Endogenous chemical exchange saturation transfer (CEST) effects are always diluted by competing effects, such as direct water proton saturation (spillover) and semi-solid macromolecular magnetization transfer (MT). This leads to unwanted T2 and MT signal contributions that lessen the CEST signal specificity to the underlying biochemical exchange processes. A spillover correction is of special interest for clinical static field strengths and protons resonating near the water peak. This is the case for all endogenous CEST agents, such as amide proton transfer, –OH-CEST of glycosaminoglycans, glucose or myo-inositol, and amine exchange of creatine or glutamate. All CEST effects also appear to be scaled by the T1 relaxation time of water, as they are mediated by the water pool. This forms the motivation for simple metrics that correct the CEST signal. Based on eigenspace theory, we propose a novel magnetization transfer ratio (MTRRex), employing the inverse Z-spectrum, which eliminates spillover and semi-solid MT effects. This metric can be simply related to Rex, the exchange-dependent relaxation rate in the rotating frame, and ka, the inherent exchange rate. Furthermore, it can be scaled by the duty cycle, allowing for simple translation to clinical protocols. For verification, the amine proton exchange of creatine in solutions with different agar concentrations was studied experimentally at a clinical field strength of 3 T, where spillover effects are large. We demonstrate that spillover can be properly corrected and that quantitative evaluation of pH and creatine concentration is possible. This proves that MTRRex is a quantitative and biophysically specific CEST-MRI metric. Applied to acute stroke induced in rat brain, the corrected CEST signal shows significantly higher contrast between the stroke area and normal tissue, as well as less B1 dependence, than conventional approaches.

Chemical exchange observed by NMR saturation transfer (CEST) and spin-lock (SL) experiments provide an MRI contrast by indirect detection of exchanging protons. The determination of the relative concentrations and exchange rates is commonly achieved by numerical integration of the Bloch-McConnell equations. We derive an analytical solution of the Bloch-McConnell equations that describes the magnetization of coupled spin populations under radiofrequency irradiation. As CEST and off-resonant SL are equivalent, their steady-state magnetization and dynamics can be predicted by the same single eigenvalue: the longitudinal relaxation rate in the rotating frame R1ρ . For the case of slowly exchanging systems, e.g. amide protons, the saturation of the small proton pool is affected by transverse relaxation (R2b ). It turns out, that R2b is also significant for intermediate exchange, such as amine- or hydroxyl-exchange or paramagnetic CEST agents, if pools are only partially saturated. We propose a solution for R1ρ that includes R2 of the exchanging pool by extending existing approaches, and verify it by numerical simulations. With the appropriate projection factors, we obtain an analytical solution for CEST and SL for nonzero R2 of the exchanging pool, exchange rates in the range 1-10(4) Hz, B1 from 0.1 to 20 μT and arbitrary chemical shift differences between the exchanging pools, whilst considering the dilution by direct water saturation across the entire Z-spectra. This allows the optimization of irradiation parameters and the quantification of pH-dependent exchange rates and metabolite concentrations. In addition, we propose evaluation methods that correct for concomitant direct saturation effects. It is shown that existing theoretical treatments for CEST are special cases of this approach.

Chemical exchange saturation transfer (CEST) of metabolite protons that undergo exchange processes with the abundant water pool enables a specific contrast for magnetic resonance imaging (MRI). The CEST image contrast depends on physical and physiological parameters that characterize the microenvironment such as temperature, pH, and metabolite concentration. However, CEST imaging in vivo is a complex technique because of interferences with direct water saturation (spillover effect), the involvement of other exchanging pools, in particular macromolecular systems (magnetization transfer, MT), and nuclear Overhauser effects (NOEs). Moreover, there is a strong dependence of the diverse effects on the employed parameters of radiofrequency irradiation for selective saturation which makes interpretation of acquired signals difficult. This review considers analytical solutions of the Bloch–McConnell (BM) equation system which enable deep insight and theoretical description of CEST and the equivalent off-resonant spinlock (SL) experiments. We derive and discuss proposed theoretical treatments in detail to understand the influence of saturation parameters on the acquired Z-spectrum and how the different effects interfere and can be isolated in MR Z-spectroscopy. Finally, we provide an overview of reported CEST effects in vivo and discuss proposed methods and technical approaches applicable to in vivo CEST studies on clinical MRI systems.