Single-voxel Proton Spectroscopy Research Articles

Effect of antibiotic therapy on proton MR spectroscopy findings in human pyogenic brain abscesses.

This work aims to determine how antibiotic therapy influences MR spectroscopic findings in patients undergoing treatment for pyogenic brain abscess. This prospective, single center study included all patients who received treatment for brain abscesses at the Neurosurgery Department of University Hospital Ostrava between 2012-2017. Preoperative MR imaging was carried out on all patients including diffusion-weighted imaging and in vivo single-voxel proton spectroscopy with intermediate echo time. The following factors were evaluated: duration of antibiotic therapy, characteristics of MR imaging and spectra findings and culture results. MR spectroscopy findings characteristic of brain abscesses, i.e. the resonances of at least one of the metabolites concerned (amino acids, acetate, alanine and succinate), were observed in 23 patients who had undergone antibiotic therapy for less than 72 hours beforehand (median 7 hours; IQR 30 hours). The 20 patients who underwent antibiotic therapy for longer than this (the median time was 336 hours with an IQR of 284 hours) showed no abscess-specific metabolites, only nonspecific lactate and/or lipid resonance (P<0.0005). These results were further compared with culture findings of pus samples taken intraoperatively: a significantly higher rate of positive culture (78.2%) was determined in cases where antibiotics were administered less than 72 hours before MRS (P<0.0005). Prolonged antibiotic therapy can influence MRS findings in pyogenic brain abscesses - a fact which is certainly necessary to take into account in its differential diagnosis. The disappearance of the characteristic metabolites can be indirectly interpreted as an indicator of successful antibiotic therapy in cases where surgical intervention is not possible. Further study in this field is required to confirm the results of this study.

Effect of linewidth on estimation of metabolic concentration when using water lineshape spectral model fitting for single voxel proton spectroscopy at 7 T.

Good B0 field homogeneity is considered an essential requirement to obtain high-quality MRS data. Many commonly used spectral fitting methods assume that all metabolite signals have Lorentzian or Gaussian shapes. However, B0 inhomogeneity can both broaden the linewidth and modify the lineshape. In this study, it is hypothesized that a realistic metabolite fitting model, which accounts for B0 homogeneity on the basis of the water lineshape, will improve the accuracy of estimation of metabolite concentrations. In-vivo water suppressed/unsuppressed single voxel spectroscopy signals were acquired under three different B0 field homogeneity regimes. Individual realistic basis sets were created for each acquisition. Frequency-domain spectral fitting with LCModel was used to quantify the metabolite concentrations with fitting uncertainties given in terms of the Cramer-Rao lower bound. The quantification results obtained using the water lineshape basis set yielded similar concentrations independent of linewidth and showed a larger fitting error as the linewidth increased. The conventional approach, however quantifies metabolite concentrations with greater variations despite showing a supposedly improved fitting quality. The water lineshape basis set achieved single voxel spectroscopy accuracy that is less sensitive to the linewidth compared to the conventional spectral fitting method for the range of linewidths used in this study, but the precision deteriorated with worsening B0 field inhomogeneity. The beneficial effect was ascribed to a reduction in the number of degrees of freedom when using the water lineshape to generate the basis set.

Implications of the magnetic susceptibility difference between grey and white matter for single-voxel proton spectroscopy at 7 T.

Magnetic susceptibility differences between grey matter (GM) and white matter (WM) can potentially affect lineshapes and chemical shifts in single-voxel spectroscopy. This study aimed to investigate the consequences and potential utility of these effects. Spectroscopy voxels were segmented into GM, WM, and cerebrospinal fluid based on T1-weighted images. GM and WM lineshapes were computed using multi-echo gradient-echo images to measure the frequency distribution. Twenty 7 Tesla single voxel spectra with corresponding T1-weighted images were acquired from the frontal and parietal lobes from five healthy human volunteers. Consistent frequency shifts (mean [±SD] 4.9 ± 2.0 Hz) and linewidth differences (2.4 ± 1.5 Hz) between the two tissue types were observed. Directly visible metabolites (creatine, choline, and myo-inositol) exhibited frequency shifts and linewidth differences that were consistent with a linear-weighted summation of their expected GM and WM distribution ratios. The magnetic susceptibility difference between GM and WM had a detectable effect on single-voxel proton spectra, which results in both frequency shifts and lineshape broadening. This effect can be used to estimate the relative metabolic distribution in the GM and WM for directly observable metabolites. Fractional distributions estimated with this method demonstrated good agreement with literature values for the selected metabolites.

The application of magnetic resonance fingerprinting to single voxel proton spectroscopy.

Magnetic resonance fingerprinting has been proposed as a method for undersampling k-space while simultaneously yielding multiparametric tissue maps. In the context of single voxel spectroscopy, fingerprinting can provide a unified framework for parameter estimation. We demonstrate the utility of such a magnetic resonance spectroscopic fingerprinting (MRSF) framework for simultaneously quantifying metabolite concentrations, T1 and T2 relaxation times and transmit inhomogeneity for major singlets of N-acetylaspartate, creatine and choline. This is achieved by varying TR , TE and the flip angle of the first pulse in a PRESS sequence between successive excitations (i.e. successive TR values). The need for multiparametric schemes such as MRSF for accurate medical diagnostics is demonstrated with the aid of realistic in vivo simulations; these show that certain schemes lead to substantial increases to the area under receiver operating characteristics of metabolite concentrations, when viewed as classifiers of pathologies. Numerical simulations and phantom and in vivo experiments using several different schedules of variable length demonstrate superior precision and accuracy for metabolite concentrations and longitudinal relaxation, and similar performance for the quantification of transverse relaxation.

Non-invasive quantification of hepatic steatosis in living, related liver donors using dual-echo Dixon imaging and single-voxel proton spectroscopy

To evaluate the diagnostic implications of hepatic fat fraction calculated using dual-echo Dixon imaging and (1)H magnetic resonance spectroscopy (MRS) to detect hepatic steatosis in potential liver donors using histopathology as the reference standard. One hundred and forty-five potential liver donors were included in the study. Magnetic resonance imaging (MRI) was performed using a 1.5 T system using a three-dimensional dual-echo MRI sequence with automated reconstruction of in-phase (IP), out-of-phase (OP), fat-signal-only, and water-signal-only images. Hepatic fat fraction was calculated by drawing 15 regions of interest on the IP, OP, fat-only, and water-only images. Single-voxel MRS was performed at echo times (TEs) of 30ms in the right and left lobes of liver. Liver fat fraction was calculated from water and fat peaks. One hundred and forty-five biopsies were prospectively evaluated for steatosis by a pathologist using traditional determination of the cell-count fraction. MRI and pathology values of steatosis were correlated using Pearson's correlation coefficient. The sensitivity and specificity of each of these methods was calculated using histopathology as the reference standard. Reproducibility was assessed in 40 patients who had repeat scanning within 4-40 days. Measurement error was calculated from the coefficient of variation (CoV) with histopathologically proven <5% fat (n=112). The Bland-Altman limits of agreement with 95% confidence intervals (CI) was -2.9 to 5.3%. The intraclass correlation coefficient (ICC) for interobserver variability and reproducibility was 0.94 (95% CI: 0.91-0.97), 0.92 (95% CI: 0.91-0.97). The CoV was 7.6% (95% CI: 3.4-11.85). The area under the receiver operating characteristic (ROC) curve (AUC) for Dixon imaging 0.89 (95% CI: 0.87-0.91), for MRS 0.88 (95% CI: 0.86-0.90). The sensitivity for detecting <5% fat was 84% and specificity was 90%. Combination of dual-echo Dixon imaging and proton MRS is a useful tool for the preoperative diagnosis of hepatic steatosis in potential living liver donors. This can help avoid unnecessary biopsies in these patients.

Detection of hepatic and pancreatic fat infiltration in type II diabetes mellitus patients with IDEAL-Quant using 3.0T MR: comparison with single-voxel proton spectroscopy

Background Type II diabetes mellitus usually related to visceral and other organ (ectopic) fat. The purpose of this study was to detect hepatic and pancreatic fat infiltration in type II diabetes mellitus patients using 3.0T magnetic resonance (MR) and to compare the performance of iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL-Quant) with single-voxel proton spectroscopy (H1-MRS). Methods The study protocol was approved by our Institutional Review Board. Written informed consent was obtained from each subject in this study. We prospectively performed IDEAL-Quant and single-voxel proton spectroscopy with an echo time of 35 ms on 24 type II diabetes patients and 10 healthy volunteers. The hepatic proton density fat fraction (HPDFF) and pancreatic proton density fat fraction (PPDFF) were calculated, compared, and analyzed by t-tests and Spearman's correlation. Results The HPDFF and PPDFF measured with IDEAL-Quant were significantly different between the healthy volunteers and type II diabetes patients (th =9.377, P=0.000; tp =2.813, P=0.008). The HPDFF and PPDFF measured with MRS were also significantly different between the healthy volunteers and type II diabetes patients (th=5.342, P=0.000; tp =2.63, P=0.013). The HPDFF and PPDFF measured by the two methods were in good agreement (rh=0.854, P=0.000; rp =0.774, P=0.000). The HPDFF and PPDFF were not significantly correlated with each other (r MRS=0.203, p=0.248; r IDEAL-Quant=0.301, P=0.084). The PPDFF measured with IDEAL-Quant was associated with body mass index (r=0.377, P=0.028). Conclusion IDEAL-Quant is a nice method for hepatic and pancreatic fat detection, and it can be applied in clinical practice.

Chemical shift-based MRI to measure fat fractions in dystrophic skeletal muscle

The relationship between fat fractions (FFs) determined based on multiple TE, unipolar gradient echo images and (1) H magnetic resonance spectroscopy (MRS) was evaluated using different models for fat-water decomposition, signal-to-noise ratios, and excitation flip angles. A combination of single-voxel proton spectroscopy ((1) H-MRS) and gradient echo imaging was used to determine muscle FFs in both normal and dystrophic muscles. In order to cover a large range of FFs, the soleus and vastus lateralis muscles of 22 unaffected control subjects, 16 subjects with collagen VI deficiency (COL6), and 71 subjects with Duchenne muscular dystrophy (DMD) were studied. (1) H-MRS-based FF were corrected for the increased muscle (1) H2 O T1 and T2 values observed in dystrophic muscles. Excellent agreement was found between coregistered FFs derived from gradient echo images fit to a multipeak model with noise bias correction and the relaxation-corrected (1) H-MRS FFs (y = 0.93x + 0.003; R(2) = 0.96) across the full range of FFs. Relaxation-corrected (1) H-MRS FFs and imaging-based FFs were significantly elevated (P < 0.01) in the muscles of COL6 and DMD subjects. FFs, T2 , and T1 were all sensitive to muscle involvement in dystrophic muscle. MRI offered an additional advantage over single-voxel spectroscopy in that the tissue heterogeneity in FFs could be readily determined.

Real-time automated spectral assessment of the BOLD response for neurofeedback at 3 and 7 T

Echo-planar imaging is the dominant functional MRI data acquisition scheme for evaluating the BOLD signal. To date, it remains the only approach providing neurofeedback from spatially localized brain activity. Real-time functional single-voxel proton spectroscopy (fSVPS) may be an alternative for spatially specific BOLD neurofeedback at 7T because it allows for a precise estimation of the local T2* signal, EPI-specific artifacts may be avoided, and the signal contrast may increase. In order to explore and optimize this alternative neurofeedback approach, we tested fully automated real-time fSVPS spectral estimation procedures to approximate T2* BOLD signal changes from the unsuppressed water peak, i.e. lorentzian non-linear complex spectral fit (LNLCSF) in frequency and frequency-time domain. The proposed approaches do not require additional spectroscopic localizers in contrast to conventional T2* approximation based on linear regression of the free induction decay (FID). For methods comparison, we evaluated quality measures for signals from the motor and the visual cortex as well as a real-time feedback condition at high (3T) and at ultra-high (7T) magnetic field strengths. Using these methods, we achieved reliable and fast water peak spectral parameter estimations. At 7T, we observed an absolute increase of spectra line narrowing due to the BOLD effect, but quality measures did not improve due to artifactual line broadening. Overall, the automated fSVPS approach can be used to assess dynamic spectral changes in real-time, and to provide localized T2* neurofeedback at 3 and 7T.

Obesity Is Associated With Structural and Functional Brain Abnormalities

Obesity Is Associated With Structural and Functional Brain Abnormalities

Single Voxel Proton Spectroscopy for Neurofeedback at 7 Tesla

Echo-planar imaging (EPI) in fMRI is regularly used to reveal BOLD activation in presubscribed regions of interest (ROI). The response is mediated by relative changes in T2* which appear as changes in the image pixel intensities. We have proposed an application of functional single-voxel proton spectroscopy (fSVPS) for real-time studies at ultra-high MR field which can be comparable to the EPI BOLD fMRI technique. A spin-echo SVPS protocol without water suppression was acquired with 310 repetitions on a 7T Siemens MR scanner (TE/TR = 20/1000 ms, flip angle α = 90°, voxel size 10 × 10 × 10 mm3). Transmitter reference voltage was optimized for the voxel location. Spectral processing of the water signal free induction decay (FID) using log-linear regression was used to estimate the T2* change between rest and activation of a functional task. The FID spectrum was filtered with a Gaussian window around the water peak, and log-linear regression was optimized for the particular ROI by adoption of the linearization length. The spectroscopic voxel was positioned on an ROI defined from a real-time fMRI EPI BOLD localizer. Additional online signal processing algorithms performed signal drift removal (exponential moving average), despiking and low-pass filtering (modified Kalman filter) and, finally, the dynamic feedback signal normalization. Two functional tasks were used to estimate the sensitivity of the SVPS method compared to BOLD signal changes, namely the primary motor cortex (PMC, left hand finger tapping) and visual cortex (VC, blinking checkerboard). Four healthy volunteers performed these tasks and an additional session using real-time signal feedback modulating their activation level of the PMC. Results show that single voxel spectroscopy is able to provide a good and reliable estimation of the ΒΟLD signal changes. Small data size and FID signal processing instead of processing entire brain volumes as well as more information revealed from the acquired total water spectrum, i.e., direct estimation of the T2* values and B0 changes, make SVPS proton spectroscopy suitable and advantageous for real-time neurofeedback studies. Particular challenges of ultra-high field spectroscopy due to the non-linearity in the spectral information, e.g., poor main magnetic field homogeneity and the absence of motion correction for the SVPS sequence may lead to the special artifacts in the control signal which still need to be addressed. The contrast to noise ratio (CNR), experimental statistic (t-values) and percent signal change were used as quality parameters to estimate the method performance. The potential and challenges of the spectroscopic approach for fMRI studies needs to be further investigated.

Identification of brown adipose tissue in mice with fat–water IDEAL‐MRI

To investigate the feasibility of using IDEAL (Iterative Decomposition with Echo Asymmetry and Least squares estimation) fat-water imaging and the resultant fat fraction metric in detecting brown adipose tissue (BAT) in mice, and in differentiating BAT from white adipose tissue (WAT). Excised WAT and BAT samples and whole-mice carcasses were imaged with a rapid three-dimensional fat-water IDEAL-SPGR sequence on a 3 Tesla scanner using a single-channel wrist coil. An isotropic voxel size of 0.6 mm was used. Excised samples were also scanned with single-voxel proton spectroscopy. Fat fraction images from IDEAL were reconstructed online using research software, and regions of WAT and BAT were quantified. A broad fat fraction range for BAT was observed (40-80%), in comparison to a tighter and higher WAT range of 90-93%, in both excised tissue samples and in situ. Using the fat fraction metric, the interscapular BAT depot in each carcass could be clearly identified, as well as peri-renal and inguinal depots that exhibited a mixed BAT and WAT phenotype appearance. Due to BAT's multi-locular fat distribution and extensive mitochondrial, cytoplasm, and vascular supply, its fat content is significantly less than that of WAT. We have demonstrated that the fat fraction metric from IDEAL-MRI is a sensitive and quantitative approach to noninvasively characterize BAT.

In vivo 1H magnetic resonance spectroscopy of amniotic fluid and fetal lung at 1.5 T: Technical challenges

To identify the major technical challenges associated with in utero single-voxel proton spectroscopy of amniotic fluid and fetal lung and to evaluate the feasibility of performing in utero fetal spectroscopy for fetal lung maturity testing. Fetal magnetic resonance (MR) spectroscopy of amniotic fluid and fetal lung were performed at 1.5 T in 8 near-term pregnant women. Presence/absence of lactate and choline peaks was tabulated. Ex vivo spectra were obtained from amniotic fluid samples to investigate and refine sequence parameters. Spectroscopy failed in 3 of 8 cases due to maternal discomfort (n = 1) or fetal gastroschisis (n = 2). Both fetal motion and low signal-to-noise ratio were limiting factors for the remaining 5 clinical in vivo studies at 1.5 T. Ex vivo and in vivo studies suggested feasibility for detecting lactate from amniotic fluid within a reasonable clinical scan time (4-5 minutes). Lactate was detected in 3 of 5 patients. Choline detection was limited and was detected in 1 patient. Minor motion effects can be overcome but continuous fetal motion is problematic. Lactate detection seems clinically feasible, but choline detection requires additional technical development and, potentially, further imaging at a higher field strength because of the low signal-to-noise ratio at 1.5 T.

Extrapontine Myelinolysis in a Child: A Rare Case with MRI, DWI and MRS Follow-up

We describe a case of extrapontine myelinolysis in a child presenting with chorea and parkinsonian symptoms after treatment for hyponatremic dehydration. Although both extrapontine myelinolysis (EPM) in childhood and extrapyramidal presentation of EPM are very rare in children, the patient presented with pure extrapyramidal symptoms. Besides basal ganglia involvement and sparing brain stem, MRI demonstrated involvement of the amygdala bilaterally hitherto never reported in EPM patients. While single voxel proton spectroscopy (MRS) of the basal ganglia at the beginning was normal, the follow-up MRS showed moderate to severe NAA and mI decrease. Diffusion-weighted imaging abnormalities appeared relatively late during the disease course, also an unexpected finding. In addition, there were apparent increases in apparent diffusion coefficient (ADC) values of the affected basal ganglia instead of diffusion restriction.

Comparative MR study of hepatic fat quantification using single‐voxel proton spectroscopy, two‐point dixon and three‐point IDEAL

Hepatic fat fraction (HFF) was measured in 28 lean/obese humans by single-voxel proton spectroscopy (MRS), a two-point Dixon (2PD), and a three-point iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) method (3PI). For the lean, obese, and total subject groups, the range of HFF measured by MRS was 0.3-3.5% (1.1 +/- 1.4%), 0.3-41.5% (11.7 +/- 12.1), and 0.3-41.5% (10.1 +/- 11.6%), respectively. For the same groups, the HFF measured by 2PD was -6.3-2.2% (-2.0 +/- 3.7%), -2.4-42.9% (12.9 +/- 13.8%), and -6.3-42.9% (10.5 +/- 13.7%), respectively, and for 3PI they were 7.9-12.8% (10.1 +/- 2.0%), 11.1-49.3% (22.0 +/- 12.2%), and 7.9-49.3% (20.0 +/- 11.8%), respectively. The HFF measured by MRS was highly correlated with those measured by 2PD (r = 0.954, P < 0.001) and 3PI (r = 0.973, P < 0.001). With the MRS data as a reference, the percentages of correct differentiation between normal and fatty liver with the MRI methods ranged from 68-93% for 2PD and 64-89% for 3PI. Our study demonstrates that the apparent HFF measured by the MRI methods can significantly vary depending on the choice of water-fat separation methods and sequences. Such variability may limit the clinical application of the MRI methods, particularly when a diagnosis of early fatty liver needs to be performed. Therefore, protocol-specific establishment of cutoffs for liver fat content may be necessary.

Measuring mania metabolites: a longitudinal proton spectroscopy study of hypomania

Using single-voxel proton spectroscopy we aimed to investigate changes in metabolite levels in key brain regions during hypomania and euthymia in patients with bipolar disorder (BD). Nine patients with a diagnosis of BD and nine age, sex, education, and handedness-matched comparison subjects underwent magnetic resonance proton spectroscopy (H(1)-MRS) using a 1.5 T magnet. Patients were assessed whilst hypomanic and euthymic. Metabolite (N-acetyl asparTate, NAA; myo-inositol, mI; choline, Cho) levels in the basal ganglia (BG), anterior cingulate cortex (AC), and frontal cortex (FC) were compared both between groups and within the patient group. Multivariate analysis revealed significant complex relationships between metabolite levels and brain regions with significant differences observed both between bipolar patients (hypomanic and euthymic) and controls, and across the two mood states. Hypomanic patients had lower mean metabolite levels when averaged across the AC and FC regions, compared with the controls. They also had a smaller difference in mean metabolite levels between the BG and FC than the control group. Euthymic patients were also found to have a smaller difference in the level of NAA between the BG and AC than the control group. This exploratory study of BD demonstrates significant differences in metabolite levels that vary both with respect to brain region and mood state. Not withstanding the confounding effects of medication and the limitation of small sample size the findings are important as they demonstrate that a longitudinal approach is a useful design especially in the context of a long-term phasic illness.

Neurological aspects of tuberous sclerosis in relation to MRI/MR spectroscopy findings in children with epilepsy

Our aim was to evaluate the relationship between the neurological outcome of tuberous sclerosis complex (TSC) and the findings obtained from both cranial magnetic resonance imaging (MRI) and single voxel proton spectroscopy (SVPS). MRIs of 13 children who met the diagnostic criteria for TSC were taken. Eleven of these children also underwent a prospective analysis of SVPS. Fisher's exact test and Mann-Whitney U test were used, where applicable, to detect any signs of the imaging data that would indicate poor outcome, or in other words, poor seizure control and/ or high degree of mental retardation.Poor seizure control was seen in eight of the patients and multiple seizure types in seven. Mental retardation was severe in six patients and mild/moderate in seven. MRI revealed multiple bilateral tubers and subependymal nodules (13/13), confluence of tubers (8/13), subcortical linear heterotopias (7/13), gyral cores (3/13) and cortical atrophy (3/13). SVPS findings of tubers were characterized by decreased NAA/Cr (1.43 ± 0.33, p<0.001), increased Cho/Cr (0.91 ± 0.082, p< 0.05) and mI/Cr (0.97 ± 0.19, p<0.01) ratios when compared with those of the control group. Lactate peak was detected in six patients.Unfavorable outcome in TSC can be predicted with the help of the following: multiple seizure types, a number of confluent appearances of the tubers and cortical atrophy. SVPS could be a useful clue to understand the pathophysiologic function of the tubers, especially in children with refractory epilepsy along with TSC.

The NIH MRI study of normal brain development

MRI is increasingly used to study normal and abnormal brain development, but we lack a clear understanding of “normal”. Previous studies have been limited by small samples, narrow age ranges and few behavioral measures. This multi-center project conducted epidemiologically based recruitment of a large, demographically balanced sample across a wide age range, using strict exclusion factors and comprehensive clinical/behavioral measures. A mixed cross-sectional and longitudinal design was used to create a MRI/clinical/behavioral database from approximately 500 children aged 7 days to 18 years to be shared with researchers and the clinical medicine community. Using a uniform acquisition protocol, data were collected at six Pediatric Study Centers and consolidated at a Data Coordinating Center. All data were transferred via a web-network into a MYSQL database that allowed (i) secure data transfer, (ii) automated MRI segmentation, (iii) correlation of neuroanatomical and clinical/behavioral variables as 3D statistical maps and (iv) remote interrogation and 3D viewing of database content. A population-based epidemiologic sampling strategy minimizes bias and enhances generalizability of the results. Target accrual tables reflect the demographics of the U.S. population (2000 Census data). Enrolled subjects underwent a standardized protocol to characterize neurobehavioral and pubertal status. All subjects underwent multi-spectral structural MRI. In a subset, we acquired T1/T2 relaxometry, diffusion tensor imaging, single-voxel proton spectroscopy and spectroscopic imaging. In the first of three cycles, successful structural MRI data were acquired in 392 subjects aged 4:6–18:3 years and in 72 subjects aged 7 days to 4:6 years. We describe the methodologies of MRI data acquisition and analysis, using illustrative results. This database will provide a basis for characterizing healthy brain maturation in relationship to behavior and serve as a source of control data for studies of childhood disorders. All data described here will be available to the scientific community from July, 2006.

Untreated Pediatric Primitive Neuroectodermal Tumor in Vivo: Quantitation of Taurine with MR Spectroscopy

To retrospectively investigate whether quantitation of taurine (Tau) concentrations with proton magnetic resonance (MR) spectroscopy in vivo improves the differentiation of primitive neuroectodermal tumors (PNET) from other common brain tumors in pediatric patients. The institutional review board approved this review of clinical data; it was not necessary to obtain parental consent. This study was HIPAA compliant. Single-voxel proton spectroscopy was added to the preoperative MR imaging work-up of 29 patients (12 boys and 17 girls; mean age, 6.5 years +/- 3.5) with untreated brain tumors; 13 had PNETs, and 16 had other tumors. Absolute concentrations (measured in millimoles per kilogram of brain tissue) of metabolites of the proton spectrum were determined. Student t tests were used for statistical comparisons. Elevated absolute Tau concentration proved to be the most significant metabolite in the differentiation of PNETs from other tumors (6.09 mmol/kg +/- 2.24 vs 0.76 mmol/kg +/- 0.95, P < .001). PNETs also exhibited a higher ratio of Tau relative to choline (1.21 +/- 0.48 vs 0.28 +/- 0.39, P < .001), a higher ratio of Tau relative to creatine (1.28 +/- 0.44 vs 0.38 +/- 0.67, P < .001), a reduced a ratio of N-acetyl-aspartate relative to choline (0.20 +/- 0.20 vs 0.79 +/- 0.56, P < .001), and an increased choline concentration (5.30 mmol/kg +/- 1.64 vs 3.08 mmol/kg +/- 2.53, P < .05). Tau concentrations ranged from 2.62 to 11.15 mmol/kg in individual patients with a PNET. Single-voxel quantitative (1)H MR spectroscopy performed in patients with untreated pediatric brain tumors showed that the Tau concentration was significantly elevated in PNETs and was useful in the differentiation of PNETs from other tumors.

Proton Spectroscopic Findings in Children With Epilepsy Owing to Tuberous Sclerosis Complex

Tuberous sclerosis complex is an autosomal dominant disorder that often causes refractory seizures. The presence of multiple lesions makes it difficult to identify a single lesion responsible for the epilepsy. Our purpose is to assess the single-voxel proton spectroscopic findings of the tubers in 11 children with tuberous sclerosis complex. Prior to age 4 years, all of the patients had presented with epileptic seizures and multiple bilateral tubers in magnetic resonance images. Single-voxel proton spectroscopy was performed from the tubers especially showing epileptogenic activity using both the long and short echo time and in 14 controls. The results were analyzed using the Mann-Whitney U-test. Compared with the control group, the spectroscopic findings of tubers were characterized by decreased N-acetylaspartate to creatine ratios (1.43 +/- 0.33; P < .001) in both the long and short echo time spectra, increased choline to creatine ratios (0.91 +/- 0.082; P < .05), and myo-inositol to creatine ratios (0.97 +/- 0.19; P < .01) in the short echo time spectra. A lactate peak was detected in the regions corresponding to an epileptic focus on electroencephalography in six patients. Single-voxel proton spectroscopy could be a useful noninvasive method to evaluate epileptogenic tubers.

Proton Spectroscopic Findings in Children With Epilepsy Owing to Tuberous Sclerosis Complex

Tuberous sclerosis complex is an autosomal dominant disorder that often causes refractory seizures. The presence of multiple lesions makes it difficult to identify a single lesion responsible for the epilepsy. Our purpose is to assess the single-voxel proton spectroscopic findings of the tubers in 11 children with tuberous sclerosis complex. Prior to age 4 years, all of the patients had presented with epileptic seizures and multiple bilateral tubers in magnetic resonance images. Single-voxel proton spectroscopy was performed from the tubers especially showing epileptogenic activity using both the long and short echo time and in 14 controls. The results were analyzed using the Mann-Whitney U-test. Compared with the control group, the spectroscopic findings of tubers were characterized by decreased N-acetylaspartate to creatine ratios (1.43 ± 0.33 ; P &lt; .001) in both the long and short echo time spectra, increased choline to creatine ratios (0.91 ± 0.082; P &lt; .05), and myo-inositol to creatine ratios (0.97 ± 0.19; P &lt; .01) in the short echo time spectra. A lactate peak was detected in the regions corresponding to an epileptic focus on electroencephalography in six patients. Single-voxel proton spectroscopy could be a useful noninvasive method to evaluate epileptogenic tubers. ( J Child Neurol 2005;20:517-522).