Pulse Sequence Design Research Articles

Highly efficient image navigator based 3D whole-heart cardiac MRA at 0.55T.

To develop and evaluate a highly efficient free-breathing and contrast-agent-free three-dimensional (3D) whole-heart Cardiac Magnetic Resonance Angiography (CMRA) sequence at 0.55T. Free-breathing whole-heart CMRA has been previously proposed at 1.5 and 3T. Direct application of this sequence to 0.55T is not possible due to changes in the magnetic properties of the tissues. To enable free-breathing CMRA at 0.55T, pulse sequence design and acquisition parameters of a previously proposed whole-heart CMRA framework are optimized via Bloch simulations. Image navigators (iNAVs) are used to enable nonrigid respiratory motion-correction and 100% respiratory scan efficiency. Patch-based low-rank denoising is employed to accelerate the scan and account for the reduced signal-to-noise ratio at 0.55T. The proposed approach was evaluated on 11 healthy subjects. Image quality was assessed by a clinical expert (1: poor to 5: excellent) for all intrapericardiac structures. Quantitative evaluation was performed by assessing the vessel sharpness of the proximal right coronary artery (RCA). Optimization resulted in an imaging flip angle of , fat saturation flip angle of , and six k-space lines for iNAV encoding. The relevant cardiac structures and main coronary arteries were visible in all subjects, with excellent image quality (mean ) and minimal artifacts (mean ), with RCA vessel sharpness ( ) comparable to previous studies at 1.5T. The proposed approach enables 3D whole-heart CMRA at 0.55T in a 6-min scan ( ), providing excellent image quality, minimal artifacts, and comparable vessel sharpness to previous 1.5T studies. Future work will include the evaluation of the proposed approach in patients with cardiovascular disease.

Robust Hamiltonian Engineering for Interacting Qudit Systems

Dynamical decoupling and Hamiltonian engineering are well-established techniques that have been used to control qubit systems. However, designing the corresponding methods for qudit systems has been challenging due to the lack of a Bloch sphere representation, more complex interactions, and additional control constraints. By identifying several general structures associated with such problems, we develop a formalism for the robust dynamical decoupling and Hamiltonian engineering of strongly interacting qudit systems. Our formalism significantly simplifies qudit pulse-sequence design while naturally incorporating robustness conditions necessary for experimental practicality. We experimentally demonstrate these techniques in a strongly interacting, disordered ensemble of spin-1 nitrogen-vacancy centers, achieving more than an order-of-magnitude improvement in coherence time over existing pulse sequences. We further describe how our techniques enable the engineering of exotic many-body phenomena such as quantum many-body scars, and open up new opportunities for quantum metrology with enhanced sensitivities. These results enable wide-reaching new applications for dynamical decoupling and Hamiltonian engineering in many-body physics and quantum metrology. Published by the American Physical Society 2024

PhoenixMR: A GPU-based MRI simulation framework with runtime-dynamic code execution.

Simulations of physical processes and behavior can provide unique insights and understanding of real-world problems. Magnetic Resonance Imaging (MRI) is an imaging technique with several components of complexity. Several of these components have been characterized and simulated in the past. However, several computational challenges prevent simulations from being simultaneously fast, flexible, and accurate. The simulation of MRI experiments is underutilized by medical physicists and researchers using currently available simulators due to reasons including speed, accuracy, and extensibility constraints. This paper introduces an innovative MRI simulation engine and framework that aims to overcome these issues making available realistic and fast MRIsimulation. Using the CUDA C/C++ programing language, an MRI simulation engine (PhoenixMR), incorporating a Turing-complete virtual machine (VM) to simulate abstract spatiotemporal complexities, was developed. This engine solves a set of time-discrete Bloch equationsusing the symmetric operator splitting technique. An extensible front-end framework package (written in Python) aids the use of PhoenixMR to simplify simulationdevelopment. The PhoenixMR library and front-end codes have been developed and tested. A set of example simulations were performed to demonstrate the ease of use and flexibility of simulation components such as geometrical setup, pulse sequence design, phantom design, and so forth. Initial validation of PhoenixMR is performed by comparing its accuracy and performance against a widely used MRI simulator using identical simulation parameters. Validation results show PhoenixMR simulations are three orders of magnitude faster. There is also strong agreement betweenmodels. A novel MRI simulation platform called PhoenixMR has been introduced. This research tool is designed to be usable by physicists and engineers interested in performing MRI simulations. Examples are shown demonstrating the accuracy, flexibility, and usability of PhoenixMR in several key areas of MRIsimulation.

A digital twin for parallel liquid-state nuclear magnetic resonance spectroscopy

One approach to increasing nuclear magnetic resonance measurement sample throughput is to implement multiple, independent detection sites. However, the presence of radio frequency interference poses a challenge in multi-detector systems, particularly in unshielded coil arrays lacking sufficient electrical isolation. This issue can lead to unwanted coupling of inductive coils, resulting in excitation pulse interference and signal transfer among multiple detection sites. Here we propose a theoretical framework that combines electromagnetic simulation with spin-dynamic calculations. This framework enables the evaluation of coil coupling effects, the design of parallel pulse sequences to mitigate inter-channel coupling, and the separation of composite free induction decays obtained from multiple detectors. The parallel pulse compensation scheme was validated by a 2-channel parallel spectroscopy experiment. These results provide valuable insights for the design of parallel nuclear magnetic resonance hardware and for exploring the limits of parallelization capacity within a fixed magnet system.

The generalized Ernst angle

Though the Ernst angle concept presented in the original paper introducing Fourier NMR spectroscopy was developed for sensitivity optimization in a time-averaged single-pulse experiment it is shown here that its conclusions may be generalized to complex multidimensional experiments. The salient message is to explore (re-)design of NMR pulse sequences to return some of the magnetization to the z axis at the end, so that they can be performed without a relaxation delay. In favorable cases, such pulse sequences can be concatenated in a synergistic way to further enhance sensitivity.

Extracting double-quantum coherence in two-dimensional electronic spectroscopy under pump-probe geometry.

Two-dimensional electronic spectroscopy (2DES) can be implemented with different geometries, e.g., BOXCARS, collinear, and pump-probe geometries. The pump-probe geometry has the advantage of overlapping only two beams and reducing phase cycling steps. However, its applications are typically limited to observing the dynamics with single-quantum coherence and population, leaving the challenge to measure the dynamics of the double-quantum (2Q) coherence, which reflects the many-body interactions. We demonstrate an experimental technique in 2DES under pump-probe geometry with a designed pulse sequence and the signal processing method to extract 2Q coherence. In the designed pulse sequence, with the probe pulse arriving earlier than the pump pulses, our measured signal includes the 2Q signal as well as the zero-quantum signal. With phase cycling and data processing using causality enforcement, we extract the 2Q signal. The proposal is demonstrated with rubidium atoms. We observe the collective resonances of two-body dipole-dipole interactions in both the D1 and D2 lines.

Emerging Trends in Magnetic Resonance Fingerprinting for Quantitative Biomedical Imaging Applications: A Review.

Magnetic resonance imaging (MRI) stands as a vital medical imaging technique, renowned for its ability to offer high-resolution images of the human body with remarkable soft-tissue contrast. This enables healthcare professionals to gain valuable insights into various aspects of the human body, including morphology, structural integrity, and physiological processes. Quantitative imaging provides compositional measurements of the human body, but, currently, either it takes a long scan time or is limited to low spatial resolutions. Undersampled k-space data acquisitions have significantly helped to reduce MRI scan time, while compressed sensing (CS) and deep learning (DL) reconstructions have mitigated the associated undersampling artifacts. Alternatively, magnetic resonance fingerprinting (MRF) provides an efficient and versatile framework to acquire and quantify multiple tissue properties simultaneously from a single fast MRI scan. The MRF framework involves four key aspects: (1) pulse sequence design; (2) rapid (undersampled) data acquisition; (3) encoding of tissue properties in MR signal evolutions or fingerprints; and (4) simultaneous recovery of multiple quantitative spatial maps. This paper provides an extensive literature review of the MRF framework, addressing the trends associated with these four key aspects. There are specific challenges in MRF for all ranges of magnetic field strengths and all body parts, which can present opportunities for further investigation. We aim to review the best practices in each key aspect of MRF, as well as for different applications, such as cardiac, brain, and musculoskeletal imaging, among others. A comprehensive review of these applications will enable us to assess future trends and their implications for the translation of MRF into these biomedical imaging applications.

Higher-order methods for Hamiltonian engineering pulse sequence design

Higher-order methods for Hamiltonian engineering pulse sequence design

An improved algorithm for design of broadband excitation, inversion, and mixing pulse sequences by iterative optimization of phases: TOPS-2

This paper presents an improved iterative algorithm (TOPS-2) for the design of broadband inversion, excitation and coherent transfer mixing sequence (TOCSY) pulses. The evolution of the Bloch vector is presented as a sequence of small constant flip angle pulses with varying phases and constant amplitude. This paper describes an improved algorithm for iterative optimization of piece-wise constant phases as we incorporate the quadratic terms in the propagators. In our iterative optimization we obtain a closed-form expression for each phase, and these phases are optimized sequentially using the new improved algorithm. This paper compares the simulation results of the TOPS vs TOPS-2 and shows that TOPS-2 perform better. Experimental validation of excitation and inversion TOPS-2 pulse sequence is performed with .5% H2O in 99.5% D2O, and experimental validation of TOPS-2 mixing (TOCSY) pulse sequence is done with 0.1% of Ethylbenzene (EB) in CDCl3 solvent.

Bespoke pulse design for robust rapid two-qubit gates with trapped ions

Two-qubit gate performance is vital for scaling up ion-trap quantum computing. Optimized quantum control is needed to achieve reductions in gate-time and gate error-rate. We describe two-qubit gates with addressed Raman beams within a linear trapped-ion chain by a quantum master equation (QME). The QME incorporates the single-ion two-photon effective Rabi frequency, Autler-Townes and vibrational Bloch-Siegert energy shifts, off-resonant transitions, Raman and Rayleigh scattering, laser-power fluctuations, motional heating, cross-Kerr phonon coupling, laser spillover, asymmetric addressing beams and an imperfect initial motional ground state, with no fitting parameters. Whereas state-of-the-art methods are oblivious to these effects in the gate design procedure. We employ global optimization to design pulse sequences for achieving a robust rapid two-qubit gate for seven trapped $^{171}$Yb$^{+}$ ions by optimizing over numerically integrated QME solutions. Here, robust means resilient against slow drift of motional frequencies, and rapid means gate execution where the effective Rabi frequency is comparable to the detuning of the laser from the ion's bare electronic transition. Our robust quantum control delivers rapid high-quality two-qubit gates in long ion chains, enabling scalable quantum computing with trapped ions.

Arterial Spin Labeling: Techniques, Clinical Applications, and Interpretation.

Arterial spin labeling (ASL) is an emerging noninvasive MRI technique for assessing cerebral perfusion. An important advantage of ASL perfusion is the lack of a requirement for an exogenous tracer. ASL uses magnetically labeled water protons from arterial blood as an endogenous diffusible tracer. For this reason, ASL is an attractive perfusion imaging modality for children and for patients with contraindications or adverse reactions to gadolinium, patients with renal failure, and those who need repeated follow-up imaging. Another advantage of ASL is the possibility of quantifying cerebral blood flow, which provides an opportunity for comparative analysis among multiple longitudinal studies, unlike other MR perfusion techniques, which are semiquantitative and yield relative perfusion parameters. Advances in MRI technology and pulse sequence design have translated ASL beyond the research arena to successful clinical implementation. However, ASL is still underused in routine clinical practice. Some disadvantages of ASL include a lower signal-to-noise ratio and a longer acquisition time than those with dynamic susceptibility contrast-enhanced MRI. Additional factors limiting the use of ASL include variations in existing techniques and pulse sequence design, the complexity of implementation and postprocessing, insufficient experience with and/or knowledge of the potential clinical applications, and the absence of interpretation guidelines. The authors review the technical and physiologic basis of ASL perfusion, as well as artifacts, pitfalls, and its current clinical applications. A practical approach for interpreting ASL findings is also suggested.

Using a novel rapid alternating steering angles pulse sequence to evaluate the impact of theranostic ultrasound-mediated ultra-short pulse length on blood-brain barrier opening volume and closure, cavitation mapping, drug delivery feasibility, and safety.

Background: Focused ultrasound (FUS)-mediated blood-brain barrier (BBB) opening is a noninvasive, safe and reversible technique for targeted drug delivery to the brain. Most preclinical systems developed to perform and monitor BBB opening are comprised of a separate geometrically focused transducer and passive cavitation detector (PCD) or imaging array. This study builds upon previous work from our group developing a single imaging phased array configuration for simultaneous BBB opening and monitoring called theranostic ultrasound (ThUS), leveraging ultra-short pulse lengths (USPLs) and a novel rapid alternating steering angles (RASTA) pulse sequence design for simultaneous bilateral sonications with target-specific USPL. The RASTA sequence was further employed to evaluate the impact of USPL on BBB opening volume, power cavitation imaging (PCI) pixel intensity, BBB closing timeline, drug delivery efficiency, and safety. Methods: A P4-1 phased array transducer driven by a Verasonics Vantage ultrasound system was operated using a custom script to run the RASTA sequence which consisted of interleaved steered, focused transmits and passive imaging. Contrast-enhanced magnetic resonance imaging (MRI) confirmed initial opening volume and closure of the BBB by longitudinal imaging through 72 hours post-BBB opening. For drug delivery experiments, mice were systemically administered a 70 kDa fluorescent dextran or adeno-associated virus serotype 9 (AAV9) for fluorescence microscopy or enzyme-linked immunosorbent assay (ELISA) to evaluate ThUS-mediated molecular therapeutic delivery. Additional brain sections were also H&E-stained to evaluate histological damage, and IBA1- and GFAP-stained to elucidate the effects of ThUS-mediated BBB opening on stimulation of key cell types involved in the neuro-immune response, microglia and astrocytes. Results: The ThUS RASTA sequence induced distinct BBB openings simultaneously in the same mouse where volume, PCI pixel intensity, level of dextran delivery, and AAV reporter transgene expression were correlated with brain hemisphere-specific USPL, consistent with statistically significant differences between 1.5, 5, and 10-cycle USPL groups. BBB closure after ThUS required 2-48 hours depending on USPL. The potential for acute damage and neuro-immune activation increased with USPL, but such observable damage was nearly reversed 96 hours post-ThUS. Conclusion: ThUS is a versatile single-array technique which exhibits the potential for investigating a variety of non-invasive therapeutic delivery applications in the brain.

Deep learning to harmonize MRI scans for better diagnosis and prognosis in multi‐center studies

AbstractBackgroundData heterogeneity due to cross‐scanner variations is a major challenge in multi‐center aging and dementia studies. Brain structural measures for the same participant can vary due to scanner differences (manufacturer, scanner age/technology, signal‐to‐noise ratio, pulse sequence design, contrast, resolution) and result in biomarker variability. In this work, we applied basic image processing and deep learning methods (style transfer (ST) and generative adversarial networks (GANs)) for harmonizing T1‐weighted MRI scans across change in vendors (GE to Siemens) and resolution (1x1x1.2mm to 0.8x0.8x0.8mm) and test whether this harmonization improved compatibility of AD biomarker measures.MethodWe utilized training (n=814) and test (n=113 same participants scanned on two scanners close‐in‐time, typically on the same day, with different resolution) data from cognitively impaired and unimpaired participants scanned on GE and Siemens scanners from Mayo Clinic Study of Aging and Mayo ADRC. The harmonization was conducted to translate GE to Siemens. All scans were affine transformed to the same template space, resampled to 1.5 mm3, and bias corrected. Histogram matching was performed using cumulative density functions. A ResNet18 was trained for the ST’s content and style layers. Two types of GANs, conditional GANs (cGAN) and cycle‐consistent GANs (cycleGAN), were constructed. We then measured regional cortical thickness from each image using FreeSurfer‐7.1.1 and compared the thickness measurements from the original and translated scans using intraclass‐correlation (ICC) and Deming regression.ResultIn the test dataset, ST and cycleGAN showed the best performances when comparing the translated GE to Siemens. With ST, the ICC increased (vs. the original scans) slightly for the temporal meta‐ROI (0.956 from 0.954) and more substantially for the frontal pole ROI (0.706 from 0.594). The cycleGAN showed an increase in ICC for the frontal pole ROI (0.610 from 0.594) but not the meta‐ROI (Fig. 1).ConclusionEach method leveraged a different strength. Histogram matching captures contrast, ST extracts textural information, and GANs learn combination of contrast, edge and texture properties. We found that deep learning is a promising approach to cross‐scanner variability. Our comparisons revealed anatomical differences across methods; thus, disease specific measure should be considered for selection of the scanner harmonization method.

Intrinsic Temporal Performance of the RF Receive Coil in Magnetic Resonance Imaging.

The functional magnetic resonance imaging (fMRI) at ultra-high field (UHF, [Formula: see text]) is a powerful temporal acquisition method which promises to capture neuronal activities at submillimeter scale. But high-spatial-resolution fMRI still remains difficult, as the nuisance temporal noise which also grows with the main magnetic field strength. For decades, mainstream solutions in reducing motion-induced temporal noise include motion-correction algorithms in image post-processing as well as MR acquisition schemes in RF pulse sequence designs, however hardware-related studies have been rarely reported over the RF receive coil. In this study, we have proposed the intrinsic temporal performance model, which is specifically used for measuring coil-related intrinsic temporal SNR (tSNR*), and the intrinsic sensitivity variability and thermal noise variability have been proposed as model parameters. The intrinsic temporal performance of single-channel loops and array coils were evaluated using numerical electromagnetic simulations, and phantom experiments were designed to investigate the intrinsic thermal noise variability. It was observed that the achievable intrinsic tSNR* can be greatly lowered by ~90% even with 2 mm translational motion in the normal direction, suggesting the effect of RF receive coils in producing temporal noise. The proposed model provides a new perspective in optimizing coil designs and array coil temporal combination methods, which may offer a feasible means in achieving submillimeter resolutions at UHF. Moreover, model parameters from the intrinsic temporal performance model can be directly calculated based on single MRI acquisition, offering a practical performance metric for manufactures and customers in quality and assurance checks of RF receive coil products.

Four-in-one: HSQC, HSQC-TOCSY (or H2BC), TOCSY, and enhanced HMBC spectra integrated into a single NO Relaxation Delay (NORD) NMR experiment

The NMR pulse sequence design strategy of NORD (NO Relaxation Delay) is extended to design of two new three-module experiments, NORD {HMBC}-{HSQC-TOCSY}-{TOCSY} and NORD {HMBC}-{2BOB}-{TOCSY}, each delivering four spectra – HMBC, HSQC, TOCSY, and either HSQC-TOCSY or H2BC. Compared to individual recording of these spectra particularly the sensitivity of the least sensitive module, HMBC, is enhanced by designing the homonuclear TOCSY module to allow buildup of magnetization pertinent to HMBC during its execution. Effectively, the sensitivity of the heteronuclear modules is boosted at the expense of the inherently much higher TOCSY sensitivity, thus resulting in a significant saving in spectrometer time.

Review of Recent Developments in NMR Core Analysis

The last 10 years have witnessed numerous new developments and advancements in nuclear magnetic resonance (NMR) rock core analysis both in conventional and unconventional reservoirs. On the hardware side, NMR instruments are now capable of handling hundreds of thousands of radio frequency (RF) pulses, and the pulses can be more closely spaced than ever. This allows measuring samples with very fast relaxation times, which was not possible before. Higher field NMR spectrometers operating at frequencies of ~12 MHz and ~20 MHz (in addition to the standard low-field ~2 MHz instruments) were introduced, which drastically improved the signal-to-noise ratio (SNR) and even allowed two-dimensional (2D) and three-dimensional (3D) NMR imaging to be performed on the samples to complement traditional relaxation measurements. Another consequence of using higher field instruments is that even samples with a very low amount of NMR signal can now provide useful data in a reasonable amount of time. Additional hardware improvements include the development of NMR-compatible high-temperature and high-pressure vessels and faster and more robust electronics and computers, which allow faster data acquisition, processing, and a more user-friendly environment for new NMR pulse sequence design and implementation. Following the hardware improvements, new applications were developed for rock core analysis, including modified Carl-Purcell-Meiboom-Gill (CPMG) pulse sequences for minimizing sample heating. NMR-based wettability, relative permeability, capillary pressure, cuttings, and long core measurements have also been successful. In unconventionals, NMR-based gas isotherm measurements and fluid-typing measurements are now common practices. This review paper sets out to summarize the recent NMR developments in the industry as well as provide references where more details can be found on each topic.

The "Spin-3/2 Bloch Equation": System matrix formalism ofexcitation, relaxation, and off-resonance effects in biological tissue.

This work proposes "Spin-3/2 Bloch Equation" (SBE), a consolidated formalism for spin-3/2 dynamics in biological environments. The formalism encapsulates excitation, relaxation, and off-resonance with accessible matrix representation for a straightforward implementation with high computational efficiency. The SBE is derived using spherical tensor operators to encapsulate the spin-3/2 dynamics in biological systems in a single system matrix, a formalism akin to the well-known Bloch Equations (BE). Using the proposed SBE, simulations of three classical 23 Na pulse sequences were performed to demonstrate the versatility and applicability of the model, returning the evolution of the 23 Na spin system during these experiments: soft rectangular and adiabatic inversion recovery (IR) and triple-quantum filtering. IR simulations were compared with two existing spin-3/2 simulators and the adaptive BE as a first-order approximation. The proposed SBE is straightforward to implement and facilitates accurate and fast simulations of the underlying higher order coherence in sodium experiments of biological tissues. SBE simulations and comparison spin-3/2 simulators outperform the BE simulations as expected, with the SBE offering superior computational efficiency achieved by the single system matrix formalism. The proposed SBE enables comprehensive and accurate simulations for spin-3/2 systems in biological tissue. With a one-line call to an ordinary differential equation solver, it offers a computationally efficient and accessible method for use in 23 Na pulse sequence design.

Rational Pulse Design for Enantiomer-Selective Microwave Three-Wave Mixing

Microwave three-wave mixing allows for enantiomer-selective excitation of randomly oriented chiral molecules into rotational states with different energy. The random orientation of molecules is reflected in the degeneracy of the rotational spectrum with respect to the orientational quantum number M and reduces, if not accounted for, enantiomer-selectivity. Here, we show how to design pulse sequences with maximal enantiomer-selectivity from an analysis of the M-dependence of the Rabi frequencies associated with rotational transitions induced by resonant microwave drives. We compare different excitations schemes for rotational transitions and show that maximal enantiomer-selectivity at a given rotational temperature is achieved for synchronized three-wave mixing with circularly polarized fields.

Cardiac MR: From Theory to Practice.

Cardiovascular disease (CVD) is the leading single cause of morbidity and mortality, causing over 17. 9 million deaths worldwide per year with associated costs of over $800 billion. Improving prevention, diagnosis, and treatment of CVD is therefore a global priority. Cardiovascular magnetic resonance (CMR) has emerged as a clinically important technique for the assessment of cardiovascular anatomy, function, perfusion, and viability. However, diversity and complexity of imaging, reconstruction and analysis methods pose some limitations to the widespread use of CMR. Especially in view of recent developments in the field of machine learning that provide novel solutions to address existing problems, it is necessary to bridge the gap between the clinical and scientific communities. This review covers five essential aspects of CMR to provide a comprehensive overview ranging from CVDs to CMR pulse sequence design, acquisition protocols, motion handling, image reconstruction and quantitative analysis of the obtained data. (1) The basic MR physics of CMR is introduced. Basic pulse sequence building blocks that are commonly used in CMR imaging are presented. Sequences containing these building blocks are formed for parametric mapping and functional imaging techniques. Commonly perceived artifacts and potential countermeasures are discussed for these methods. (2) CMR methods for identifying CVDs are illustrated. Basic anatomy and functional processes are described to understand the cardiac pathologies and how they can be captured by CMR imaging. (3) The planning and conduct of a complete CMR exam which is targeted for the respective pathology is shown. Building blocks are illustrated to create an efficient and patient-centered workflow. Further strategies to cope with challenging patients are discussed. (4) Imaging acceleration and reconstruction techniques are presented that enable acquisition of spatial, temporal, and parametric dynamics of the cardiac cycle. The handling of respiratory and cardiac motion strategies as well as their integration into the reconstruction processes is showcased. (5) Recent advances on deep learning-based reconstructions for this purpose are summarized. Furthermore, an overview of novel deep learning image segmentation and analysis methods is provided with a focus on automatic, fast and reliable extraction of biomarkers and parameters of clinical relevance.

Molecular Imaging of Brain Tumors and Drug Delivery Using CEST MRI: Promises and Challenges.

Chemical exchange saturation transfer (CEST) magnetic resonance imaging (MRI) detects molecules in their natural forms in a sensitive and non-invasive manner. This makes it a robust approach to assess brain tumors and related molecular alterations using endogenous molecules, such as proteins/peptides, and drugs approved for clinical use. In this review, we will discuss the promises of CEST MRI in the identification of tumors, tumor grading, detecting molecular alterations related to isocitrate dehydrogenase (IDH) and O-6-methylguanine-DNA methyltransferase (MGMT), assessment of treatment effects, and using multiple contrasts of CEST to develop theranostic approaches for cancer treatments. Promising applications include (i) using the CEST contrast of amide protons of proteins/peptides to detect brain tumors, such as glioblastoma multiforme (GBM) and low-grade gliomas; (ii) using multiple CEST contrasts for tumor stratification, and (iii) evaluation of the efficacy of drug delivery without the need of metallic or radioactive labels. These promising applications have raised enthusiasm, however, the use of CEST MRI is not trivial. CEST contrast depends on the pulse sequences, saturation parameters, methods used to analyze the CEST spectrum (i.e., Z-spectrum), and, importantly, how to interpret changes in CEST contrast and related molecular alterations in the brain. Emerging pulse sequence designs and data analysis approaches, including those assisted with deep learning, have enhanced the capability of CEST MRI in detecting molecules in brain tumors. CEST has become a specific marker for tumor grading and has the potential for prognosis and theranostics in brain tumors. With increasing understanding of the technical aspects and associated molecular alterations detected by CEST MRI, this young field is expected to have wide clinical applications in the near future.