen, Germany
| | - T Veselinović
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
- JARA - BRAIN - Translational Medicine, Aachen, Germany
| | - I Neuner
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany.
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich GmbH, 52425, Jülich, Germany.
- JARA - BRAIN - Translational Medicine, Aachen, Germany.
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Gogishvili A, Farrher E, Doppler CEJ, Seger A, Sommerauer M, Shah NJ. Quantification of the neurochemical profile of the human putamen using STEAM MRS in a cohort of elderly subjects at 3 T and 7 T: Ruminations on the correction strategy for the tissue voxel composition. PLoS One 2023; 18:e0286633. [PMID: 37267283 DOI: 10.1371/journal.pone.0286633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 05/19/2023] [Indexed: 06/04/2023] Open
Abstract
The aim of this work is to quantify the metabolic profile of the human putamen in vivo in a cohort of elderly subjects using single-voxel proton magnetic resonance spectroscopy. To obtain metabolite concentrations specific to the putamen, we investigated a correction method previously proposed to account for the tissue composition of the volume of interest. We compared the method with the conventional approach, which a priori assumes equal metabolite concentrations in GM and WM. Finally, we compared the concentrations acquired at 3 Tesla (T) and 7 T MRI scanners. Spectra were acquired from 15 subjects (age: 67.7 ± 8.3 years) at 3 T and 7 T, using an ultra-short echo time, stimulated echo acquisition mode sequence. To robustly estimate the WM-to-GM metabolite concentration ratio, five additional subjects were measured for whom the MRS voxel was deliberately shifted from the putamen in order to increase the covered amount of surrounding WM. The concentration and WM-to-GM concentration ratio for 16 metabolites were reliably estimated. These ratios ranged from ~0.3 for γ-aminobutyric acid to ~4 for N-acetylaspartylglutamate. The investigated correction method led to significant changes in concentrations compared to the conventional method, provided that the ratio significantly differed from unity. Finally, we demonstrated that differences in tissue voxel composition cannot fully account for the observed concentration difference between field strengths. We provide not only a fully comprehensive quantification of the neurochemical profile of the putamen in elderly subjects, but also a quantification of the WM-to-GM concentration ratio. This knowledge may serve as a basis for future studies with varying tissue voxel composition, either due to tissue atrophy, inconsistent voxel positioning or simply when pooling data from different voxel locations.
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Affiliation(s)
- Ana Gogishvili
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich, Jülich, Germany
- Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Engineering Physics Department, Georgian Technical University, Tbilisi, Georgia
| | - Ezequiel Farrher
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich, Jülich, Germany
| | - Christopher E J Doppler
- Cognitive Neuroscience, Institute of Neuroscience and Medicine 3, INM-3, Forschungszentrum Jülich, Jülich, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Aline Seger
- Cognitive Neuroscience, Institute of Neuroscience and Medicine 3, INM-3, Forschungszentrum Jülich, Jülich, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Sommerauer
- Cognitive Neuroscience, Institute of Neuroscience and Medicine 3, INM-3, Forschungszentrum Jülich, Jülich, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich, Jülich, Germany
- Institute of Neuroscience and Medicine 11, INM-11, JARA, Forschungszentrum Jülich, Jülich, Germany
- JARA - BRAIN - Translational Medicine, Aachen, Germany
- Department of Neurology, RWTH Aachen University, Aachen, Germany
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Gras V, Farrher E, Grinberg F, Shah NJ. Diffusion-weighted DESS protocol optimization for simultaneous mapping of the mean diffusivity, proton density and relaxation times at 3 Tesla. Magn Reson Med 2016; 78:130-141. [PMID: 27476684 DOI: 10.1002/mrm.26353] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 06/16/2016] [Accepted: 07/01/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE To design a general framework for the optimization of an MRI protocol based on the the diffusion-weighted dual-echo steady-state (DW-DESS) sequence, enabling quantitative and simultaneous mapping of proton density (PD), relaxation times T1 and T2 and diffusion coefficient D. METHODS A parameterization of the DW-DESS sequence minimizing the Cramér-Rao lower bound of each parameter estimate was proposed and tested in a phantom experiment. An extension of the protocol was implemented for brain imaging to return the rotationally invariant mean diffusivity (MD). RESULTS In an NiCl2 -doped agar gel phantom wherein T1/T2=920/65 ms, the parameter estimation errors were below 3% for PD and T1 and below 7% for T2 and D while the measured signal-to-noise ratio always exceeded 20. In the human brain, the in vivo parametric maps obtained were overall in reasonable agreement with gold standard measurements, despite a broadening of the distributions due to physiological motion. CONCLUSION Within the optimization framework presented here, DW-DESS images can be quantitatively interpreted to yield four intrinsic parameters of the tissue. Currently, the method is limited by the sensitivity of the DW-DESS sequence in terms of physiological motion. Magn Reson Med 78:130-141, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Vincent Gras
- Institute of Neuroscience and Medicine - 4, Medical Imaging Physics, Forschungszentrum Jülich GmbH, Jülich, Germany.,UNIRS, Institut d'Imagerie Biomédicale, Neurospin, CEA Saclay, Gif-sur-Yvette, France
| | - Ezequiel Farrher
- Institute of Neuroscience and Medicine - 4, Medical Imaging Physics, Forschungszentrum Jülich GmbH, Jülich, Germany
| | - Farida Grinberg
- Institute of Neuroscience and Medicine - 4, Medical Imaging Physics, Forschungszentrum Jülich GmbH, Jülich, Germany.,Department of Neurology, Faculty of Medicine, JARA, RWTH Aachen University, Aachen, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine - 4, Medical Imaging Physics, Forschungszentrum Jülich GmbH, Jülich, Germany.,Department of Neurology, Faculty of Medicine, JARA, RWTH Aachen University, Aachen, Germany
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Ramadan S, Ratai EM, Wald LL, Mountford CE. In vivo 1D and 2D correlation MR spectroscopy of the soleus muscle at 7T. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2010; 204:91-8. [PMID: 20206561 PMCID: PMC3741347 DOI: 10.1016/j.jmr.2010.02.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Revised: 01/07/2010] [Accepted: 02/09/2010] [Indexed: 05/14/2023]
Abstract
AIM This study aims to (1) undertake and analyse 1D and 2D MR correlation spectroscopy from human soleus muscle in vivo at 7T, and (2) determine T1 and T2 relaxation time constants at 7T field strength due to their importance in sequence design and spectral quantitation. METHOD Six healthy, male volunteers were consented and scanned on a 7T whole-body scanner (Siemens AG, Erlangen, Germany). Experiments were undertaken using a 28cm diameter detunable birdcage coil for signal excitation and an 8.5cm diameter surface coil for signal reception. The relaxation time constants, T1 and T2 were recorded using a STEAM sequence, using the 'progressive saturation' method for the T1 and multiple echo times for T2. The 2D L-Correlated SpectroscopY (L-COSY) method was employed with 64 increments (0.4ms increment size) and eight averages per scan, with a total time of 17min. RESULTS T1 and T2 values for the metabolites of interest were determined. The L-COSY spectra obtained from the soleus muscle provided information on lipid content and chemical structure not available, in vivo, at lower field strengths. All molecular fragments within multiple lipid compartments were chemically shifted by 0.20-0.26ppm at this field strength. 1D and 2D L-COSY spectra were assigned and proton connectivities were confirmed with the 2D method. CONCLUSION In vivo 1D and 2D spectroscopic examination of muscle can be successfully recorded at 7T and is now available to assess lipid alterations as well as other metabolites present with disease. T1 and T2 values were also determined in soleus muscle of male healthy volunteers.
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Affiliation(s)
- Saadallah Ramadan
- Centre for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 4 Blackfan St., H.I.M., 8th Floor, Boston, MA 02115, USA.
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Ratiney H, Noworolski SM, Sdika M, Srinivasan R, Henry RG, Nelson SJ, Pelletier D. Estimation of metabolite T1 relaxation times using tissue specific analysis, signal averaging and bootstrapping from magnetic resonance spectroscopic imaging data. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2007; 20:143-55. [PMID: 17602253 PMCID: PMC2798973 DOI: 10.1007/s10334-007-0076-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Revised: 04/20/2007] [Accepted: 04/26/2007] [Indexed: 11/05/2022]
Abstract
Object A novel method of estimating metabolite T1 relaxation times using MR spectroscopic imaging (MRSI) is proposed. As opposed to conventional single-voxel metabolite T1 estimation methods, this method investigates regional and gray matter (GM)/white matter (WM) differences in metabolite T1 by taking advantage of the spatial distribution information provided by MRSI. Material and methods The method, validated by Monte Carlo studies, involves a voxel averaging to preserve the GM/WM distribution, a non-linear least squares fit of the metabolite T1 and an estimation of its standard error by bootstrapping. It was applied in vivo to estimate the T1 of N-acetyl compounds (NAA), choline, creatine and myo-inositol in eight normal volunteers, at 1.5 T, using a short echo time 2D-MRSI slice located above the ventricles. Results WM-T1,NAA was significantly (P < 0.05) longer in anterior regions compared to posterior regions of the brain. The anterior region showed a trend of a longer WM T1 compared to GM for NAA, creatine and myo-Inositol. Lastly, accounting for the bootstrapped standard error estimate in a group mean T1 calculation yielded a more accurate T1 estimation. Conclusion The method successfully measured in vivo metabolite T1 using MRSI and can now be applied to diseased brain.
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Affiliation(s)
- H. Ratiney
- Department of Neurology, University of California, 185 Berry Street, Box 0946, San Francisco, 94107 CA USA
| | - S. M. Noworolski
- Department of Radiology, University of California, San Francisco, CA USA
| | - M. Sdika
- Department of Neurology, University of California, 185 Berry Street, Box 0946, San Francisco, 94107 CA USA
| | - R. Srinivasan
- Department of Radiology, University of California, San Francisco, CA USA
| | - R. G. Henry
- Department of Radiology, University of California, San Francisco, CA USA
| | - S. J. Nelson
- Department of Radiology, University of California, San Francisco, CA USA
| | - D. Pelletier
- Department of Neurology, University of California, 185 Berry Street, Box 0946, San Francisco, 94107 CA USA
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Viau M, Marchand L, Bard C, Boulanger Y. (1)H magnetic resonance spectroscopy of autosomal ataxias. Brain Res 2005; 1049:191-202. [PMID: 15963476 DOI: 10.1016/j.brainres.2005.05.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Revised: 05/06/2005] [Accepted: 05/09/2005] [Indexed: 11/24/2022]
Abstract
Multiple forms of autosomal ataxia exist which can be identified by genetic testing. Due to their wide variety, the identification of the appropriate genetic test is difficult but could be aided by magnetic resonance data. In this study, magnetic resonance spectroscopy (MRS) and imaging (MRI) data were recorded for 20 ataxia patients of six different types and compared to 20 normal subjects. Spectra were acquired in the pons, left frontal lobe, left basal ganglia, left cerebellar hemisphere and vermis. Both metabolite spectra and absolute metabolite concentrations were determined. Differences in metabolite levels were observed between ataxia patients and control subjects and between ataxia patients of different types. A number of correlations were found between metabolite ratios, atrophy levels, number of repeats on the small and large allele, age at examination, symptoms duration and age at symptoms onset for ataxia patients. These MR characteristics are expected to be useful for the identification of the ataxia type.
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Affiliation(s)
- Martin Viau
- Département de radiologie, Hôpital Saint-Luc du CHUM, 1058 St-Denis, Montréal, Québec, Canada H2X 3J4
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Knight-Scott J, Dunham SA, Shanbhag DD. Increasing the speed of relaxometry-based compartmental analysis experiments in STEAM spectroscopy. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2005; 173:169-174. [PMID: 15705525 DOI: 10.1016/j.jmr.2004.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Revised: 11/30/2004] [Indexed: 05/24/2023]
Abstract
In this work we present a method for improving the speed of spin-spin relaxation time (T2) measurements for compartmental analysis in stimulated echo localized magnetic resonance spectroscopy without reducing the sampling density. The technique uses a progressive repetition time (TR) to compensate for echo time (TE) dependent variations in saturation effects that would otherwise modulate the received signal at short TRs. The method was validated in T2 studies on 10 young healthy subjects in spectroscopic voxels localized along either the right or left Sylvian fissure (2 x 2 x 1.5 cm3, 10 ms mixing time (TM), 2048 data points, 819.2 ms acquisition time). The TR was automatically adjusted so that TR-TM-TE/2 was kept constant as the TE was incremented. Compared to long TR T2 experiments, the progressive TR technique consistently replicated the T2 relaxation times and reference signals of the tissue water compartment while reducing the data acquisition time by more than 50%. The percent error was on average less than 2% for estimates of T2 and S(0) for the tissue water, an indication that the progressive TR technique is a useful method for determining the tissue water signal for internal referencing.
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Affiliation(s)
- Jack Knight-Scott
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908, USA.
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Knight-Scott J. Application of multiple inversion recovery for suppression of macromolecule resonances in short echo time (1)H NMR spectroscopy of human brain. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 1999; 140:228-234. [PMID: 10479566 DOI: 10.1006/jmre.1999.1799] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Macromolecules contribute broad "background" resonances to the (1)H NMR brain spectra at short echo times. The application of long echo times is the most widely used method for removing these resonances. Here, it is demonstrated that these background resonances may be suppressed at short echo times using multiple inversion recovery (MIR). In the technique presented, the MIR sequence consists of four adiabatic inversion pulses, applied preparatory to a 20-ms echo time stimulated echo localization sequence. The inversion times (359, 157, 69, and 20 ms) were selected to preferentially suppress macromolecules with longitudinal relaxation times between 38 and 300 ms. While the resulting spectra have lower overall signal-to-noise, baseline contributions from macromolecules are greatly reduced. Unlike the typical long TE acquisitions, the short TE MIR acquisition preserves the myo-inositol resonance.
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Affiliation(s)
- J Knight-Scott
- Department of Radiology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA
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