Guidelines for Acquiring and Reporting Clinical Neurospectroscopy

Abstract

Since the advent of CPT 76390 in 1998, magnetic resonance spectroscopy (MRS) of the brain, or neurospectroscopy, has moved from the realm of academic research into that of the clinical world. All major MR manufacturers have aided in the endeavor by automating neurospectroscopy so that it no longer requires an MR physicist and is a push-button technique that can be run by technologists just as a typical MR sequence. Thousands of studies have demonstrated the clinical efficacy of neurospectroscopy, and there are many medical reviews of how this technique can be applied across a wide range of neurologic disorders. However, few studies address the practical issue of acquiring and reporting neurospectroscopy in a clinical practice. Based on clinical experience at three different sites across the country and nearly two decades of applications training for technologists and radiologists at international clinical neurospectroscopy courses, the guidelines described in this article demonstrate proven protocols for clinical diagnosis and outline the strategies involved in acquiring, interpreting, and reporting clinical neurospectroscopy successfully. A standard operating procedure used across the three sites is described and high reproducibility across different platforms is shown.

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“…Typically, the analysis pipeline is one of the main contributors to result variability. Therefore, in order to allow comparison and replication, the complete disclosure of analysis parameters is crucial ( Lin et al, 2012 , Ridgway et al, 2008 ). Moreover, validation studies, such as those seen in structural MRI, are necessary whenever a new technique is introduced ( Duan et al, 2015 , Franco et al, 2013 , Lawrenz et al, 2015 , Zuo et al, 2010 , Zuo and Xing, 2014 ), or the settings of an existing method are modified ( Goto et al, 2015 , Landman et al, 2007 , Radua et al, 2014 ).…”

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“…A normal spectrum demonstrates upward sloping of peaks from myo-inositol to choline, forming the so-called Hunter’s angle of approximately 45°. 73–75 …”

“…75 Generally, absolute heights of metabolite peaks are not used, and rather the peaks are analyzed as ratios such as Cho/NAA and Cho/Cr. 74,76 MRS has been shown to differentiate gliomas by grade on the basis of a positive correlation between Cho/NAA and Cho/Cr ratios and grade.…”

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“…Data acquired using single voxel, PRESS, TR/TE: 2000/30 ms, 2×2×2 cc in posterior cingulate at 3Tas shown in bottom right inset and postprocessed using LCModel. Modified from Lin et al (2012a)…”