Diffusion-weighted MR spectroscopy: Consensus, recommendations, and resources from acquisition to modeling.

Brain cell structure and function reflect neurodevelopment, plasticity, and aging; and changes can help flag pathological processes such as neurodegeneration and neuroinflammation. Accurate and quantitative methods to noninvasively disentangle cellular structural features are needed and are a substantial focus of brain research. Diffusion-weighted MRS (dMRS) gives access to diffusion properties of endogenous intracellular brain metabolites that are preferentially located inside specific brain cell populations. Despite its great potential, dMRS remains a challenging technique on all levels: from the data acquisition to the analysis, quantification, modeling, and interpretation of results. These challenges were the motivation behind the organization of the Lorentz Center workshop on "Best Practices & Tools for Diffusion MR Spectroscopy" held in Leiden, the Netherlands, in September 2021. During the workshop, the dMRS community established a set of recommendations to execute robust dMRS studies. This paper provides a description of the steps needed for acquiring, processing, fitting, and modeling dMRS data, and provides links to useful resources.

On the acquisition of the water signal during water suppression: High-speed MR spectroscopic imaging with water referencing and concurrent functional MRI.

This study evaluated the utility of concurrent water signal acquisition as part of the water suppression in MR spectroscopic imaging (MRSI), to allow simultaneous water referencing for metabolite quantification, and to concurrently acquire functional MRI (fMRI) data. We integrated a spatial-spectral binomial water excitation RF pulse and a short spatial-spectral echo-planar readout into the water suppression module of 2D and 3D proton-echo-planar-spectroscopic-imaging (PEPSI) with a voxel size as small as 4 x 4 x 6 mm3 . Metabolite quantification in reference to tissue water was validated in healthy controls for different prelocalization methods (spin-echo, PRESS and semi-LASER) and the clinical feasibility of a 3-minute 3D semi-Laser PEPSI scan (TR/TE: 1250/32 ms) with water referencing in patients with brain tumors was demonstrated. Spectral quality, SNR, Cramer-Rao-lower-bounds and water suppression efficiency were comparable with conventional PEPSI. Metabolite concentration values in reference to tissue water, using custom LCModel-based spectral fitting with relaxation correction, were in the range of previous studies and independent of the prelocalization method used. Next, we added a phase-encoding undersampled echo-volumar imaging (EVI) module during water suppression to concurrently acquire metabolite maps with water referencing and fMRI data during task execution and resting state in healthy controls. Integration of multimodal signal acquisition prolongated minimum TR by less than 50 ms on average. Visual and motor activation in concurrent fMRI/MRSI (TR: 1250-1500 ms, voxel size: 4 x 4 x 6 mm3 ) was readily detectable in single-task blocks with percent signal change comparable with conventional fMRI. Resting-state connectivity in sensory and motor networks was detectable in 4 minutes. This hybrid water suppression approach for multimodal imaging has the potential to significantly reduce scan time and extend neuroscience research and clinical applications through concurrent quantitative MRSI and fMRI acquisitions.

Advanced magnetic resonance spectroscopic neuroimaging: Experts' consensus recommendations.

Magnetic resonance spectroscopic imaging (MRSI) offers considerable promise for monitoring metabolic alterations associated with disease or injury; however, to date, these methods have not had a significant impact on clinical care, and their use remains largely confined to the research community and a limited number of clinical sites. The MRSI methods currently implemented on clinical MRI instruments have remained essentially unchanged for two decades, with only incremental improvements in sequence implementation. During this time, a number of technological developments have taken place that have already greatly benefited the quality of MRSI measurements within the research community and which promise to bring advanced MRSI studies to the point where the technique becomes a true imaging modality, while making the traditional review of individual spectra a secondary requirement. Furthermore, the increasing use of biomedical MR spectroscopy studies has indicated clinical areas where advanced MRSI methods can provide valuable information for clinical care. In light of this rapidly changing technological environment and growing understanding of the value of MRSI studies for biomedical studies, this article presents a consensus from a group of experts in the field that reviews the state-of-the-art for clinical proton MRSI studies of the human brain, recommends minimal standards for further development of vendor-provided MRSI implementations, and identifies areas which need further technical development.

Real-time presurgical resting-state fMRI in patients with brain tumors: Quality control and comparison with task-fMRI and intraoperative mapping.

Resting-state functional magnetic resonance imaging (rsfMRI) is a promising task-free functional imaging approach, which may complement or replace task-based fMRI (tfMRI) in patients who have difficulties performing required tasks. However, rsfMRI is highly sensitive to head movement and physiological noise, and validation relative to tfMRI and intraoperative electrocortical mapping is still necessary. In this study, we investigate (a) the feasibility of real-time rsfMRI for presurgical mapping of eloquent networks with monitoring of data quality in patients with brain tumors and (b) rsfMRI localization of eloquent cortex compared with tfMRI and intraoperative electrocortical stimulation (ECS) in retrospective analysis. Five brain tumor patients were studied with rsfMRI and tfMRI on a clinical 3T scanner using MultiBand(8)-echo planar imaging (EPI) with repetition time: 400 ms. Moving-averaged sliding-window correlation analysis with regression of motion parameters and signals from white matter and cerebrospinal fluid was used to map sensorimotor and language resting-state networks. Data quality monitoring enabled rapid optimization of scan protocols, early identification of task noncompliance, and head movement-related false-positive connectivity to determine scan continuation or repetition. Sensorimotor and language resting-state networks were identifiable within 1 min of scan time. The Euclidean distance between ECS and rsfMRI connectivity and task-activation in motor cortex, Broca's, and Wernicke's areas was 5-10 mm, with the exception of discordant rsfMRI and ECS localization of Wernicke's area in one patient due to possible cortical reorganization and/or altered neurovascular coupling. This study demonstrates the potential of real-time high-speed rsfMRI for presurgical mapping of eloquent cortex with real-time data quality control, and clinically acceptable concordance of rsfMRI with tfMRI and ECS localization.

Terminology and concepts for the characterization of in vivo MR spectroscopy methods and MR spectra: Background and experts' consensus recommendations.

With a 40-year history of use for in vivo studies, the terminology used to describe the methodology and results of magnetic resonance spectroscopy (MRS) has grown substantially and is not consistent in many aspects. Given the platform offered by this special issue on advanced MRS methodology, the authors decided to describe many of the implicated terms, to pinpoint differences in their meanings and to suggest specific uses or definitions. This work covers terms used to describe all aspects of MRS, starting from the description of the MR signal and its theoretical basis to acquisition methods, processing and to quantification procedures, as well as terms involved in describing results, for example, those used with regard to aspects of quality, reproducibility or indications of error. The descriptions of the meanings of such terms emerge from the descriptions of the basic concepts involved in MRS methods and examinations. This paper also includes specific suggestions for future use of terms where multiple conventions have emerged or coexisted in the past.

Methodological consensus on clinical proton MRS of the brain: Review and recommendations.

Proton MRS (1 H MRS) provides noninvasive, quantitative metabolite profiles of tissue and has been shown to aid the clinical management of several brain diseases. Although most modern clinical MR scanners support MRS capabilities, routine use is largely restricted to specialized centers with good access to MR research support. Widespread adoption has been slow for several reasons, and technical challenges toward obtaining reliable good-quality results have been identified as a contributing factor. Considerable progress has been made by the research community to address many of these challenges, and in this paper a consensus is presented on deficiencies in widely available MRS methodology and validated improvements that are currently in routine use at several clinical research institutions. In particular, the localization error for the PRESS localization sequence was found to be unacceptably high at 3 T, and use of the semi-adiabatic localization by adiabatic selective refocusing sequence is a recommended solution. Incorporation of simulated metabolite basis sets into analysis routines is recommended for reliably capturing the full spectral detail available from short TE acquisitions. In addition, the importance of achieving a highly homogenous static magnetic field (B0 ) in the acquisition region is emphasized, and the limitations of current methods and hardware are discussed. Most recommendations require only software improvements, greatly enhancing the capabilities of clinical MRS on existing hardware. Implementation of these recommendations should strengthen current clinical applications and advance progress toward developing and validating new MRS biomarkers for clinical use.

On the detection of high frequency correlations in resting state fMRI.

Current studies of resting-state connectivity rely on coherent signal fluctuations at frequencies below 0.1 Hz, however, recent studies using high-speed fMRI have shown that fluctuations above 0.5 Hz may exist. This study replicates the feasibility of measuring high frequency (HF) correlations in six healthy controls and a patient with a brain tumor while analyzing non-physiological signal sources via simulation. Resting-state data were acquired using a high-speed multi-slab echo-volumar imaging pulse sequence with 136 ms temporal resolution. Bandpass frequency filtering in combination with sliding window seed-based connectivity analysis using running mean of the correlation maps was employed to map HF correlations up to 3.7 Hz. Computer simulations of Rician noise and the underlying point spread function were analyzed to estimate baseline spatial autocorrelation levels in four major networks (auditory, sensorimotor, visual, and default-mode). Using seed regions based on Brodmann areas, the auditory and default-mode networks were observed to have significant frequency band dependent HF correlations above baseline spatial autocorrelation levels. Correlations in the sensorimotor network were at trend level. The auditory network was still observed using a unilateral single voxel seed. In the patient, HF auditory correlations showed a spatial displacement near the tumor consistent with the displacement seen at low frequencies. In conclusion, our data suggest that HF connectivity in the human brain may be observable with high-speed fMRI, however, the detection sensitivity may depend on the network observed, data acquisition technique, and analysis method.

Diffusion tensor spectroscopic imaging of the human brain in children and adults.

PURPOSE: We developed diffusion tensor spectroscopic imaging (DTSI), based on proton-echo-planar-spectroscopic imaging (PEPSI), and evaluated the feasibility of mapping brain metabolite diffusion in adults and children. METHODS: PRESS prelocalized DTSI at 3 Tesla (T) was performed using navigator-based correction of movement-related phase errors and cardiac gating with compensation for repetition time (TR) related variability in T1 saturation. Mean diffusivity (MD) and fractional anisotropy (FA) of total N-acetyl-aspartate (tNAA), total creatine (tCr), and total choline (tCho) were measured in eight adults (17-60 years) and 10 children (3-24 months) using bmax = 1734 s/mm2 , 1 cc and 4.5 cc voxel sizes, with nominal scan times of 17 min and 8:24 min. Residual movement-related phase encoding ghosting (PEG) was used as a regressor across scans to correct overestimation of MD. RESULTS: After correction for PEG, metabolite slice-averaged MD estimated at 20% PEG were lower (P < 0.042) for adults (0.17/0.20/0.18 × 10-3 mm2 /s) than for children (0.26/0.27/0.24 × 10-3 mm2 /s). Extrapolated to 0% PEG, the MD estimates decreased further (0.09/0.11/0.11 × 10-3 mm2 /s versus 0.15/0.16/0.15 × 10-3 mm2 /s). Slice-averaged FA of tNAA (P = 0.049), tCr (P = 0.067), and tCho (P = 0.003) were higher in children. CONCLUSION: This high-speed DTSI approach with PEG regression allows for estimation of metabolite MD and FA with improved tolerance to movement. Our preliminary data suggesting age-related changes support DTSI as a sensitive technique for investigating intracellular markers of biological processes. Magn Reson Med 78:1246-1256, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Clinical proton MR spectroscopy in central nervous system disorders.

A large body of published work shows that proton (hydrogen 1 [(1)H]) magnetic resonance (MR) spectroscopy has evolved from a research tool into a clinical neuroimaging modality. Herein, the authors present a summary of brain disorders in which MR spectroscopy has an impact on patient management, together with a critical consideration of common data acquisition and processing procedures. The article documents the impact of (1)H MR spectroscopy in the clinical evaluation of disorders of the central nervous system. The clinical usefulness of (1)H MR spectroscopy has been established for brain neoplasms, neonatal and pediatric disorders (hypoxia-ischemia, inherited metabolic diseases, and traumatic brain injury), demyelinating disorders, and infectious brain lesions. The growing list of disorders for which (1)H MR spectroscopy may contribute to patient management extends to neurodegenerative diseases, epilepsy, and stroke. To facilitate expanded clinical acceptance and standardization of MR spectroscopy methodology, guidelines are provided for data acquisition and analysis, quality assessment, and interpretation. Finally, the authors offer recommendations to expedite the use of robust MR spectroscopy methodology in the clinical setting, including incorporation of technical advances on clinical units.

Sliding window functional connectivity inference with nonstationary autocorrelations and cross-correlations.

Functional connectivity (FC) is the degree of synchrony of time series between distinct, spatially separated brain regions. While traditional FC analysis assumes the temporal stationarity throughout a brain scan, there is growing recognition that connectivity can change over time and is not stationary, leading to the concept of dynamic FC (dFC). Resting-state functional magnetic resonance imaging (fMRI) can assess dFC using the sliding window method with the correlation analysis of fMRI signals. Accurate statistical inference of sliding window correlation must consider the autocorrelated nature of the time series. Currently, the dynamic consideration is mainly confined to the point estimation of sliding window correlations. Using in vivo resting-state fMRI data, we first demonstrate the non-stationarity in both the cross-correlation function (XCF) and the autocorrelation function (ACF). Then, we propose the variance estimation of the sliding window correlation considering the nonstationary of XCF and ACF. This approach provides a means to dynamically estimate confidence intervals in assessing dynamic connectivity. Using simulations, we compare the performance of the proposed method with other methods, showing the impact of dynamic ACF and XCF on connectivity inference. Accurate variance estimation can help in addressing the critical issue of false positivity and negativity.

MR spectroscopic imaging: principles and recent advances.

MR spectroscopic imaging (MRSI) has become a valuable tool for quantifying metabolic abnormalities in human brain, prostate, breast and other organs. It is used in routine clinical imaging, particularly for cancer assessment, and in clinical research applications. This article describes basic principles of commonly used MRSI data acquisition and analysis methods and their impact on clinical applications. It also highlights technical advances, such as parallel imaging and newer high-speed MRSI approaches that are becoming viable alternatives to conventional MRSI methods. Although the main focus is on (1) H-MRSI, the principles described are applicable to other MR-compatible nuclei. This review of the state-of-the-art in MRSI methodology provides a framework for critically assessing the clinical utility of MRSI and for defining future technical development that is expected to lead to increased clinical use of MRSI. Future technical development will likely focus on ultra-high field MRI scanners, novel hyperpolarized contrast agents using metabolically active compounds, and ultra-fast MRSI techniques because these technologies offer unprecedented sensitivity and specificity for probing tissue metabolic status and dynamics.

Multi-echo acquisition.

The rapid development of fMRI was paralleled early on by the adaptation of MR spectroscopic imaging (MRSI) methods to quantify water relaxation changes during brain activation. This review describes the evolution of multi-echo acquisition from high-speed MRSI to multi-echo EPI and beyond. It highlights milestones in the development of multi-echo acquisition methods, such as the discovery of considerable gains in fMRI sensitivity when combining echo images, advances in quantification of the BOLD effect using analytical biophysical modeling and interleaved multi-region shimming. The review conveys the insight gained from combining fMRI and MRSI methods and concludes with recent trends in ultra-fast fMRI, which will significantly increase temporal resolution of multi-echo acquisition.

Enhancement of temporal resolution and BOLD sensitivity in real-time fMRI using multi-slab echo-volumar imaging.

In this study, a new approach to high-speed fMRI using multi-slab echo-volumar imaging (EVI) is developed that minimizes geometrical image distortion and spatial blurring, and enables nonaliased sampling of physiological signal fluctuation to increase BOLD sensitivity compared to conventional echo-planar imaging (EPI). Real-time fMRI using whole brain 4-slab EVI with 286 ms temporal resolution (4mm isotropic voxel size) and partial brain 2-slab EVI with 136 ms temporal resolution (4×4×6 mm(3) voxel size) was performed on a clinical 3 Tesla MRI scanner equipped with 12-channel head coil. Four-slab EVI of visual and motor tasks significantly increased mean (visual: 96%, motor: 66%) and maximum t-score (visual: 263%, motor: 124%) and mean (visual: 59%, motor: 131%) and maximum (visual: 29%, motor: 67%) BOLD signal amplitude compared with EPI. Time domain moving average filtering (2s width) to suppress physiological noise from cardiac and respiratory fluctuations further improved mean (visual: 196%, motor: 140%) and maximum (visual: 384%, motor: 200%) t-scores and increased extents of activation (visual: 73%, motor: 70%) compared to EPI. Similar sensitivity enhancement, which is attributed to high sampling rate at only moderately reduced temporal signal-to-noise ratio (mean: -52%) and longer sampling of the BOLD effect in the echo-time domain compared to EPI, was measured in auditory cortex. Two-slab EVI further improved temporal resolution for measuring task-related activation and enabled mapping of five major resting state networks (RSNs) in individual subjects in 5 min scans. The bilateral sensorimotor, the default mode and the occipital RSNs were detectable in time frames as short as 75 s. In conclusion, the high sampling rate of real-time multi-slab EVI significantly improves sensitivity for studying the temporal dynamics of hemodynamic responses and for characterizing functional networks at high field strength in short measurement times.

Quantitative mapping of total choline in healthy human breast using proton echo planar spectroscopic imaging (PEPSI) at 3 Tesla.

PURPOSE: To quantitatively measure tCho levels in healthy breasts using Proton-Echo-Planar-Spectroscopic-Imaging (PEPSI). MATERIALS AND METHODS: The two-dimensional mapping of tCho at 3 Tesla across an entire breast slice using PEPSI and a hybrid spectral quantification method based on LCModel fitting and integration of tCho using the fitted spectrum were developed. This method was validated in 19 healthy females and compared with single voxel spectroscopy (SVS) and with PRESS prelocalized conventional Magnetic Resonance Spectroscopic Imaging (MRSI) using identical voxel size (8 cc) and similar scan times (∼7 min). RESULTS: A tCho peak with a signal to noise ratio larger than 2 was detected in 10 subjects using both PEPSI and SVS. The average tCho concentration in these subjects was 0.45 ± 0.2 mmol/kg using PEPSI and 0.48 ± 0.3 mmol/kg using SVS. Comparable results were obtained in two subjects using conventional MRSI. High lipid content in the spectra of nine tCho negative subjects was associated with spectral line broadening of more than 26 Hz, which made tCho detection impossible. Conventional MRSI with PRESS prelocalization in glandular tissue in two of these subjects yielded tCho concentrations comparable to PEPSI. CONCLUSION: The detection sensitivity of PEPSI is comparable to SVS and conventional PRESS-MRSI. PEPSI can be potentially used in the evaluation of tCho in breast cancer. A tCho threshold concentration value of ∼0.7 mmol/kg might be used to differentiate between cancerous and healthy (or benign) breast tissues based on this work and previous studies.

Atlas-based automated positioning of outer volume suppression slices in short-echo time 3D MR spectroscopic imaging of the human brain.

Spatial suppression of peripheral lipid-containing regions in volumetric MR spectroscopic imaging of the human brain requires placing large numbers of outer volume suppression (OVS) slices, which is time-consuming, prone to operator error and may introduce subject-dependent variability in volume coverage. We developed a novel, computationally efficient atlas-based approach for automated positioning of up to 16 OVS slices and the MR spectroscopic imaging slab. Standardized positions in Montreal Neurological Institute atlas space were established offline using a recently developed iterative optimization procedure. During the scanning session, positions in subject space were computed using affine transformation of standardized positions in Montreal Neurological Institute space. Offline analysis using magnetization prepared rapid gradient echo scans from 11 subjects demonstrated reliable OVS placement, comparable with but faster than iterative placement in subject space. This atlas-based method was further validated in 14 subjects using 3D short-echo time proton-echo-planar-spectroscopic-imaging at 3 T. Comparison of manual and automatic placement using 8 OVS slices demonstrated consistent MR spectroscopic imaging volume selection and comparable spectral quality with similar degree of lipid suppression and number of usable voxels. Automated positioning of 16 OVS slices enabled larger volume coverage, while maintaining similar spectral quality and lipid suppression. Atlas-based automatic prescription of short echo time MR spectroscopic imaging is expected to be advantageous for longitudinal and cross-sectional studies.

Automatic placement of outer volume suppression slices in MR spectroscopic imaging of the human brain.

Spatial suppression of peripheral regions (outer volume suppression) is used in MR spectroscopic imaging to reduce contamination from strong lipid and water signals. The manual placement of outer volume suppression slices requires significant operator interaction, which is time consuming and introduces variability in volume coverage. Placing a large number of outer volume saturation bands for volumetric MR spectroscopic imaging studies is particularly challenging and time consuming and becomes unmanageable as the number of suppression bands increases. In this study, a method is presented that automatically segments a high-resolution MR image in order to identify the peripheral lipid-containing regions. This method computes an optimized placement of suppression bands in three dimensions and is based on the maximization of a criterion function. This criterion function maximizes coverage of peripheral lipid-containing areas and minimizes suppression of cortical brain regions and regions outside of the head. Computer simulation demonstrates automatic placement of 16 suppression slices to form a convex hull that covers peripheral lipid-containing regions above the base of the brain. In vivo metabolite mapping obtained with short echo time proton-echo-planar spectroscopic imaging shows that the automatic method yields a placement of suppression slices that is very similar to that of a skilled human operator in terms of lipid suppression and usable brain voxels.

Real-Time Resting-State Functional Magnetic Resonance Imaging Using Averaged Sliding Windows with Partial Correlations and Regression of Confounding Signals.

Background/Introduction: There is considerable interest in using real-time functional magnetic resonance imaging (fMRI) for monitoring functional connectivity dynamics. To date, the majority of real-time resting-state fMRI studies have examined a limited number of brain regions. This is, in part, due to the computational demands of traditional seed- and independent component analysis-based methods, in particular when using increasingly available high-speed fMRI methods. Methods: This study describes a computationally efficient, real-time, seed-based, resting-state fMRI analysis pipeline using moving averaged sliding-windows (ASW) with partial correlations and regression of motion parameters and signals from white matter and cerebrospinal fluid. Results: Analytical and numerical analyses of ASW correlation and sliding-window regression as a function of window width show selectable bandpass filter characteristics and effective suppression of artifactual correlations resulting from signal drifts and transients. The analysis pipeline is compatible with multislab echo-volumar imaging and simultaneous multislice echo-planar imaging with repetition times as short as 136 msec. High-speed, resting-state fMRI data in healthy controls demonstrate the effectiveness of this approach for minimizing artifactual correlations in white and gray matter, which was comparable to conventional regression across the entire scan. Integrating sliding-window averaging (width: W1) within a second-level sliding-window (width: W2) enabled monitoring of intra- and internetwork correlation dynamics of up to 12 resting-state networks with bandpass filter characteristics determined by the first-level sliding-window and temporal resolution W1 + W2. Conclusions: The computational performance and confound tolerance make this seed-based, resting-state fMRI approach suitable for real-time monitoring of data quality and resting-state connectivity dynamics in neuroscience and clinical research studies. Impact statement Using averaged sliding-windows for seed-based correlation and regression of confounding signals provides a powerful model-free approach to increase tolerance to artifactual signal transients in resting-state analysis. The algorithmic efficiency of this sliding-window approach enables real-time, seed-based, resting-state functional magnetic resonance imaging (fMRI) of multiple networks with computation of connectivity matrices and online monitoring of data quality. Integration of a second-level sliding-window enables mapping of resting-state connectivity dynamics. Sensitivity and tolerance to confounding signals compare favorably with conventional correlation and confound regression across the entire scan. This methodological advance has the potential to enhance the clinical utility of resting-state fMRI and facilitate neuroscience applications.

Neurochemical correlates of behavioral treatment of pediatric trichotillomania.

BACKGROUND: Trichotillomania (TTM) is a chronic and impairing psychiatric disorder with suspected dysfunctional cortico-striato-thalamo-cortical (CSTC) circuit activity reflecting excitatory/inhibitory signaling imbalance. TTM neurochemistry is understudied, with no prior research using magnetic resonance spectroscopy (MRS). This pilot investigation examined associations between TTM diagnosis, symptom severity, and response to behavioral treatment with MRS neurometabolites glutamate (Glu) and γ-aminobutyric acid (GABA) in CSTC structures. METHODS: Proton echo-planar spectroscopic imaging (PEPSI) MRS was acquired from bilateral pregenual anterior cingulate cortex (pACC), caudate, putamen, globus pallidus, thalamus, and proximal white matter in 10 unmedicated girls with TTM, ages 9-17 years, before and after treatment, and from 13 age- and sex-matched healthy controls. RESULTS: Nine of 10 TTM patients were treatment responders. Pretreatment mean Glu and GABA did not differ significantly between participants and controls. Pretreatment TTM symptoms were correlated with Glu in (left + right) pACC (r = 0.88, p = 0.02) and thalamus (r = 0.82, p = 0.012), and were negatively correlated with pACC GABA (r = -0.84, p = 0.034). Mean GABA in putamen increased 69% (baseline to post-treatment) (p = 0.027). Higher pretreatment Glu in caudate, putamen, globus pallidus, and thalamus predicted greater symptom decreases with treatment (all r < -0.6, p < 0.05); higher caudate GABA predicted less treatment-related symptom decline (r = 0.86, p = 0.014). LIMITATIONS: Small sample, GABA quantified with spectral fitting rather than editing. CONCLUSION: Consistent with other neuroimaging, MRS reveals discrete CSTC chemical changes with effective behavior therapy, and possibly with TTM etiology. TTM symptoms relate to excess excitatory versus inhibitory signaling in pACC and thalamus; symptom improvement may reflect reduced excitatory drive of the CSTC direct-pathway activity.

Superresolution parallel magnetic resonance imaging: application to functional and spectroscopic imaging.

Standard parallel magnetic resonance imaging (MRI) techniques suffer from residual aliasing artifacts when the coil sensitivities vary within the image voxel. In this work, a parallel MRI approach known as Superresolution SENSE (SURE-SENSE) is presented in which acceleration is performed by acquiring only the central region of k-space instead of increasing the sampling distance over the complete k-space matrix and reconstruction is explicitly based on intra-voxel coil sensitivity variation. In SURE-SENSE, parallel MRI reconstruction is formulated as a superresolution imaging problem where a collection of low resolution images acquired with multiple receiver coils are combined into a single image with higher spatial resolution using coil sensitivities acquired with high spatial resolution. The effective acceleration of conventional gradient encoding is given by the gain in spatial resolution, which is dictated by the degree of variation of the different coil sensitivity profiles within the low resolution image voxel. Since SURE-SENSE is an ill-posed inverse problem, Tikhonov regularization is employed to control noise amplification. Unlike standard SENSE, for which acceleration is constrained to the phase-encoding dimension/s, SURE-SENSE allows acceleration along all encoding directions--for example, two-dimensional acceleration of a 2D echo-planar acquisition. SURE-SENSE is particularly suitable for low spatial resolution imaging modalities such as spectroscopic imaging and functional imaging with high temporal resolution. Application to echo-planar functional and spectroscopic imaging in human brain is presented using two-dimensional acceleration with a 32-channel receiver coil.

Single-shot magnetic resonance spectroscopic imaging with partial parallel imaging.

A magnetic resonance spectroscopic imaging (MRSI) pulse sequence based on proton-echo-planar-spectroscopic-imaging (PEPSI) is introduced that measures two-dimensional metabolite maps in a single excitation. Echo-planar spatial-spectral encoding was combined with interleaved phase encoding and parallel imaging using SENSE to reconstruct absorption mode spectra. The symmetrical k-space trajectory compensates phase errors due to convolution of spatial and spectral encoding. Single-shot MRSI at short TE was evaluated in phantoms and in vivo on a 3-T whole-body scanner equipped with a 12-channel array coil. Four-step interleaved phase encoding and fourfold SENSE acceleration were used to encode a 16 x 16 spatial matrix with a 390-Hz spectral width. Comparison with conventional PEPSI and PEPSI with fourfold SENSE acceleration demonstrated comparable sensitivity per unit time when taking into account g-factor-related noise increases and differences in sampling efficiency. LCModel fitting enabled quantification of inositol, choline, creatine, and N-acetyl-aspartate (NAA) in vivo with concentration values in the ranges measured with conventional PEPSI and SENSE-accelerated PEPSI. Cramer-Rao lower bounds were comparable to those obtained with conventional SENSE-accelerated PEPSI at the same voxel size and measurement time. This single-shot MRSI method is therefore suitable for applications that require high temporal resolution to monitor temporal dynamics or to reduce sensitivity to tissue movement.