TY - JOUR

T1 - Methodological consensus on clinical proton MRS of the brain

T2 - Review and recommendations

AU - Wilson, Martin

AU - Andronesi, Ovidiu

AU - Barker, Peter B

AU - Bartha, Robert

AU - Bizzi, Alberto

AU - Bolan, Patrick J

AU - Brindle, Kevin M

AU - Choi, In-Young

AU - Cudalbu, Cristina

AU - Dydak, Ulrike

AU - Emir, Uzay E

AU - Gonzalez, Ramon G

AU - Gruber, Stephan

AU - Gruetter, Rolf

AU - Gupta, Rakesh K

AU - Heerschap, Arend

AU - Henning, Anke

AU - Hetherington, Hoby P

AU - Huppi, Petra S

AU - Hurd, Ralph E

AU - Kantarci, Kejal

AU - Kauppinen, Risto A

AU - Klomp, Dennis W J

AU - Kreis, Roland

AU - Kruiskamp, Marijn J

AU - Leach, Martin O

AU - Lin, Alexander P

AU - Luijten, Peter R

AU - Marjańska, Małgorzata

AU - Maudsley, Andrew A

AU - Meyerhoff, Dieter J

AU - Mountford, Carolyn E

AU - Mullins, Paul G

AU - Murdoch, James B

AU - Nelson, Sarah J

AU - Noeske, Ralph

AU - Öz, Gülin

AU - Pan, Julie W

AU - Peet, Andrew C

AU - Poptani, Harish

AU - Posse, Stefan

AU - Ratai, Eva-Maria

AU - Salibi, Nouha

AU - Scheenen, Tom W J

AU - Smith, Ian C P

AU - Soher, Brian J

AU - Tkáč, Ivan

AU - Vigneron, Daniel B

AU - Howe, Franklyn A

N1 - © 2019 International Society for Magnetic Resonance in Medicine.

PY - 2019/8

Y1 - 2019/8

N2 - 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.

AB - 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.

KW - brain

KW - consensus

KW - metabolites

KW - MRS

KW - semi-LASER

KW - shimming

U2 - 10.1002/mrm.27742

DO - 10.1002/mrm.27742

M3 - Review article

C2 - 30919510

VL - 82

SP - 527

EP - 550

JO - Magnetic Resonance in Medicine

JF - Magnetic Resonance in Medicine

SN - 0740-3194

IS - 2

ER -