A novel method for Magnetic Resonance Spectroscopy lipid signal suppression using Semi-classical signal analysis and Bidirectional Long short-term memory.

Magnetic resonance spectroscopy (MRS) is a non-invasive method that enables the analysis and quantification of brain metabolites, which provide useful information about the neuro-biological substrates of brain function. Lactate plays a pivotal role in the diagnosis of various brain diseases. However, accurate lactate quantification is generally difficult to achieve due to the presence of large lipid peaks resonating at a similar spectral position. To overcome this problem several techniques have been proposed. However, most of them suffer from lactate signal loss or poor lipid peak removal. In this paper, a novel method for lipid suppression for MRS signal is proposed. The method combines a semi-classical signal analysis method and a bidirectional long short term memory technique. The method is validated using simulated data that mimics real MRS data.

Application of a 2D frequency encoding sectoral approach to hyperpolarized 129Xe MRI at low field.

Inhaled hyperpolarized 129Xe MRI is a non-invasive and radiation risk free lung imaging method, which can directly measure the business unit of the lung where gas exchange occurs: the alveoli and acinar ducts (lung function). Currently, three imaging approaches have been demonstrated to be useful for hyperpolarized 129Xe MR in lungs: Fast Gradient Recalled Echo (FGRE), Radial Projection Reconstruction (PR), and spiral/cones. Typically, non-Cartesian acquisitions such as PR and spiral/cones require specific data post-processing, such as interpolating, regridding, and density-weighting procedures for image reconstruction, which often leads to smoothing effects and resolution degradation. On the other hand, Cartesian methods such as FGRE are not short-echo time (TE) methods; they suffer from imaging gradient-induced diffusion-weighting of the k-space center, and employ a significant number of radio-frequency (RF) pulses. Due to the non-renewable magnetization of the hyperpolarized media, the use of a large number of RF pulses (FGRE/PR) required for full k-space coverage is a significant limitation, especially for low field (<0.5 T) hyperpolarized gas MRI. We demonstrate an ultra-fast, purely frequency-encoded, Cartesian pulse sequence called Frequency-Encoding Sectoral (FES), which takes advantage of the long T2* of hyperpolarized 129Xe gas at low field strength (0.074 T). In contrast to PR/FGRE, it uses a much smaller number of RF pulses, and consequently maximizes image Signal-to-Noise Ratio (SNR) while shortening acquisition time. Additionally, FES does not suffer from non-uniform T2* decay leading to image blurring; a common issue with interleaved spirals/cones. The Cartesian k-space coverage of the proposed FES method does not require specific k-space data post-processing, unlike PR/FGRE and spiral/cones methods. Proton scans were used to compare the FES sequence to both FGRE and Phase Encoding Sectoral, in terms of their SNR values and imaging efficiency estimates. Using FES, proton and hyperpolarized 129Xe images were acquired from a custom hollow acrylic phantom (0.04L) and two normal rats (129Xe only), utilizing both single-breath and multiple-breath schemes. For the 129Xe phantom images, the apparent diffusion coefficient, T1, and T2* relaxation maps were acquired and generated. Blurring due to the T2* decay and B0 field variation were simulated to estimate dependence of the image resolution on the duration of the data acquisition windows (i.e. sector length), and temperature-induced resonance frequency shift from the low field magnet hardware.

Application of a stretched-exponential model for morphometric analysis of accelerated diffusion-weighted 129Xe MRI of the rat lung.

OBJECTIVE: Diffusion-weighted, hyperpolarized 129Xe MRI is useful for the characterization of microstructural changes in the lung. A stretched exponential model was proposed for morphometric extraction of the mean chord length (Lm) from diffusion-weighted data. The stretched exponential model enables accelerated mapping of Lm in a single-breathhold using compressed sensing. Our purpose was to compare Lm maps obtained from stretched-exponential model analysis of accelerated versus unaccelerated diffusion-weighted 129Xe MRI data obtained from healthy/injured rat lungs. MATERIAL AND METHODS: Lm maps were generated using a stretched-exponential model analysis of previously acquired fully sampled diffusion-weighted 129Xe rat data (b values = 0 … 110 s/cm2) and compared to Lm maps generated from retrospectively undersampled data simulating acceleration factors of 7/10. The data included four control rats and five rats receiving whole-lung irradiation to mimic radiation-induced lung injury. Mean Lm obtained from the accelerated/unaccelerated maps were compared to histological mean linear intercept. RESULTS: Accelerated Lm estimates were similar to unaccelerated Lm estimates in all rats, and similar to those previously reported (< 12% different). Lm was significantly reduced (p < 0.001) in the irradiated rat cohort (90 ± 20 µm/90 ± 20 µm) compared to the control rats (110 ± 20 µm/100 ± 15 µm) and agreed well with histological mean linear intercept. DISCUSSION: Accelerated mapping of Lm using a stretched-exponential model analysis is feasible, accurate and agrees with histological mean linear intercept. Acceleration reduces scan time, thus should be considered for the characterization of lung microstructural changes in humans where breath-hold duration is short.

Schrödinger filtering: a precise EEG despiking technique for EEG-fMRI gradient artifact.

In EEG data acquired in the presence of fMRI, gradient-related spike artifacts contaminate the signal following the common preprocessing step of average artifact subtraction. Spike artifacts compromise EEG data quality since they overlap with the EEG signal in frequency, thereby confounding frequency-based inferences on activity. As well, spike artifacts can inflate or deflate correlations among time series, thereby confounding inferences on functional connectivity. We present Schrödinger filtering, which uses the Schrödinger equation to decompose the spike-containing input. The basis functions of the decomposition are localized and pulse-shaped, and selectively capture the various input peaks, with the spike components clustered at the beginning of the spectrum. Schrödinger filtering automatically subtracts the spike components from the data. On real and simulated data, we show that Schrödinger filtering (1) simultaneously accomplishes high spike removal and high signal preservation without affecting evoked activity, and (2) reduces spurious pairwise correlations in spontaneous activity. In these regards, Schrödinger filtering was significantly better than three other despiking techniques: median filtering, amplitude thresholding, and wavelet denoising. These results encourage the use of Schrödinger filtering in future EEG-fMRI pipelines, as well as in other spike-related applications (e.g., fMRI motion artifact removal or action potential extraction).

A New Class of Smart Gadolinium Contrast Agent for Tissue pH Probing Using Magnetic Resonance Imaging.

: Detecting tissue pH in vivo is extremely vital for medical diagnosis and formulation of treatment decisions. To this end, many investigations have been carried out to develop an accurate and efficient method of in vivo pH measurement. Most of the techniques developed so far suffer from inadequate accuracy, due to poor sensitivity at low concentration of the target or nonspecific interactions within the tissue matrix. To overcome these issues, we describe herein the development of a simple, yet reliable, way to estimate pH with high precision using a Gd(III)-DOTA-silyl-based acid-labile group as a pH-sensitive contrast agent with Magnetic Resonance Imaging (MRI). With this method, a change in T1 weighted image intensity of the newly developed pH-sensitive contrast is directly linked to the proton concentration in the media. As a result, we were able estimate the pH of the target with 95% reliability.

Demonstration and suppression of respiration-related artifacts in Bloch-Siegert shift-based B1+ maps of the human brain.

Respiration-induced movement of the chest wall and internal organs causes temporal B0 variations extending throughout the brain. This study demonstrates that these variations can cause significant artifacts in B1+ maps obtained at 7 T with the Bloch-Siegert shift (BSS) B1+ mapping technique. To suppress these artifacts, a navigator correction scheme was proposed. Two sets of experiments were performed. In the first set of experiments, phase shifts induced by respiration-related B0 variations were assessed for five subjects at 7 T by using a gradient echo (GRE) sequence without phase-encoding. In the second set of experiments, B1+ maps were acquired using a GRE-based BSS pulse sequence with navigator echoes. For this set, the measurements were consecutively repeated 16 times for the same imaging slice. These measurements were averaged to obtain the reference B1+ map. Due to the periodicity of respiration-related phase shifts, their effect on the reference B1+ map was assumed to be negligible through averaging. The individual B1+ maps of the 16 repetitions were calculated with and without using the proposed navigator scheme. These maps were compared with the B1+ reference map. The peak-to-peak value of respiration-related phase shifts varied between subjects. Without navigator correction, the interquartile range of percentage error in B1+ varied between 4.0% and 8.3% among subjects. When the proposed navigator scheme was used, these numbers were reduced to 2.5% and 2.9%, indicating an improvement in the precision of GRE-based BSS B1+ mapping at high magnetic fields.

Using variable-rate selective excitation (VERSE) radiofrequency pulses to reduce power deposition in pulsed arterial spin labeling sequence at 7 Tesla.

PURPOSE: Arterial spin labeling (ASL) is an established noninvasive MRI technique used for cerebral blood flow measurement, which generally suffers from a low signal-to-noise ratio (SNR). The use of ultra-high fields to enhance sensitivity inevitably results in an increase in TR because of specific absorption rate (SAR) constraints, causing inadequate sampling of hemodynamic response in functional MRI, and adversely affecting concurrent measurement such as blood oxygen level dependent. To address this problem, variable-rate selective excitation (VERSE) radiofrequency (RF) pulses were used. METHODS: The conventional (sinc) selective RF pulses of the Q2TIPS block in the PICORE pulsed ASL (PASL) sequence used for blood saturation were replaced by their equivalent VERSE RF waveforms. Nine healthy volunteers were scanned using the conventional and VERSE PASL sequences on a head-only 7T scanner operating in parallel transmit mode. RESULTS: VERSE PASL sequence provides perfusion images similar to the conventional version, with comparable perfusion SNR (conventional, 3.33 ± 0.48; VERSE, 3.26 ± 0.55) and temporal SNR (conventional, 1.02 ± 0.20; VERSE, 1.05 ± 0.12) for TR = 3.5 seconds and 70 measurements. With shorter acquisition time (TR = 2.5 seconds), VERSE PASL sequence still provides similar results to those acquired using the conventional PASL sequence with longer TR = 3.5 seconds. CONCLUSION: The use of VERSE RF pulses in the Q2TIPS block of a PASL sequence allowed for the reduction of RF power deposition and, consequently, an increase in the temporal resolution and/or perfusion SNR.

Reduction of Acquisition time using Partition of the sIgnal Decay in Spectroscopic Imaging technique (RAPID-SI).

To overcome long acquisition times of Chemical Shift Imaging (CSI), a new Magnetic Resonance Spectroscopic Imaging (MRSI) technique called Reduction of Acquisition time by Partition of the sIgnal Decay in Spectroscopic Imaging (RAPID-SI) using blipped phase encoding gradients inserted during signal acquisition was developed. To validate the results using RAPID-SI and to demonstrate its usefulness in terms of acquisition time and data quantification; simulations, phantom and in vivo studies were conducted, and the results were compared to standard CSI. The method was based upon the partition of a magnetic resonance spectroscopy (MRS) signal into sequential sub-signals encoded using blipped phase encoding gradients inserted during signal acquisition at a constant time interval. The RAPID-SI technique was implemented on a clinical 3 T Siemens scanner to demonstrate its clinical utility. Acceleration of data collection was performed by inserting R (R = acceleration factor) blipped gradients along a given spatial direction during data acquisition. Compared to CSI, RAPID-SI reduced acquisition time by the acceleration factor R. For example, a 2D 16x16 data set acquired in about 17 min with CSI, was reduced to approximately 2 min with the RAPID-SI (R = 8). While the SNR of the acquired RAPID-SI signal was lower compared to CSI by approximately the factor √R, it can be improved after data pre-processing and reconstruction. Compared to CSI, RAPID-SI reduces acquisition time, while preserving metabolites information. Furthermore, the method is flexible and could be combined with other acceleration methods such as Parallel Imaging.

A New ROI-Based performance evaluation method for image denoising using the Squared Eigenfunctions of the Schrödinger Operator.

In this paper a new Region Of Interest (ROI) characterization for image denoising performance evaluation is proposed. This technique consists of balancing the contrast between the dark and bright ROIs, in Magnetic Resonance (MR) images, to track the noise removal. It achieves an optimal compromise between removal of noise and preservation of image details. The ROI technique has been tested using synthetic MRI images from the BrainWeb database. Moreover, it has been applied to a recently developed denoising method called Semi-Classical Signal Analysis (SCSA). The SCSA decomposes the image into the squared eigenfunctions of the Schrödinger operator where a soft threshold $h$ is used to remove the noise. The results obtained using real MRI data suggest that this method is suitable for real medical image processing evaluation where the noise-free image is not available.

New generation of electrochemical immunoassay based on polymeric nanoparticles for early detection of breast cancer.

Screening and early diagnosis are the key factors for the reduction of mortality rate and treatment cost of cancer. Therefore, sensitive and selective methods that can reveal the low abundance of cancer biomarkers in a biological sample are always desired. Here, we report the development of a novel electrochemical biosensor for early detection of breast cancer by using bioconjugated self-assembled pH-responsive polymeric micelles. The micelles were loaded with ferrocene molecules as "tracers" to specifically target cell surface-associated epithelial mucin (MUC1), a biomarker for breast and other solid carcinoma. The synthesis of target-specific, ferrocene-loaded polymeric micelles was confirmed, and the resulting sensor was capable of detecting the presence of MUC1 in a sample containing about 10 cells/mL. Such a high sensitivity was achieved by maximizing the loading capacity of ferrocene inside the polymeric micelles. Every single event of binding between the antibody and antigen was represented by the signal of hundreds of thousands of ferrocene molecules that were released from the polymeric micelles. This resulted in a significant increase in the intensity of the ferrocene signal detected by cyclic voltammetry.

Spectral data de-noising using semi-classical signal analysis: application to localized MRS.

In this paper, we propose a new post-processing technique called semi-classical signal analysis (SCSA) for MRS data de-noising. Similar to Fourier transformation, SCSA decomposes the input real positive MR spectrum into a set of linear combinations of squared eigenfunctions equivalently represented by localized functions with shape derived from the potential function of the Schrödinger operator. In this manner, the MRS spectral peaks represented as a sum of these 'shaped like' functions are efficiently separated from noise and accurately analyzed. The performance of the method is tested by analyzing simulated and real MRS data. The results obtained demonstrate that the SCSA method is highly efficient in localized MRS data de-noising and allows for an accurate data quantification.

Metabolic consequences of hepatic steatosis in overweight and obese adolescents.

OBJECTIVE: To test the hypothesis that hepatic steatosis is associated with risk factors for type 2 diabetes in overweight and obese youth, mediated by cardiorespiratory fitness. RESEARCH DESIGN AND METHODS: This was a cross-sectional study comparing insulin sensitivity between 30 overweight and obese adolescents with hepatic steatosis, 68 overweight and obese adolescents without hepatic steatosis, and 11 healthy weight adolescents without hepatic steatosis. Cardiorespiratory fitness was determined by a graded maximal exercise test on a cycle ergometer. Secondary outcomes included presence of metabolic syndrome and glucose response to a 75-g oral glucose challenge. RESULTS: The presence of hepatic steatosis was associated with 55% lower insulin sensitivity (P = 0.02) and a twofold greater prevalence of metabolic syndrome (P = 0.001). Differences in insulin sensitivity (3.5 vs. 4.5 mU ⋅ kg(-1) ⋅ min(-1), P = 0.03), prevalence of metabolic syndrome (48 vs. 20%, P = 0.03), and glucose area under the curve (816 vs. 710, P = 0.04) remained between groups after matching for age, sex, and visceral fat. The association between hepatic steatosis and insulin sensitivity (ß = -0.24, t = -2.29, P < 0.025), metabolic syndrome (ß = -0.54, t = -5.8, P < 0.001), and glucose area under the curve (ß = 0.33, t = 3.3, P < 0.001) was independent of visceral and whole-body adiposity. Cardiorespiratory fitness was not associated with hepatic steatosis, insulin sensitivity, or presence of metabolic syndrome. CONCLUSIONS: Hepatic steatosis is associated with type 2 diabetes risk factors independent of cardiorespiratory fitness, whole-body adiposity, and visceral fat mass.

Hepatic steatosis and low cardiorespiratory fitness in youth with type 2 diabetes.

The purpose of this study was to examine the association between cardiorespiratory fitness, ectopic triglyceride accumulation, and insulin sensitivity among youth with and without type 2 diabetes. Subjects included 137 youth ages 13-18 years including 27 with type 2 diabetes, 97 overweight normoglycemic controls, and 13 healthy weight normoglycemic controls. The primary outcome measure was cardiorespiratory fitness defined as peak oxygen uptake indexed to fat free mass. Secondary outcomes included liver and muscle triglyceride content determined by (1)H-magnetic resonance spectroscopy and insulin sensitivity determined by frequently sampled intravenous glucose tolerance test. Despite similar measures of adiposity, peak oxygen uptake was 11% lower (38.9 ± 7.9 vs. 43.9 ± 6.1 ml/kgFFM/min, P = 0.002) and hepatic triglyceride content was nearly threefold higher (14.4 vs. 5.7%, P = 0.001) in youth with type 2 diabetes relative to overweight controls. In all 137 youth, cardiorespiratory fitness was negatively associated with hepatic triglyceride content (r = -0.22, P = 0.02) and positively associated with insulin sensitivity (r = 0.29, P = 0.002) independent of total body and visceral fat mass. Hepatic triglyceride content was also negatively associated with insulin sensitivity (r = -0.35, P < 0.001), independent of adiposity, sex, age, and peak oxygen uptake. This study demonstrated that low cardiorespiratory fitness and elevated hepatic triglyceride content are features of type 2 diabetes in youth. Furthermore, cardiorespiratory fitness and hepatic triglyceride are associated with insulin sensitivity in youth. Taken together, these data suggest that cardiorespiratory fitness and hepatic steatosis are potential clinical biomarkers for type 2 diabetes among youth.

Fast magnetic resonance spectroscopic imaging (MRSI) using wavelet encoding and parallel imaging: in vitro results.

In previous work we have shown that wavelet encoding spectroscopic imaging (WE-SI) reduces acquisition time and voxel contamination compared to the standard Chemical Shift Imaging (CSI) also known as phase encoding (PE). In this paper, we combine the wavelet encoding method with parallel imaging (WE-PI) technique to further reduce the acquisition time by the acceleration factor R, and preserve the spatial metabolite distribution. Wavelet encoding provides results with a lower signal-to-noise ratio (SNR) than the phase encoding method. Their combination with parallel imaging, introduces an intrinsic SNR reduction. The rate of SNR reduction is slower in wavelet encoding with PI than PE with parallel imaging (PE-PI). This is due to the fact that in WE-PI, the SNR reduction is a function of the acceleration factor R and the voxel number N, whereas in PE-PI it is a function of the acceleration factor R only.

Wavelet-encoding gradient-echo imaging sequence using real-time de-noising method for acquisition time reduction.

OBJECT: To reduce acquisition time and increase signal-to-noise ratio (SNR) of the wavelet-encoding gradient-echo (GE-WE) sequence used in small field of view dynamic magnetic resonance imaging. MATERIALS AND METHODS: A GE-WE imaging sequence acquires wavelet lines from a 3-Tesla scanner. Those with intensity below a given threshold are skipped in real time, improving SNR and reducing acquisition time. RESULTS: The SNR of GE-WE images increases by approximately three times in simulation, while the acquisition time reduction ranges from 5 to 10% on phantom tests. CONCLUSION: This technique improves the SNR of GE-WE images, while reducing acquisition time.

Small field of view imaging using wavelet encoding with 2 dimensional RF pulses and gradient echo: phantom results.

OBJECT: The objective of this work is to propose an imaging sequence based upon the wavelet encoding approach to provide MRI images free from folding artifacts, in the small field of view (FOV) regime, such as dynamic magnetic resonance imaging (MRI) studies. MATERIALS AND METHODS: The method consists of using a 2D spatially selective RF excitation pulse inserted into a gradient- echo pulse sequence to excite spins within a determined plane where wavelet encoding is achieved in one direction and slice selection is performed in the second direction. Wavelet encoding allows for spatially localized excitation and consequently restricts the spins excited within a reduced FOV. It consists of varying, according to a predetermined scheme, the width and position of the profile of the so-called fast RF pulse of the 2D RF excitation pulse, to obey wavelet encoding translation and dilation conditions. This sequence is implemented on a 3 Tesla whole body Siemens scanner. RESULTS: Compared to Fourier encoding, the proposed technique tested on phantoms with different shapes and structures, is able to provide gradient-echo reduced FOV images free from aliased signals. CONCLUSION: Wavelet encoding is suitable for small FOV imaging in dynamic MRI studies.

Implementation of three-dimensional wavelet encoding spectroscopic imaging: in vivo application and method comparison.

We have recently proposed a two-dimensional Wavelet Encoding-Spectroscopic Imaging (WE-SI) technique as an alternative to Chemical Shift Imaging (CSI), to reduce acquisition time and crossvoxel contamination in magnetic resonance spectroscopic imaging (MRSI). In this article we describe the extension of the WE-SI technique to three dimensions and its implementation on a clinical 1.5 T General Electric (GE) scanner. Phantom and in vivo studies are carried out to demonstrate the usefulness of this technique for further acquisition time reduction with low voxel contamination. In wavelet encoding, a set of dilated and translated prototype functions called wavelets are used to span a localized space by dividing it into a set of subspaces with predetermined sizes and locations. In spectroscopic imaging, this process is achieved using radiofrequency (RF) pulses with profiles resembling the wavelet shapes. Slice selective excitation and refocusing RF pulses, with single-band and dual-band profiles similar to Haar wavelets, are used in a modified PRESS sequence to acquire 3D WE-SI data. Wavelet dilation and translation are achieved by changing the strength of the localization gradients and frequency shift of the RF pulses, respectively. The desired spatial resolution in each direction sets the corresponding number of dilations (increases in the localization gradients), and consequently, the number of translations (frequency shift) of the Haar wavelets (RF pulses), which are used to collect magnetic resonance (MR) signals from the corresponding subspaces. Data acquisition time is reduced by using the minimum recovery time (TR(min)), also called effective time, when successive MR signals from adjacent subspaces are collected. Inverse wavelet transform is performed on the acquired data to produce metabolite maps. The proposed WE-SI method is compared in terms of acquisition time, pixel bleed, and signal-to-noise ratio to the CSI technique. The study outcome shows that 3D WE-SI provides accurate results while reducing both acquisition time and voxel contamination.

Acquisition time reduction in magnetic resonance spectroscopic imaging using discrete wavelet encoding.

This paper describes a new magnetic resonance spectroscopic imaging (MRSI) technique based upon the discrete wavelet transform to reduce acquisition time and cross voxel contamination. Prototype functions called wavelets are used in wavelet encoding to localize defined regions in localized space by dilations and translations. Wavelet encoding in MRSI is achieved by matching the slice selective RF pulse profiles to a set of dilated and translated wavelets. Single and dual band slice selective excitation and refocusing pulses, with profiles resembling Haar wavelets, are used in a spin-echo sequence to acquire 2D-MRSI wavelet encoding data. The 2D space region is spanned up to the desired resolution by a proportional number of dilations (increases in the localization gradients) and translations (frequency shift) of the Haar wavelets (RF pulses). Acquisition time is reduced by acquiring successive MR signals from regions of space with variable size and different locations with no requirement for a TR waiting time between acquisitions. An inverse wavelet transform is performed on the data to produce the correct spatial MR signal distribution.

Lactate doublet quantification and lipid signal suppression using a new biexponential decay filter: application to simulated and 1H MRS brain tumor time-domain data.

A new postprocessing filter based on the continuous wavelet transform (CWT) method modeled as a biexponential decay function to isolate the lactate doublet from overlapping lipid resonance(s) and estimate its magnetic resonance spectroscopy (MRS) parameters (signal amplitude, resonance frequencies, and apparent relaxation time (T(*) (2))) is proposed. The new filter employs the same iterative process used in the previously single exponential decay filter. A comparison of the results obtained from application of both filters to simulated data and real (1)H MRS data collected from human blood plasma and brain tumors demonstrates that the new filter provides a better estimate of MRS parameters of lactate, with less computation time. Furthermore, the results show that the new filter is less sensitive to noise and provides a direct estimate of J-coupling value of the lactate doublet.

Prediction of treatment response of head and neck cancers with P-31 MR spectroscopy from pretreatment relative phosphomonoester levels.

RATIONALE AND OBJECTIVES: Combinations of chemotherapy and fractionated radiation therapy are the currently preferred nonsurgical treatment methods for squamous cell carcinoma of the head and neck, but to the authors' knowledge there is no reliable marker for predicting therapeutic response. Early identification of nonresponders would allow prompt replacement of ineffective, toxic therapy by alternative, potentially more effective procedures. Frequent regional node involvement facilitates surface coil investigation with phosphorus-31 magnetic resonance spectroscopy. MATERIALS AND METHODS: P-31 magnetic resonance spectra were acquired from 12 patients before radiation therapy or chemotherapy. In vivo three-dimensional localized P-31 nuclear magnetic resonance chemical shift imaging was performed with a 1.5-T clinical imager and a dual-tuned H-1/P-31 surface coil. Proton decoupling and nuclear Overhauser enhancement were used to improve sensitivity and resolve overlapping signals in the phosphomonoester region of the spectrum. RESULTS: The average pretreatment ratio of phosphomonoester to beta-nucleoside triphosphate was significantly smaller in complete responders (n = 4) than in incomplete responders (partial responders plus nonresponders, n = 8) (0.0 +/- 0.0 vs 1.22 +/- 0.17 [P = .004]). CONCLUSION: Results of this preliminary study suggest that H-1-decoupled P-31 magnetic resonance spectroscopy may prove to be a useful predictor of therapeutic response in head and neck cancers.