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

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  • Martin Wilson
    University of Birmingham
  • Ovidiu Andronesi
    Harvard Medical School, Boston
  • Peter B Barker
    Johns Hopkins University
  • Robert Bartha
    University of Western Ontario
  • Alberto Bizzi
    UOC Neuroradiologia, Istituto Neurologico Carlo Besta, Milano
  • Patrick J Bolan
    University of Minnesota
  • Kevin M Brindle
    University of Cambridge
  • In-Young Choi
    University of Kansas Medical Centre
  • Cristina Cudalbu
    École Polytechnique Fédérale de Lausanne
  • Ulrike Dydak
    Purdue University
  • Uzay E Emir
    Purdue University
  • Ramon G Gonzalez
    Harvard Medical School, Boston
  • Stephan Gruber
    University of Vienna
  • Rolf Gruetter
    École Polytechnique Fédérale de Lausanne
  • Rakesh K Gupta
    Fortis Memorial Research Institute, Gurugram, Haryana, India.
  • Arend Heerschap
    Radboud University Medical Center
  • Anke Henning
    Max Planck Institute for Biological Cybernetics, Tuebingen
  • Hoby P Hetherington
    University of Pittsburg
  • Petra S Huppi
    University of Geneva
  • Ralph E Hurd
    Stanford Radiological Sciences Lab, Stanford, California.
  • Kejal Kantarci
    Department of Radiology, Mayo Clinic, Rochester, Minnesota.
  • Risto A Kauppinen
    University of Bristol
  • Dennis W J Klomp
    University Medical Centre, Utrecht
  • Roland Kreis
    University of Bern
  • Marijn J Kruiskamp
    Philips N.V.
  • Martin O Leach
    Royal Marsden Hospital
  • Alexander P Lin
    Harvard Medical School, Boston
  • Peter R Luijten
    University Medical Centre, Utrecht
  • Małgorzata Marjańska
    University of Minnesota
  • Andrew A Maudsley
    University of Miami
  • Dieter J Meyerhoff
    University of California, San Francisco
  • Carolyn E Mountford
    Translational Research Institute, Woolloongabba
  • Paul G Mullins
  • James B Murdoch
    Canon Medical Research USA, Mayfield Village, Ohio.
  • Sarah J Nelson
    University of California, San Francisco
  • Ralph Noeske
    GE Healthcare, Berlin
  • Gülin Öz
    University of Minnesota
  • Julie W Pan
    University of Pittsburgh, PA
  • Andrew C Peet
    University of Birmingham
  • Harish Poptani
    University of Liverpool
  • Stefan Posse
    The University of New Mexico
  • Eva-Maria Ratai
    Harvard Medical School, Boston
  • Nouha Salibi
    MR R&D, Siemens Healthineers, Malvern, Pennsylvania.
  • Tom W J Scheenen
    Radboud University Medical Center
  • Ian C P Smith
    Innovative Biodiagnostics, Winnipeg, Canada.
  • Brian J Soher
    Duke University
  • Ivan Tkáč
    University of Minnesota
  • Daniel B Vigneron
    University of California, San Francisco
  • Franklyn A Howe
    St George's University of London

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.


  • brain, consensus, metabolites, MRS, semi-LASER, shimming
Original languageEnglish
Pages (from-to)527-550
Number of pages24
JournalMagnetic Resonance in Medicine
Issue number2
Early online date28 Mar 2019
Publication statusPublished - Aug 2019

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