Mr Spectroscopy in Clinical Research

Abstract

MR spectroscopy (MRS) offers unique possibilities for non-invasive evaluation of biochemistry in vivo. During recent years there has been a growing body of evidence from clinical research studies on human beings using lip and 'H MRS. The results indicate that it is possible to evaluate phosphorous energy metabolism, loss of neurones, and lactate production in a large number of brain diseases. Furthermore, lip and IH MRS may be particularly clinically useful in evaluation of various disorders in skeletal muscle. In the heart Jlp MRS seems at the moment the most suitable for evaluation of global affections of the myocardium. In the liver lip MRS appears to be rather insensitive and non-specific, but absolute quantification of metabolite concentrations and using metabolic "stress models" may prove useful in the future. The clinical role of MRS in oncology is still unclear, but it may be useful for noninvasive follow-up of treatment.Taken together, the evidence obtained so far certainly shows some trends for clinical applications of MRS. Methods are now available for the clinical research necessary for establishing routine clinical MRS examinations.MR spectroscopy (MRS) offers unique possibilities for non-invasive evaluation of biochemistry in vivo. While morphological imaging by MR has been established in medical diagnostics, the development of MRS for clinical practice has been relatively slow. The reasons for this may be that MRS of human beings requires a high quality of performance of the MR equipment with respect to magnetic field homogeneity, detection sensitivity and gradient behaviour (eddy currents), and, secondly, measurement techniques are not fully developed for routine clinical use but depend greatly on the skill of the operators (MR technologists, physicians). Despite these difficulties there has been a grow-96 ing amount of knowledge about human MRS, but its clinical efficacy remains to be established.The present review deals mainly with applications of MRS methods in clinical research studies in order to assess the present state-of-the-art with respect to the possible clinical utility.Furthermore, a brief description of methods for volume selection together with aspects of quantification of metabolite concentration_s will be given in the Appendix. Metabolic AspectsEven though a number of nuclei can be detected by MRS the clinical research on human beings has mainly been concentrated on IH and 31p spectroscopy. For this reason a brief description of the metabolic aspects underlying phosphorous and proton spectroscopy will be given.3Ip MRS 31p spectrum of the brain of a healthy volunteer obtained by spectroscopic imaging at 1.5 T shows 7 resonance lines (Fig. 1). These are y, (t,~-ATP; phosphocreatine (PCr) , inorganic phosphate (Pi); phosphodiesters (PDE), and phosphomonoesters (PME). The chemical shift relative to PCr is shown in Table 1. As can be seen in Fig. 1 these resonances are superimposed on a broad peak ("hump"), which most likely represents phosphorous compounds in cell membranes with a ver...

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