Purpose To integrate deuterium metabolic imaging (DMI) with clinical MRI through an interleaved MRI and DMI acquisition workflow. Interleaved MRI‐DMI was enabled with hardware and pulse sequence modifications, and the performance was demonstrated using fluid‐attenuated inversion recovery (FLAIR) MRI as an example. Methods Interleaved FLAIR‐DMI was developed by interleaving the 2H excitation and acquisition time windows into the intrinsic delay periods presented in the FLAIR method. All 2H MR signals were up‐converted to the 1H Larmor frequency using a custom‐built hardware unit, which also achieved frequency and phase locking of the output signal in real‐time. The interleaved measurements were compared with direct measurements both in phantom and in the human brain in vivo. Results The interleaved MRI‐DMI acquisition strategy allowed simultaneous detection of FLAIR MRI and DMI in the same scan time as a FLAIR‐only MRI acquisition. Both phantom and in vivo data showed that the MR image quality, DMI sensitivity as well as information content were preserved using interleaved MRI‐DMI. Conclusion The interleaved MRI‐DMI technology can be used to extend clinical MRI protocols with DMI, thereby offering a metabolic component to the MR imaging contrasts without a penalty on patient comfort or scan time.

Deuterium Metabolic Imaging (DMI) is an emerging method to spatially map metabolism in vivo. To enhance the time efficiency of a combined MRI-DMI protocol, interleaved MRI-DMI acquisitions were developed for multiple clinical MRI sequences. The protocol includes four MRIs that are commonly used in neurological MRI exams, namely FLAIR, T2W, SWI and T1W MP-RAGE, with DMI acquisition in parallel, acquired in 28 minutes. We demonstrate the performance of the interleaved MRI-DMI protocol on healthy human brain and discuss the guiding principles as well as limitations of extending other MRI sequences with DMI using the presented interleaving strategy.