Localized in vivo 1H spectroscopy of human skeletal muscle: normal and pathologic findings

Investigation of the effect of taurine supplementation on muscle taurine content in the mdx mouse model of Duchenne muscular dystrophy using chemically specific synchrotron imaging

Duchenne muscular dystrophy (DMD) is a lethal genetic muscle wasting disorder, which currently has no cure. Supplementation with the drug taurine has been shown to offer therapeutic benefit in the mdx model for DMD, however the mechanism by which taurine protects dystrophic muscle is not fully understood. Mdx muscle is deficient in taurine, however it is not known if this deficiency occurs in the extracellular space, in other cells present in the tissue (such as immune cells) or in the myofibre itself. Likewise, the tissue location of taurine enrichment in taurine treated mdx muscle is not known. In this study we applied X-ray absorption near edge spectroscopy (XANES) at the sulfur K-edge in an imaging format to determine taurine distribution in muscle tissue. XANES is the only technique currently capable of imaging taurine directly in muscle tissue, at a spatial resolution approaching myocyte cell size (20-50 μm). Using a multi-modal approach of XANES imaging and histology on the same tissue sections, we show that in mdx muscle, it is the myofibres that are deficient in taurine, and taurine supplementation ameliorates this deficiency. Increasing the taurine content of mdx myofibres was associated with a decrease in myofibre damage (as shown by the percentage of intact myofibres) and inflammation. These data will help drive future studies to better elucidate the molecular mechanisms through which taurine protects dystrophic muscle; they also support the continued investigation of taurine as a therapeutic intervention for DMD.

Navigator-free metabolite-cycled proton spectroscopy of the heart

PURPOSE

Respiratory gating in cardiac water-suppressed (WS) proton spectroscopy leads to long and unpredictable scan times. Metabolite cycling allows to perform frequency and phase correction on the water signal and, hence, offers an approach to navigator-free cardiac spectroscopy with fixed scan time. The objective of the present study was to develop and implement navigator-free metabolite-cycled cardiac proton spectroscopy (MC nonav) and compare it with standard navigator-gated WS (WS nav) and navigator-free WS (WS nonav) measurements for the assessment of triglyceride-to-water ratios (TG/W) and creatine-to-water ratios (CR/W) in the intraventricular septum of the in vivo heart.

METHODS

Navigator-free metabolite-cycled spectroscopy was implemented on a clinical 1.5T system. In vivo measurements were performed on 10 young and 5 older healthy volunteers to assess signal-to-noise ratio efficiency as well as TG/W and CR/W and the relative Cramér-Rao lower bounds for CR. The performance of the metabolite-cycled sequence was verified using simulations.

RESULTS

On average, scan times of MC nonav were 3.4 times shorter compared with WS nav, while no significant bias for TG/W was observed (coefficient of variation = 14.0%). signal-to-noise ratio efficiency of both TG and CR increased for MC nonav compared with WS nav. Relative Cramér-Rao lower bounds of CR decreased for MC nonav. Overall spectral quality was found comparable between MC nonav and WS nav, while it was inferior for WS nonav.

CONCLUSION

Navigator-free metabolite-cycled cardiac proton spectroscopy offers 3.4-fold accelerated assessment of TG/W and CR/W in the heart with preserved spectral quality when compared with navigator-gated WS scans.

Advancements in magnetic resonance imaging-based biomarkers for muscular dystrophy

Recent years have seen steady progress in the identification of genetic muscle diseases as well as efforts to develop treatment for these diseases. Consequently, sensitive and objective new methods are required to identify and monitor muscle pathology. Magnetic resonance imaging offers multiple potential biomarkers of disease severity in the muscular dystrophies. This Review uses a pathology-based approach to examine the ways in which MRI and spectroscopy have been used to study muscular dystrophies. Methods that have been used to quantitate intramuscular fat, edema, fiber orientation, metabolism, fibrosis, and vascular perfusion are examined, and this Review describes how MRI can help diagnose these conditions and improve upon existing muscle biomarkers by detecting small increments of disease-related change. Important challenges in the implementation of imaging biomarkers, such as standardization of protocols and validating imaging measurements with respect to clinical outcomes, are also described.

A minimum-phase Shinnar-Le Roux spectral-spatial excitation RF pulse for simultaneous water and lipid suppression in 1H-MRSI of body extremities

PURPOSE

To develop a spectral-spatial (SPSP) excitation RF pulse for simultaneous water and lipid suppression in proton (1H) magnetic resonance spectroscopic imaging (MRSI) of body extremities.

METHODS

An SPSP excitation pulse is designed to excite Creatine (Cr) and Choline (Cho) metabolite signals while suppressing the overwhelming water and lipid signals. The SPSP pulse is designed using a recently proposed multidimensional Shinnar-Le Roux (SLR) RF pulse design method. A minimum-phase spectral selectivity profile is used to minimize signal loss from T2⁎ decay.

RESULTS

The performance of the SPSP pulse is evaluated via Bloch equation simulations and phantom experiments. The feasibility of the proposed method is demonstrated using three-dimensional, short repetition-time, free induction decay-based 1H-MRSI in the thigh muscle at 3T.

CONCLUSION

The proposed SPSP excitation pulse is useful for simultaneous water and lipid suppression. The proposed method enables new applications of high-resolution 1H-MRSI in body extremities.

Advanced MRI Techniques for Muscle Imaging

Advanced magnetic resonance imaging (MRI) techniques can evaluate a wide array of muscle pathologies including acute or chronic muscle injury, musculotendinous response to injury, intramuscular collections and soft tissue masses, and others. In recent years, MRI has played a more important role in muscle disease diagnosis and monitoring. MRI provides excellent spatial and contrast resolution and helps direct optimal sites for muscle biopsy. Whole-body MRI now helps identify signature patterns of muscular involvement in large anatomical regions with relative ease. Quantitative MRI has advanced the evaluation and disease tracking of muscle atrophy and fatty infiltration in entities such as muscular dystrophies. Multivoxel magnetic resonance spectroscopy (MRS) now allows a more thorough, complete evaluation of a muscle of interest without the inherent sampling bias of single-voxel MRS or biopsy. Diffusion MRI allows quantification of muscle inflammation and capillary perfusion as well as muscle fiber tracking.

Quick water-selective excitation of fast relaxing tissues with 3D UTE sequences

PURPOSE

The aim of this study was to implement a time effective 1-1 double pulse water-selective excitation (WE) into a three-dimensional ultrashort echo time (UTE) sequence (WE-UTE) for visualization of short-T2 tissues with positive contrast and sufficient suppression of surrounding fat.

METHODS

First, an analytical description of magnetization components in the steady state applying WE-UTE was derived and results were compared with numerical simulations based on Bloch's equations. Parameters were optimized for best positive contrast between short-T2 tissues and fat under consideration of variable relaxation properties over a broad range. Maximal signal yield and signal efficiency of on-resonant protons were compared with UTE sequences with and without off-resonance fat saturation (FatSat). WE-UTE was exemplarily applied for in-vivo musculoskeletal imaging on a 3T whole-body MR unit.

RESULTS

Steady state magnetization of WE-UTE could be described analytically and showed excellent accordance with numerical simulations. Even for tissues with T2 = 1 ms WE-UTE resulted in 79% of maximal signal yield of UTE without FatSat and was more efficient regarding signal yield if compared with UTE with FatSat. Using WE-UTE in-vivo tendons and ligaments could be well delineated with positive contrast to surrounding fat.

CONCLUSION

WE-UTE provides a quick method for visualizing short-T2 tissues with positive contrast.

Role of MR spectroscopy in musculoskeletal imaging

Magnetic resonance spectroscopy (MRS) is an imaging approach that allows for the noninvasive molecular characterization of a region of interest. By detecting signals of water, lipids, and other metabolites, MRS can provide metabolic information for lesion characterization and assessment of treatment response. Although MRS has been routinely used in the brain, clinical applications within the musculoskeletal system have only more recently emerged. The aim of this article is to review the technical considerations for performing MRS in the musculoskeletal system, focusing on proton MRS, and to discuss its potential roles in musculoskeletal tumor imaging and the assessment of muscle physiology and disease.

Chemical shift-based MRI to measure fat fractions in dystrophic skeletal muscle

PURPOSE

The relationship between fat fractions (FFs) determined based on multiple TE, unipolar gradient echo images and (1) H magnetic resonance spectroscopy (MRS) was evaluated using different models for fat-water decomposition, signal-to-noise ratios, and excitation flip angles.

METHODS

A combination of single-voxel proton spectroscopy ((1) H-MRS) and gradient echo imaging was used to determine muscle FFs in both normal and dystrophic muscles. In order to cover a large range of FFs, the soleus and vastus lateralis muscles of 22 unaffected control subjects, 16 subjects with collagen VI deficiency (COL6), and 71 subjects with Duchenne muscular dystrophy (DMD) were studied. (1) H-MRS-based FF were corrected for the increased muscle (1) H2 O T1 and T2 values observed in dystrophic muscles.

RESULTS

Excellent agreement was found between coregistered FFs derived from gradient echo images fit to a multipeak model with noise bias correction and the relaxation-corrected (1) H-MRS FFs (y = 0.93x + 0.003; R(2)  = 0.96) across the full range of FFs. Relaxation-corrected (1) H-MRS FFs and imaging-based FFs were significantly elevated (P < 0.01) in the muscles of COL6 and DMD subjects.

CONCLUSION

FFs, T2 , and T1 were all sensitive to muscle involvement in dystrophic muscle. MRI offered an additional advantage over single-voxel spectroscopy in that the tissue heterogeneity in FFs could be readily determined.

Magnetic resonance imaging of pediatric muscular disorders: recent advances and clinical applications

This review describes various quantitative magnetic resonance imaging techniques that can be used to objectively analyze the composition (T2 relaxation time mapping, Dixon imaging, and diffusion-weighted imaging), architecture (diffusion tensor imaging), mechanical properties (magnetic resonance elastography), and function (magnetic resonance spectroscopy) of normal and pathologic skeletal muscle in the pediatric population.

Cardiac proton spectroscopy using large coil arrays

Large coil arrays are widely used in clinical routine for cardiovascular imaging providing extended spatial coverage and enabling accelerated acquisition using parallel imaging approaches. This work investigates the use of large coil arrays in single-voxel cardiac spectroscopy for the detection of myocardial creatine and triglyceride content. For this purpose, a navigator-gated and cardiac-triggered point-resolved spectroscopy sequence was implemented, and data obtained in 11 healthy volunteers using 32- and 5-element coil arrays were compared. For combination of the individual coil element signals, four strategies were evaluated differing in the manner of estimation of the complex coil weights and the amount of additional information required for coil combination. In all volunteers, and with both the 32- and 5-channel coil arrays, triglyceride-to-water (0.44 ± 0.19% and 0.45 ± 0.17%) and total creatine-to-water (0.05 ± 0.02% and 0.05 ± 0.01%) contents were computed. The values were found to agree well, showing an intraclass correlation coefficient of 0.76 (p < 0.003). The results revealed a gain in signal-to-noise ratio of approximately 24% with the 32-channel coil relative to the 5-channel array. The findings may foster the integration of cardiac spectroscopy into clinical practice using large coil arrays, provided that appropriate reconstruction algorithms are implemented.

Proton MR spectroscopy in metabolic assessment of musculoskeletal lesions

OBJECTIVE

The purposes of this review are to describe the principles and method of MR spectroscopy, summarize current published data on musculoskeletal lesions, and report additional cases that have been analyzed with recently developed quantitative methods.

CONCLUSION

Proton MR spectroscopy can be used to identify key tissue metabolites and may serve as a useful adjunct to radiographic evaluation of musculoskeletal lesions. A pooled analysis of 122 musculoskeletal tumors revealed that a discrete choline peak has a sensitivity of 88% and specificity of 68% in the detection of malignancy. Modest improvements in diagnostic accuracy in 22 of 122 cases when absolute choline quantification was used encourage the pursuit of development of choline quantification methods.

Metabolic MR imaging of regional triglyceride and creatine content in the human heart

An optimized echo-planar spectroscopic imaging sequence is proposed to facilitate spatial mapping of triglyceride and total creatine content in the human heart. The sequence integrates local-look field of view reduction, cardiac and respiratory gating, and dedicated reconstruction steps to account for gradient channel delays, field inhomogeneity, and phase incoherence due to residual motion. The technique is demonstrated in 12 volunteers in comparison to single voxel point-resolved spectroscopy in the septal wall at 1.5 T. Triglyceride-to-water and total creatine-to-water ratios derived from echo-planar spectroscopic imaging (0.48 ± 0.18% and 0.06 ± 0.03%) and point-resolved spectroscopy (0.52 ± 0.17% and 0.07 ± 0.02%) were found to agree well. In the septal region, intraclass correlation coefficients ranging from 0.67 to 0.72 were estimated. A relatively weak agreement (intraclass correlation coefficients: 0.34 and 0.52) was found for sectors in the lateral wall due to field gradients induced by the posterior vein and limited sensitivity of the receive coil array in this area. On the basis of the findings, it is concluded that fast spectroscopic imaging of both cardiac triglyceride and total creatine content is feasible. Shimming and sensitivity challenges in the lateral region remain, however, to be addressed.

Quantification of muscle choline concentrations by proton MR spectroscopy at 3 T: technical feasibility

OBJECTIVE

The quantification of choline in musculoskeletal tissues has several potential uses, including characterizing malignancy, but has not been previously achievable. We present a method of measuring the absolute concentration of choline by proton MR spectroscopy (MRS) in skeletal muscle at 3 T.

MATERIALS AND METHODS

At 3 T, choline measurements were performed in phantoms and healthy volunteers using proton MRS (point-resolved spectroscopy sequence [PRESS]; TR/TE, 2,000/135). In vitro choline concentrations were measured in three phantom solutions (10, 5, 1.25 mmol). Choline T1 and T2 relaxation times were measured in the muscles of five healthy subjects. In vivo choline concentrations were measured using water as an internal reference and average T1 and T2 relaxation times in 20 muscle locations (quadriceps, hamstring, adductor) of seven healthy subjects (four men, three women). Descriptive statistics are reported.

RESULTS

In vitro, the average measured choline concentrations of the 10-, 5-, and 1.25-mmol solutions were 9.91, 5.03, and 1.22 mmol, respectively. In vivo, the average T1 and T2 relaxation times of choline were 1,372+/-57 (SD) and 134+/-11 milliseconds, respectively. The average choline concentrations in the quadriceps and hamstring muscles were 10.0+/-0.4 (SD) and 8.0+/-2.9 mmol/kg. Interindividual variation existed in the choline concentrations (quadriceps range, 6.7-13 mmol/kg), but there was little variation by patient sex.

CONCLUSION

In the musculoskeletal system, the measurement of choline concentration by proton MRS at 3 T is feasible using water as an internal reference. These data provide a quantitative basis for future investigations of metabolite concentrations in normal and diseased musculoskeletal tissues.

Magnetization transfer effect on the creatine methyl resonance studied by CW off-resonance irradiation in human skeletal muscle on a clinical MR system

Magnetization transfer (MT) between the mobile (MR-visible) spin pool and immobile (MR-invisible) spin pool of creatine (Cr) was studied on a clinical 1.5 T MR scanner in human skeletal muscle using continuous wave (CW) pre-irradiation as the saturation method for the immobile pool. For this purpose, only slight modifications to the MR system were made. A specially designed electronic circuit was used to couple a CW amplifier to the RF channel of the scanner. The CW pulse power (gammaB(2)/2pi) and pulse length were determined to be approximately 550 Hz and 3 s, respectively, for optimal signal attenuation of the Cr methyl signal. The bound Cr fraction in human gastrocnemius muscle was determined to be 0.4-1.3% using a two-pool exchange model function to describe the MT effect.

The carnosine C-2 proton's chemical shift reports intracellular pH in oxidative and glycolytic muscle fibers

The appearance of new peaks in the 7.7-8.6 and 6.8-7.4 ppm regions of the postexercise (1)H spectrum of frog muscle is reported. These new peaks result from the splitting of single pre-exercise carnosine C-2 and C-4 peaks into two peaks, representing the intracellular pH (pH(I)) of oxidative and glycolytic fibers. The following data support this conclusion: 1) comparison of means and regression analysis indicates equivalence of the pH(I) measurements by (1)H and (31)P NMR; 2) the pre- and poststimulation concentrations of carnosine are equal; 3) in ischemic rat hindlimb muscles, the presence of a single, more acidic peak in the plantaris; a single, less acidic peak in the soleus; and two peaks (more and less acidic) in the gastrocnemius correspond to published values for the fiber-type composition of these muscles; and 4) in muscles treated with iodoacetate prior to and during stimulation, a second peak never appears. These data indicate that it is feasible to measure separately the pH(I) of oxidative and glycolytic fibers using (1)H NMR spectroscopy.

Investigation of skeletal muscle denervation and reinnervation using magnetic resonance spectroscopy

OBJECTIVE

To determine changes in skeletal muscle metabolism after nerve transection and repair and to correlate metabolic changes with functional recovery.

STUDY DESIGN AND SETTING

Male Wistar rats were divided into 6 experimental groups plus a control group. The posterior tibial nerve was transected and reapproximated. At varying times after surgery (1, 2, 4, 6, or 8 weeks) animals were sacrificed, the gastrocnemius muscle was harvested, and proton nuclear magnetic resonance (NMR) spectroscopy was performed. Functional recovery was measured using the sciatic function index.

RESULTS

Animals undergoing nerve repair all showed functional recovery whereas the nonrepaired nerve group did not. Concentration of glucose and lactate increased after denervation and then returned toward normal. Choline concentration decreased and then returned toward normal. In animals not undergoing nerve repair, the metabolic abnormalities persisted and showed no sign of recovery over the 8-week observation period.

CONCLUSIONS

1H NMR spectroscopy is a potentially useful tool to study changes in skeletal muscle metabolism after motor nerve injury.

SIGNIFICANCE

NMR spectroscopy is rapidly developing into a clinically useful tool. High-field magnets have improved resolution and data acquisition. Basic experiments, such as those described here, will help guide the use of NMR spectroscopy in clinical medicine and will also lead to a better understanding of basic mechanisms of nerve injury and repair.

Lactate editing and lipid suppression by continuous wavelet transform analysis: application to simulated and (1)H MRS brain tumor time-domain data

Determination of lactate concentrations in vivo is required in the noninvasive diagnosis, staging, and therapeutic monitoring of diseases such as cancer, heart disease, and stroke. An iterative filtering process based on the continuous wavelet transform (CWT) method in the time domain is proposed to isolate the lactate doublet signal from overlapping lipid resonances and estimate the magnetic resonance spectroscopy (MRS) parameters of the lactate methyl signal (signal amplitude, chemical shift, J-coupling and apparent transverse relaxation time (T*(2))). This method offers a number of advantages over the multiple quantum (MQ) and difference spectroscopy approaches, including: 1) full recovery of the lactate methyl signal, whereas the MQ methods usually detect 50% of the signal intensity; 2) in contrast to MQ methods, the lipid signal is retained together with J-coupling data on the lactate peak; 3) the CWT method is much less sensitive to motion artifacts than difference spectroscopy. Application of the method to simulated and real (1)H MRS data collected from human blood plasma and brain tumors demonstrated that this filter provides accurate estimates of the MRS parameters of the lactate doublet and efficiently removes lipid contributions.

An interleaved sampling strategy for MR spectroscopy in vivo: applications on human calf musculature

Assessment of relaxation times, magnetization transfer rates, or apparent diffusion coefficients by volume selective (1)H MR spectroscopy requires data from several single spectra with variable sequence parameters. Unintentional movements during the examination lead to inaccuracies, especially if the spatial distribution of concentrations is inhomogeneous. Improved comparability of the single spectra in a series recorded in vivo were obtained using a modified spectroscopic technique with INTerleaved ACquisiTion of multiple SPECtra (INTACTSPEC). INTACTSPEC series of spectra from the tibialis anterior muscle (m. tib. ant.), soleus muscle (m. soleus), and tibial bone marrow of 20 healthy volunteers were analyzed. Transverse relaxation times T(2) of methylene signals in muscular lipid stores ranged from 77 ms (intramyocellular methylene component in m. tib. ant.) to 88 ms (intramyocellular methylene component in m. soleus) and were similar to those from yellow tibial bone marrow (T(2) = 84 ms). Echo time-dependent signal intensities of choline and creatine deviated markedly from a monoexponential behavior in m. tib. ant., but were nearly exponential in m. soleus. Results from water diffusion measurements parallel and perpendicular to the axis of the lower leg showed significant differences between m. tib. ant. and m. soleus, probably due to the spatial orientation of the muscle fibers. Apparent diffusion coefficients along the leg axis were found to be higher in m. tib. ant. (2.10 +/- 0.08 x 10(-3) mm(2)/s) compared to m. soleus (1.78 +/- 0.11 x 10(-3) mm(2)/s), but m. soleus showed less restricted diffusion in perpendicular orientation (1.59 +/- 0.19 x 10(-3) mm(2)/s versus 1.20 +/- 0.08 x 10(-3) mm(2)/s in m. tib. ant.). Magnetization transfer experiments with various RF preparation pulse amplitudes led to very similar results for m. tib. ant. and m. soleus.

Non-invasive magnetic-resonance detection of creatine depletion in non-viable infarcted myocardium

BACKGROUND

Preserved energy metabolism is essential for myocardial viability and the creatine kinase reaction is central to energy production and reserve. Although the appearance of myocardial creatine kinase enzyme in the blood is widely used to diagnose cardiac necrosis, there are no non-invasive ways to measure local creatine concentrations in the healthy and diseased human heart.

METHODS

We measured total myocardial creatine by spatially-localised, water-suppressed hydrogen magnetic-resonance spectroscopy (1H-MRS) on a clinical (1.5 T) magnetic-resonance-imaging system in ten healthy volunteers (controls) and ten patients with a history of myocardial infarction. We validated this technique by comparison of 1H-MRS values of creatine with biopsy assays in an animal model of infarction.

FINDINGS

Total creatine was measured in the posterior and anterior left ventricle and septum, and was significantly lower in regions of infarction (10 [9] SD micromol/g wet weight) than in non-infarcted regions (26 [11] micromol/g, p=0.001) of myocardium in patients or in the myocardium of healthy controls (28 [6] micromol/g, p<0.0001).

INTERPRETATION

Spatially localised 1H-MRS can be used to measure total creatine non-invasively throughout the human heart. The detection of regional creatine depletion may provide a metabolic means to distinguish healthy from infarcted non-viable myocardium.

Nuclear magnetic resonance spectroscopy study of muscle growth, mdx dystrophy and glucocorticoid treatments: correlation with repair

Proton nuclear magnetic resonance spectroscopy (1H NMR) can be used to study skeletal muscle metabolism. The mdx mouse is a unique animal for studies of muscle regeneration, and models the disease of Duchenne muscular dystrophy (DMD). The goals of this study were to determine the potential of 1H NMR spectroscopy as an alternative to conventional histology in monitoring: (1) normal growth in control muscle and the progression of dystrophy in mdx muscle, and (2) beneficial treatments (glucocorticoids) on mdx dystrophy. Ex vivo 1H NMR spectra of limb and diaphragm muscles were obtained from different ages of control and mdx mice, and from mice which were treated with prednisone or deflazacort. Peaks with contributions from creatine, taurine and lipids were examined. Lower levels of taurine and creatine characterized predystrophy and active dystrophy intervals in mdx muscle compared to control. Levels of taurine increased with stabilization of the disease by repair. A measure of accumulated muscle repair, fiber centronucleation and many spectral peaks were highly and significantly correlated. Greater amounts of lipids were found in the diaphragm compared to limb spectra. Treatment of dystrophy, which improved muscle phenotype, resulted in greater levels of taurine and creatine, especially in the limb muscle. Therefore, 1H NMR differentially discriminates: (1) control and mdx muscle; (2) the progression of mdx dystrophy and developmental stages in normal growth; (3) mild and severe dystrophic phenotypes (diaphragm vs limb); and (4) changes associated with improved muscle phenotype and regeneration (due to treatment or injury). The results focus on monitoring muscle repair, not degeneration. We conclude that 1H NMR is a reliable tool in the objective investigation of muscle repair status during muscular dystrophy.

Quantitative lactate-specific MR imaging and 1H spectroscopy of skeletal muscle at macroscopic and microscopic resolutions using a zero-quantum/double-quantum coherence filter and SLIM/GSLIM localization

Quantitative lactate imaging and spectroscopy were performed on phantoms and on electrically stimulated, excised frog skeletal muscle at macroscopic and microscopic resolutions. Lactate selectivity was achieved by use of a zero-quantum/double-quantum coherence (ZQC/DQC) lactate filter, which suppressed all signals besides lactate, including water and lipid, to below noise level. Three-dimensional lactate data sets were acquired in 1-3 h; one of these spatial dimensions was frequency-encoded and the other two were phase-encoded. High-resolution images were reconstructed using the spectral localization by imaging (SLIM) and generalized SLIM (GSLIM) techniques. Lactate quantitation was achieved by employing an external lactate concentration standard and was verified by comparison to quantitative STEAM-localized and nonlocalized spectra that used total creatine as an internal concentration reference. Additionally, quantitatively accurate behavior of the SLIM and GSLIM techniques as applied to data sets of low signal-to-noise ratio and to macroscopically heterogeneous objects was verified using simulations and real muscle lactate data sets with known heterogeneity.

Eosinophilia-myalgia syndrome: findings at MR imaging and proton spectroscopy of the lower leg

Five magnetic resonance (MR) studies of the lower leg were performed in three patients with eosinophilia-myalgia syndrome (EMS). The 1H spectroscopic and imaging findings were compared with seven examinations of age-matched healthy controls. Standard imaging with proton density-, T1-, and T2-weighted spin-echo (SE) sequences at 1.5 T showed marked atrophy of the calf muscles and slightly increased signal strength of muscle tissue in T2-weighted SE images. The application of frequency selective chemical shift imaging (SENEX) exhibited skin changes similar to those of scleroderma with increased water content and thickened cutis in the water selective images. In one patient the tibialis muscles showed irregular structures, but no fatty degeneration as demonstrated in the fat selective images. Proton signals from volume elements of (20 mm)3 within the soleus and gastrocnemius muscle were recorded by the PRESS localization method. A reduction of the creatine/water and the choline/water ratios was found in the 1H spectra from the EMS patients compared to the controls. Localized 1H spectroscopy exhibited modified distributions of the lipid signals in two EMS patients with slightly elevated signals from unsaturated fatty acids. The transverse relaxation of choline and creatine signals was accelerated in both examinations of one patient compared with the healthy controls.