Magnetic Resonance Spectroscopy In Diagnosis Research Articles

Applications of magnetic resonance spectroscopy in diagnosis of neurodegenerative diseases: A systematic review

BackgroundMagnetic resonance spectroscopy (MRS) is an imaging technique used to measure metabolic changes in the tissue. Due to the lack of evidence, MRS is not a priority in diagnosing neurodegenerative diseases because it is a relatively specialized technique that requires specialized equipment and expertise to perform and interpret. This systematic review aimed to present a comprehensive collection of MRS results in the most common neurodegenerative diseases. MethodsA systematic search of four electronic databases (PubMed, Scopus, Web of Science, and ScienceDirect) was conducted for studies published from 2017 to 2022. Articles that provided specific biomarker levels were selected, and studies that assessed the diseases via treatment, featured MRS applying nuclei other than 1H, or compared different animal models were excluded. ResultsA total of 25 articles, plus 3 articles for extra information in the introduction, were included in this review. Six of the most common neurodegenerative diseases, i.e., Alzheimer's and Parkinson's disease, Huntington chorea, ataxia, multiple sclerosis (MS), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP) were examined via MRS. The changes and ratios of N-acetylaspartate (NAA) could be seen in all of these disorders, which could lead to early diagnosis. However, there are other biomarkers, such as Cr and Chon, which can give convincing results. DiscussionThis observational study is the first synthesis of the latest evidence proving metabolic changes during neurodegenerative diseases using MRS as a diagnosis method. The findings indicate decreased N-acetylaspartate (NAA) and NAA/Cr ratios in Alzheimer's disease (AD), Parkinson's disease (PD), ataxias, and MS, reflecting neuronal loss or dysfunction. Increased choline and myo-inositol were noted in some studies, suggesting cell membrane turnover and neuroinflammation. Findings were less consistent for other metabolites like glutamate and gamma-aminobutyric acid. However, there were limitations due to the lack of studies on the same volumes of interest (VOIs) and the small number of participants.

Brain proton magnetic resonance spectroscopy in patients with Parkinson's disease.

Background: The accuracy of current laboratory and imaging studies for diagnosis and monitoring of Parkinson's disease (PD) severity is low and diagnosis is mainly dependent on clinical examination. Proton magnetic resonance spectroscopy (MRS) is a non-invasive technique that can assess the chemical profile of the brain. In this study, we evaluated the utility of proton MRS in diagnosis of PD and determination of its severity. Methods: Patients with PD and healthy age-matched controls were studied using proton MRS. The level of N-acetylaspartate (NAA), total creatine (Cr), and total choline (Cho), and their ratios were calculated in substantia nigra (SN), putamen (Pu), and motor cortex. PD severity was assessed by the Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn and Yahr scale. Results: Compared to 25 healthy controls (18 men, age: 59.00 ± 8.39 years), our 30 patients with PD (24 men, age: 63.80 ± 12.00 years, 29 under treatment) showed no significant difference in the metabolite ratios in SN, Pu, and motor cortex. Nigral level of NAA/Cr was significantly correlated with total UPDRS score in patients with PD (r = -0.35, P = 0.08). Moreover, patients with PD with Hoehn and Yahr scale score ≥ 2 had a lower NAA/Cr level in SN compared to patients with a lower stage. Conclusion: This study shows that 1.5 tesla proton MRS is unable to detect metabolite abnormalities in patients with PD who are under treatment. However, the NAA/Cr ratio in the SN might be a useful imaging biomarker for evaluation of disease severity in these patients.

Magnetic Resonance Spectroscopy in Diagnosis and Follow-Up of Gliomas: State-of-the-Art.

Simple SummaryMagnetic resonance spectroscopy (MRS) is a useful technique in diagnosis and follow-up of gliomas. In this review we provide an insight in the use of both proton and phosphorous MRS in clinical and scientific every day practice.Preoperative grade prediction is important in diagnostics of glioma. Even more important can be follow-up after chemotherapy and radiotherapy of high grade gliomas. In this review we provide an overview of MR-spectroscopy (MRS), technical aspects, and different clinical scenarios in the diagnostics and follow-up of gliomas in pediatric and adult populations. Furthermore, we provide a recap of the current research utility and possible future strategies regarding proton- and phosphorous-MRS in glioma research.

Value of Magnetic Resonance Images and Magnetic Resonance Spectroscopy in Diagnosis of Brain Tumors under Fuzzy C-Means Algorithm.

This study was aimed to explore the diagnostic value of magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) in brain tumors under the fuzzy C-means (FCM) algorithm. The two-dimensional FCM hybrid algorithm was improved to be three-dimensional. The MRI images and MRS spectra of 127 patients with brain tumors (low-grade glioma group) and 54 healthy people (healthy group) were analyzed. The results suggested that the membership matrix of the improved algorithm had lower ambiguity, higher segmentation accuracy, closer relationship of intrapixels, and stronger irrelevance of interclass pixels. Through the analysis of gray matter volume, it was found that, compared with the healthy group, the gray matter and white matter volumes in the brain of high-grade glioma were higher, and those of low-grade glioma group were lower. The improved FCM algorithm could obtain a higher accuracy of 88.64% in segmenting images. It had a higher sensitivity to gray matter changes in brain tumors, reaching 92.72%; its specificity was not much different from that of traditional FCM, which were 83.61% and 88.06%, respectively. In the diagnostic value, the area under the curve of mean kurtosis was the largest, which was 0.962 (P < 0.001). The best critical value was 0.4096, which had a greater reference significance for clinical treatment and prognosis. The ratio of choline/N-acetyl-aspartate and the ratio of choline/creatine also showed significant differences in high- and low-grade gliomas (P < 0.05), but the specificity and sensitivity were slightly lower. It also had guiding significance for the grading of gliomas. Overall, the improved FCM algorithm had obvious advantages in the segmentation process of MRI images, which provided help for the clinical diagnosis of brain tumors.

Proton Magnetic Resonance Spectroscopy for Diagnosis of Non-Motor Symptoms in Parkinson's Disease

BackgroundThe current diagnosis of Parkinson's disease (PD) is mainly based on the typical clinical manifestations. However, 60% dopaminergic neurons have died when the typical clinical manifestations occur. Predictive neurobiomarkers may help identify those PD patients having non-motor disorders or in different stage and achieving the aim of early diagnosis. Up to date, few if any neuroimaging techniques have been described useful for non-movement disorders diagnosis in PD patients. Here, we investigated the alteration of metabolites in PD patients in different stage of PD and non-motor symptoms including sleep, gastrointestinal and cognitive dysfunction, by using the 1H-MRS.MethodsA total of 48 subjects were included between 2017 and 2019: 37 PD (15 men, age 47–82 years) and 11 healthy people (8 men, age 49–74 years). All participants underwent MRI and multi-voxel 1H-MRS examination within 3 days in admission. Six kinds of metabolites, such as creatine (Cr), N-acetyl aspartate/creatine (NAA/Cr), N-acetyl aspartate/choline (NAA/Cho), choline/creatine (Cho/Cr), lipid/creatine (LL/Cr), and myo-Inositol/creatine ratio (mI/Cr) were tested among the PD group and the control groups. Statistical analyses and correlation analyses were performed by using SPSS. The p < 0.05 was considered statistically significant.ResultsCompared late PD group with a control group or early group, higher Cr ratio and lower NAA/Cr ratio were observed in the late PD group (p < 0.05). The mI/Cr in the late PD group was also lower than that in the early PD group (p < 0.05). Regarding the relationship between metabolites and NMS, Cho/Cr was higher in the sleep disorder group, whereas mI/Cr was lower in the gastrointestinal dysfunction group in comparison with the non-symptom groups. Moreover, Cr, Cho/Cr, mI/Cr, and LL/Cr were identified to have higher concentrations in the cognitive group in thalamus.ConclusionsProton magnetic resonance spectroscopy is an advanced tool to quantify the metabolic changes in PD. Three biomarkers (Cr, NAA/Cr, and mI/Cr) were detected in the late stage of PD, suggesting that these markers might be potential to imply the progression of PD. In addition, subgroups analysis showed that MRS of thalamus is a sensitive region for the detection of cognitive decline in PD, and the alteration of neurochemicals (involving Cr, Cho, mI, and LL) may be promising biomarkers to predict cognitive decline in PD.

Value of Magnetic Resonance Spectroscopy for Diagnosis of Creatine Deficiency Syndrome

AbstractCreatine deficiency syndromes are congenital metabolic diseases characterized by decreased cerebral creatine levels as a result of disorders in creatine synthesis and transport. Therefore, magnetic resonance spectroscopy is a valuable tool for diagnosis. This disease can be explained by congenital disorders occurring in three forms at different stages of the creatine metabolic pathway. Two of disorders arise autosomal recessively in creatine biosynthesis, arginine-glycine amidinotransferase, and guanidinoacetate methyltransferase enzyme deficiency. The third disorder occurs as a result of an SLC6A8 variant in the form of creatine carrier protein deficiency. In this article, a patient with SLC6A8 carrier deficiency is presented.

Clinical Application of Magnetic Resonance Spectroscopy in Diagnosis of Intracranial Mass Lesions.

Conventional MR imaging provides highly detailed anatomic information with unrivalled soft tissue contrast making it the mainstay in the diagnosis of suspected brain lesions. Despite this, MRI alone at times cannot answer the diagnostic questions in quite a few patients. Proton MR Spectroscopy (H-MRS) provides information on the metabolic composition within an area under interrogation. By comparing the relative concentrations of specific metabolites, the neuroradiologist can deduce critical information regarding neuronal cell density and integrity, cell membrane turnover, metabolic fuel, and possible necrosis in the region of interest. This provides a biochemical picture of the underlying pathology and thus aids in the diagnosis. This was a cross-sectional comparative study. Of the 63 patients examined by MRI and MRS for intracranial mass lesions, the radiologists were able to offer a single imaging diagnosis based on MRI alone in only 15 patients (23.8%) while when MRI imaging was combined with MR spectroscopy, a single imaging diagnosis was offered in 47 patients (74.6%). This was an overall statistically significant improvement. MRS aided the radiologist in offering a single diagnosis in high versus low-grade gliomas, high-grade gliomas versus tuberculomas, and recurrent tumours versus radiation necrosis.

The Role Of Magnetic Resonance Spectroscopy in Diagnosis of Multiple Sclerosis .

This study aims at emphasizing the role of MRS in management of post therapeutic response of different stages of the disease of multiple sclerosisBackground : Multiple Sclerosis is a chronic inflammatory, and degenerative autoimmune disorder of the CNS that is characterized by unpredictable clinical relapses and remissions and by progression of disability over time. MRS has the ability to characterize the chemical pathology of brain, as well as regions of the brain that are not associated with structural abnormalities on conventional MRI. So it can help to define the natural history of the disease process and it can help in monitoring metabolic responses to therapy Patients and Methods : A study, included 40 patients who presented with clinically diagnosed multiple sclerosis followed by conventional MRI and referred for further assessment by MR spectroscopy study .Results : The age of included patients ranged from 18 to 45 years with a mean age of 34.67±8.23 years. 60% of the patients were females and 40% of them were males, the sensitivity, specificity and positive predictive value of H-MRS in the diagnosis of MS were 94.4%, 76.2%, 71.5% respectively compared to 87.3%, 69.2%, and 65.8% in case of c-MRI.Conclusion Adding MR spectroscopy to conventional MRI increases the specificity and accuracy of MRI study in diagnosis and follow up of therapeutic response of Multiple sclerosis

Use of nuclear magnetic resonance spectroscopy in diagnosis of inborn errors of metabolism.

Nuclear Magnetic Resonance (NMR) spectroscopy has been applied in many fields of science and is increasingly being considered as a tool in the clinical setting. This review examines its application for diagnosis of inborn errors of metabolism (IEMs). IEMs, whether involving deficiency in the synthesis and degradation of metabolites, or in lipoprotein metabolism, affect nearly 3% of the global population. NMR is a preferred method for comprehensive evaluation of complex biofluids such as blood or urine, as it can provide a relatively unbiased overview of all compounds that are present and does not destroy or otherwise chemically alter the sample. While current newborn screening programs take advantage of other more sensitive methods, such as mass spectrometry, NMR has advantages especially for urine analysis with respect to ease of sample preparation and the reproducibility of results. NMR spectroscopy is particularly compatible with analysis of lipoproteins because it provides information about their size and density, not easily attained by other methods, that can help the clinician to better manage patients with dyslipidemia. We believe that NMR holds great potential for expanding clinical diagnosis in the future, in the field of IEMs and beyond.

The Role of Magnetic Resonance Spectroscopy in Diagnosis of Multiple Sclerosis

The Role of Magnetic Resonance Spectroscopy in Diagnosis of Multiple Sclerosis

Author response: Meta-analysis of magnetic resonance spectroscopy in the diagnosis of hepatic encephalopathy.

The authors thank Dr. Gupta for the comment on our article.1 Hepatic encephalopathy (HE) is associated with significant morbidity and mortality in cirrhosis; its pathophysiology is incompletely understood. Our meta-analysis was a review of magnetic resonance spectroscopy (MRS) data in HE, which confirmed a specific metabolic pattern, consisting of increased glutamine/glutamate—with reduced choline—and myo-inositol, particularly in the parietal lobes.1 The changes increased with the severity of HE. We agree that this would have limited diagnostic utility in overt HE, which is clinically obvious. We strongly disagree, however, about covert or minimal HE (MHE), which are defined as the presence of neuropsychologic or neurophysiologic abnormalities in patients with no obvious—i.e., at least disorientation for time or asterixis—clinical signs of overt HE. Here, there is a potential role for MRS in diagnosis, monitoring, and investigation. In a recent French cohort of cirrhotic individuals with and without MHE, HE pattern MRS changes in the pallidum were present in 95% of MHE vs 0% of unimpaired patients ( p < 0.001), suggesting MRS could outperform other modalities of MHE diagnosis.2 MRS may also have a significant role in future pathophysiologic and pharmacologic HE studies.

Fat fraction quantification of lumbar spine: comparison of T1-weighted two-point Dixon and single-voxel magnetic resonance spectroscopy in diagnosis of multiple myeloma.

We aimed to investigate the value of T1-weighted two-point Dixon technique and single-voxel magnetic resonance spectroscopy (MRS) in diagnosis of multiple myeloma (MM) through quantifying fat content of vertebral marrow. A total of 30 MM patients and 30 healthy volunteers underwent T1-weighted two-point Dixon and single-voxel MRS imaging. The fat fraction map (FFM) was reconstructed from the Dixon images using the equation FFM = Lip/In, where Lip represents fat maps and In represents in-phase images. The fat fraction (FF) of MRS was calculated by using the integral area of Lip peak divided by the sum of integral area of Lip peak and water peak. FF values measured by the Dixon technique and MRS were significantly decreased in MM patients (45.99%±3.39% and 47.63%±4.38%) compared with healthy controls (64.43%±0.96% and 76.22%±1.91%) (P < 0.001 with both methods). FF values measured by Dixon technique were significantly positively correlated to those measured by MRS in MM (r = 0.837, P < 0.001) and healthy control group (r = 0.735, P < 0.001), respectively. There was no significant difference between area under the curve (AUC) obtained by the Dixon technique (0.878±0.047; range, 0.785 to 0.971; optimal cutoff, 56.35 for healthy controls vs. MM) and MRS (0.883±0.047; range, 0.791 to 0.974; optimal cutoff, 61.00 for healthy controls vs. MM). The ability of Dixon technique to differentiate MM group from healthy controls was equivalent to single-voxel MRS. Regarding detection of fat contents in vertebral bone, T1-weighted two-point Dixon technique exhibited equivalent performance to single-voxel MRS in the diagnosis of multiple myeloma. Moreover, two-point Dixon is a more convenient and stable technique for assessing bone marrow changes in MM patients than single-voxel MRS.

Diagnostic Accuracy of MR-Spectroscopy in Diagnosis of Focal Liver Malignant Lesions Taking Histopathology as Gold Standard

Objective: To determine the diagnostic accuracy of MR-spectroscopy in diagnosis of focal liver malignant lesions taking histopathology as gold standard. Study Design: Cross-Sectional Validation Study. Settings: The study was conducted in Radiology Department of Allied Hospital Faisalabad. Duration: Six months from 1st October 2017 to 31st March 2018. Methodology: Permission for research was sought from hospital ethical committee. Patients were collected from OPD & indoor departments of Radiology and Medicine of Allied Hospital Faisalabad. Objective of study was explained to every subject who fulfilled the inclusion criteria and informed consent was taken. Confounding variables were controlled by restriction (by excluding subjects with history of metastatic disease and chemotherapy). MRS examination was performed with the patients in supine position using 1.5-T Philips MRI unit and a body phased array coil. This procedure was performed in Radiology Department Allied Hospital Faisalabad. Biopsy was taken from the patients and histopathology was done from histopathology lab PMC/Allied Hospital Faisalabad. Finally, the data was collected. Results: In this study, diagnostic accuracy of MR-spectroscopy in diagnosis of focal liver malignant lesions taking histopathology as gold standard was calculated as 93.75% for sensitivity, 90.20% for specificity, 92.31% for positive predictive value, 92.00% for negative predictive value and 92.17% for accuracy rate, positive likelihood ratio was 9.56 and negative likelihood ratio was 0.07. Conclusion: It is concluded that the diagnostic accuracy of MR-spectroscopy is comparable and is better as it is less invasive in diagnosing of focal liver malignant lesions taking histopathology as gold standard. However, these findings are primary and needs validation through some other local studies.

Role of magnetic resonance spectroscopy in evaluation of breast masses

Background Early detection followed by appropriate treatment is currently the most effective strategy to reduce breast cancer mortality. New techniques must provide more precise evaluation of the indeterminate lesions. Magnetic resonance spectroscopy (MRS) is one of the available new techniques on MRI. It represents a noninvasive and nonionizing method of characterizing a user-selected volume of tissue based on the metabolic (chemical) content. Aim The aim was to assess the role of in-vivo proton MRS in diagnosis, characterization, and differentiation between benign and malignant breast masses. Patients and methods In this study, 40 female patients were examined by MRI using the multiphase dynamic sequence and proton MRS using magnets of intensity field 1.5 Tesla systems. Single-voxel technique after adequate shimming was used. Results Thirty (62.5%) cases were malignant (based on the presence of high choline peak in the spectrum) and 18 (37.5%) cases were benign (no choline peak). MRS has increased the specificity of dynamic MRI for diagnosis of probable lesion from 76.5 to 94.1%. False-positive results were found in one case, and false-negative results were found in two cases. Conclusion In-vivo proton MRS is a powerful method for characterizing indeterminate breast lesions based on the presence of a high choline peak in the spectrum.

Proton magnetic-resonance spectroscopy in diagnosis of cognitive dysfunction in patients with type 1 diabetes mellitus.

The problem of cognitive dysfunction is currently of interest to doctors of various specialties, since this complication is accompanied by many systemic diseases that involve the central nervous system in the pathological process. However the diagnosis of such violations is given insufficient attention due to the lack of objective methods of verification of this diagnosis. The article presents modern ideas on the possibilities of proton magnetic resonance spectroscopy (1H-MPC) in the diagnosis of cognitive dysfunction in patients with type 1 diabetes mellitus. The role of both hypoglycemia and hyperglycemia in the formation of cognitive dysfunction is considered. The relationship between the state of carbohydrate metabolism and the disorders detected by 1H-MPC is shown.

Clinical application of magnetic resonance spectroscopy in diagnosis of pancreatic cancer

Clinical application of magnetic resonance spectroscopy in diagnosis of pancreatic cancer

A Case of Low-Grade Astrocytoma First Thought to be Demyelinating Disease on the Basis of Initial Cranial MR Findings

Oligodendrogliomas are rare childhood brain tumors. Cranial MR images are nonspecific. Identification is easier with histopathological and genetic investigation. We report a 15-month-old male patient presenting with restlessness and inability to walk over the preceding week. Although cranial MR findings suggested demyelinating white matter disease, oligodendroglioma was diagnosed on the basis of biopsy following radiological findings. We present this case in order to describe the initial radiological findings and to emphasize the importance of MR spectroscopy in diagnosis in such patients.

Role of sonoelastography and MR spectroscopy in diagnosis of solid breast lesions with histopathological correlation

ObjectiveTo demonstrate the role of ultrasound elastography and magnetic resonance spectroscopy in diagnosis of solid breast lesions with histopathological correlation. Patients and methodsThis study included 40 female patients, and their ages ranged from 17 to 73years with mean age of 43.18years. Patients were referred on the basis of suspected breast lesion and/or nipple discharge. All patients underwent elastography in addition to conventional ultrasonography and MR spectroscopy and the radiological results were correlated with histopathological examination for achieving confirmed final diagnosis. ResultsAll benign lesions were 17 on the basis of elastography, while the malignant lesions were 18. Fifteen malignant lesions (93.7%, 15/21) had an elastography score 5, while Thirteen benign lesions (86.7%, 13/19) had an elastography score 3. On the basis of DCE-MRI, benign lesions were 16, while the malignant lesions were 19. Sixteen malignant lesions (94.1%) were diagnosed as BI-RADS 5, while fourteen benign lesions (93.3%) were diagnosed as BI-RADS 3. On the basis of MR spectroscopy, benign lesions were 17, while the malignant lesions were 19. Nineteen malignant lesions (90.5) had positive choline peak while seventeen benign lesions (89.5%) had negative choline peak. The study showed conventional ultrasound sensitivity, specificity, PPV, NPV and accuracy as 85%, 80%, 80.9%, 84.2% and 82.5% respectively, and sono-elastography sensitivity, specificity, PPV, NPV and accuracy as 90%, 85%, 85.7%, 89.4% and 87.5% respectively. Dynamic contrast enhanced MRI sensitivity, specificity, PPV, NPV and accuracy were 85.7%, 84.2%, 85.7%, 84.2% and 85% respectively, while MR spectroscopy sensitivity, specificity, PPV, NPV and accuracy were 90.4%, 89.4%, 90.4%, 89.5% and 80.5% respectively. ConclusionThe study showed that sono-elastography and MR spectroscopy are valuable noninvasive diagnostic imaging techniques in diagnosis of early breast malignancy than any other diagnostic tools, consequently help to avoid nondesirable invasive surgical biopsy of the breast lesions.

Significance of magnetic resonance spectroscopy in diagnosis of minimal hepatic encephalopathy

Significance of magnetic resonance spectroscopy in diagnosis of minimal hepatic encephalopathy

Phosphorus magnetic resonance spectroscopy in diagnosis of focal liver lesions

31PMR spectroscopy was carried out in 93 patients with various focal lesions in the liver and in the control group people. The method was proved to be noninvasive and highly informative in studying of biochemical processes in the liver on the cell level but some serious technical limitations hinder its usage in the clinical practice.