Cover

Half-title

Title

Copyright

Contents

Preface

Acknowledgments

Abbreviations

Chapter 1 Introduction to MR spectroscopy in vivo

Key points

Introduction

Nuclear magnetic resonance spectroscopy

Basic theory

Signal and signal-to-noise ratio

The rotating frame: simple pulse sequences for spectroscopy

Relaxation times

Chemical shifts

Spin–spin (scalar) coupling constants

Fourier transform spectroscopy

In vivo MR spectroscopy

Nuclei for in vivo MRS

Information content of proton MR spectra of the brain

NAA

Choline

Creatine

Lactate

Myo-inositol

Glutamate and glutamine

Less commonly detected compounds

Compounds detected by proton MRS outside the CNS

References

Chapter 2 Pulse sequences and protocol design

Key points

Introduction

Single-voxel techniques

Multiple-voxel (spectroscopic imaging) techniques

Spatial resolution and scan time in MRSI

Fast MRSI techniques

Water suppression

Lipid suppression

Spectral editing sequences using selective pulses

MRS at different field strengths

MRS with multiple RF receiver coils

Shimming and other “prescan” functions

Recommended acquisition protocols

Temporal lobe epilepsy (TLE)

Hepatic encephalopathy (HE)

Supra- and infra-tentorial multi-slice MRSI

References

Chapter 3 Spectral analysis methods, quantitation, and common artifacts

Key points

Introduction

Basic MRS processing techniques

Time domain processing

Frequency domain processing

MRSI processing techniques

Spectral fitting

Quantitation methods

Units and tissue compartmentalization

Common artifacts (and other problems) in MRS

Inadequate field homogeneity

Inadequate water suppression

Inadequate lipid suppression

Effects of head motion

What’s the vertical scale?

Incorrect voxel (or MRSI slice) placement

Incorrect choice of protocol

Lesion too small, unfavorable location

Out-of-voxel magnetization

Chemical shift displacement effects

Can MRS be performed after administration of Gd contrast?

Conclusions

References

Chapter 4 Normal regional variations: brain development and aging

Key points

Introduction

Anatomical variations in brain spectra: young adults

Age-related variations in brain spectra: early brain development in children

Age-related variations in brain spectra: the elderly brain

Conclusions

References

Chapter 5 MRS in brain tumors

Key points

Introduction

New concepts about brain tumor initiation, transformation, and diffusion

Histopathological classification of brain tumors

WHO grading and patient survival

Conventional MR imaging

Semiotics of proton MR spectroscopy in brain tumors

Five frequently asked questions

Is it a tumor?

Is it a GBM, metastasis, or an abscess?

What’s the grade of this glioma?

Can MRS predict patient survival?

Is it an oligodendroglioma?

Diagnostic accuracy of MRS

MRS imaging-guided therapy planning and monitoring

Special considerations about pediatric brain tumors

Conclusions

References

Chapter 6 MRS in stroke and hypoxic–ischemic encephalopathy

Key points

Introduction: MR spectroscopy in stroke

NAA

Cr

Cho

Lactate

Metabolic changes during ischemia: animal models

Metabolic changes in human stroke

MR spectroscopy in hypoxic–ischemic encephalopathy

Normal neonatal brain MRS

31P MRS in HIE

1H MRS in HIE

Diffusion MRI in HIE: comparison to 1H MRS

Some recommendations for MRS protocols for stroke and HIE

Stroke

HIE

Conclusions

References

Chapter 7 MRS in infectious, in.ammatory, and demyelinating lesions

Key points

Introduction

Intracranial infections

Brain abscesses

Tuberculoma

Herpes simplex and other viral encephalitis

HIV encephalopathy

HIV-related infections

Toxoplasmosis and primary CNS lymphoma

Cryptococcosis

1H-MRS

Progressive multifocal leukoencephalopathy

1H-MRS

Subacute sclerosing panencephalitis

1H-MRS

Brain demyelination and inflammation

Multiple sclerosis

Acute disseminated encephalomyelitis

Summary

References

Chapter 8 MRS in epilepsy

Key points

Introduction

MR spectroscopy in epilepsy

31P MRS

Proton MRS

Temporal lobe epilepsy

Diffuse metabolic abnormalities in temporal lobe epilepsy

MRS in TLE cases where MRI is normal, or symmetrically abnormal

Cortical malformations

Frontal lobe epilepsy

Childhood epilepsies, Rasmussen’s encephalitis

Neurotransmitters: brain GABA levels

Some recommendations for MRS protocols for patients with epilepsy

Conclusions

References

Chapter 9 MRS in neurodegenerative disease

Key points

Introduction

Dementia

Alzheimer’s disease

1H-MRS

Vascular dementia

Frontotemporal dementia

1H-MRS

Dementia with Lewy bodies

1H-MRS

Parkinson’s disease and related disorders

1H-MRS

Huntington’s disease

1H-MRS

Human prion diseases

1H-MRS

Amyotrophic lateral sclerosis

1H-MRS

Summary

References

Chapter 10 MRS in traumatic brain injury

Key points

Introduction

Classification of head injury

MRI in the diagnosis of TBI

Magnetic resonance spectroscopy

Pediatric TBI

Metabolic changes and prediction of outcome

Glutamate in TBI

myo-Inositol in TBI

Diffuse metabolic abnormalities

Cognitive function and metabolism

Adult TBI

Neuropsychological correlation and vegetative state patients

Lactate in adult TBI

Microdialysis studies in TBI: Relevance to MRS

MRS studies of concussion and repeated brain injury

Magnetic resonance spectroscopic imaging studies in TBI

Metabolic changes in the early stages of TBI

Volumetric and whole-brain spectroscopy studies in TBI

Conclusion

References

Chapter 11 MRS in cerebral metabolic disorders

Key points

Introduction

Classification of metabolic disorders

Conventional MR imaging

Tips for performing 1H-MRS exams in metabolic disorders

Diagnosis-specific 1H-MRS findings

Creatine deficiency

Mitochondrial disorders

Disorders of pyruvate metabolism

Defects of the respiratory chain

Fatty acid oxidation disorders

MR imaging characteristic findings

MR spectroscopy

Amino acidopathies

Urea cycle defects

Hyperhomocysteinemias

Organic acidopathies

Propionic aciduria

Methylmalonic aciduria

Hereditary leukoencephalopathies

Hypomyelinating diseases

Pelizaeus–Merzbacher disease

Pelizaeus–Merzbacher-like disorder

Hypomyelination and atrophy of basal ganglia and cerebellum

Demyelinating and dysmyelinating diseases

Metachromatic leukodystrophy

Globoid cell leukoencephalopathy

Adrenoleukodystrophy

Alexander disease

Diseases leading to white matter rarefaction

Leukoencephalopathy with vanishing white matter

Megalencephalopathy with subcortical cyst

MRS to monitor disease outcome and response to therapy

Summary

References

Chapter 12 MRS in prostate cancer

Key points

Introduction

Prostate anatomy

Magnetic resonance imaging

Citrate metabolism

Magnetic resonance spectroscopy

MRSI techniques

MRI/MRSI protocol

Spectral interpretation

J-coupling

1.5 T vs. 3.0 T

References

Chapter 13 MRS in breast cancer

Key points

Introduction: MRS of breast tissues

Clinical background: breast cancer screening and diagnosis

Magnetic resonance spectroscopy of breast cancer

Monitoring treatment response

Technical aspects of breast spectroscopy

Field homogeneity

Water and lipid suppression

Magnetic resonance spectroscopic imaging of the breast

Spectroscopic quantitation techniques

Breast spectroscopy at high magnetic fields

Effect of contrast agents (gadolinium-chelates) on MRS of the breast

Recommended protocol for MRS of the breast

Summary

References

Chapter 14 MRS in musculoskeletal disease

Key points

Introduction

31P-MRS of muscle practical considerations

Basic principles

31P-MRS in normal muscle

31P MRS exercise-recovery paradigms: practical considerations

Assumptions and interpretation of 31P-MRS data analysis

31P-MRS in muscle diseases

Glycogenolytic and glycolytic disorders

Mitochondrial disorders

Muscular dystrophies

Inflammatory myopathies

31P-MRS of muscle in CNS disorders

1H-MRS of muscle

Summary

References

Index