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Magn Reson Med. 2019 Mar 28. doi: 10.1002/mrm.27742. [Epub ahead of print]

Methodological consensus on clinical proton MRS of the brain: Review and recommendations.

Author information

1
Centre for Human Brain Health and School of Psychology, University of Birmingham, Birmingham, England.
2
Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
3
Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
4
Robarts Research Institute, University of Western Ontario, London, Canada.
5
U.O. Neuroradiologia, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
6
Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota.
7
Department of Biochemistry, University of Cambridge, Cambridge, England.
8
Department of Neurology, Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, Kansas.
9
Center for Biomedical Imaging, Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland.
10
School of Health Sciences, Purdue University, West Lafayette, Indiana.
11
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
12
High Field MR Center, Department of Biomedical imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
13
Laboratory for Functional and Metabolic Imaging, Center for Biomedical Imaging, Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland.
14
Fortis Memorial Research Institute, Gurugram, Haryana, India.
15
Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
16
Max Planck Institute for Biological Cybernetics, Tuebingen, Germany.
17
Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
18
Department of Pediatrics, University of Geneva, Geneva, Switzerland.
19
Stanford Radiological Sciences Lab, Stanford, California.
20
Department of Radiology, Mayo Clinic, Rochester, Minnesota.
21
School of Psychological Science, University of Bristol, Bristol, England.
22
University Medical Centre Utrecht, Utrecht, the Netherlands.
23
Departments of Radiology and Biomedical Research, University of Bern, Bern, Switzerland.
24
Philips Healthcare, Best, the Netherlands.
25
CRUK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden Hospital, London, England.
26
Center for Clinical Spectroscopy, Brigham and Women's Hospital, Harvard University Medical School, Boston, Massachusetts.
27
Department of Radiology, University of Miami, Miami, Florida.
28
DVA Medical Center and Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.
29
Translational Research Institute, Woolloongabba, Australia.
30
Bangor Imaging Unit, School of Psychology, Bangor University, Bangor, Wales.
31
Canon Medical Research USA, Mayfield Village, Ohio.
32
Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.
33
GE Healthcare, Berlin, Germany.
34
Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania.
35
Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, England.
36
Centre for Preclinical Imaging, Institute of Translational Medicine, University of Liverpool, Liverpool, England.
37
Department of Neurology, University of New Mexico, Albuquerque, New Mexico.
38
MR R&D, Siemens Healthineers, Malvern, Pennsylvania.
39
Innovative Biodiagnostics, Winnipeg, Canada.
40
Department of Radiology, Duke University Medical Center, Durham, North Carolina.
41
Molecular and Clinical Sciences, St George's University of London, London, England.

Abstract

Proton MRS (1 H MRS) provides noninvasive, quantitative metabolite profiles of tissue and has been shown to aid the clinical management of several brain diseases. Although most modern clinical MR scanners support MRS capabilities, routine use is largely restricted to specialized centers with good access to MR research support. Widespread adoption has been slow for several reasons, and technical challenges toward obtaining reliable good-quality results have been identified as a contributing factor. Considerable progress has been made by the research community to address many of these challenges, and in this paper a consensus is presented on deficiencies in widely available MRS methodology and validated improvements that are currently in routine use at several clinical research institutions. In particular, the localization error for the PRESS localization sequence was found to be unacceptably high at 3 T, and use of the semi-adiabatic localization by adiabatic selective refocusing sequence is a recommended solution. Incorporation of simulated metabolite basis sets into analysis routines is recommended for reliably capturing the full spectral detail available from short TE acquisitions. In addition, the importance of achieving a highly homogenous static magnetic field (B0 ) in the acquisition region is emphasized, and the limitations of current methods and hardware are discussed. Most recommendations require only software improvements, greatly enhancing the capabilities of clinical MRS on existing hardware. Implementation of these recommendations should strengthen current clinical applications and advance progress toward developing and validating new MRS biomarkers for clinical use.

KEYWORDS:

MRS; brain; consensus; metabolites; semi-LASER; shimming

PMID:
30919510
DOI:
10.1002/mrm.27742

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