Proton MRS (1H 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.
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2Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 3Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 4Robarts Research Institute, University of Western Ontario, London, Canada 5U.O. Neuroradiologia, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy 6Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota 7Department of Biochemistry, University of Cambridge, Cambridge, England 8Department of Neurology, Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, Kansas 9Center for Biomedical Imaging, Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland 10School of Health Sciences, Purdue University, West Lafayette, Indiana 11Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 12High Field MR Center, Department of Biomedical imaging and Image‐Guided Therapy, Medical University of Vienna, Vienna, Austria 13Laboratory for Functional and Metabolic Imaging, Center for Biomedical Imaging, Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland 14Fortis Memorial Research Institute, Gurugram, Haryana, India 15Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands 16Max Planck Institute for Biological Cybernetics, Tuebingen, Germany 17Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania 18Department of Pediatrics, University of Geneva, Geneva, Switzerland 19Stanford Radiological Sciences Lab, Stanford, California 20Department of Radiology, Mayo Clinic, Rochester, Minnesota 21School of Psychological Science, University of Bristol, Bristol, England
23Departments of Radiology and Biomedical Research, University of Bern, Bern, Switzerland 24Philips Healthcare, Best, the Netherlands 25CRUK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden Hospital, London, England 26Center for Clinical Spectroscopy, Brigham and Women’s Hospital, Harvard University Medical School, Boston, Massachusetts 27Department of Radiology, University of Miami, Miami, Florida 28DVA Medical Center and Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California 29Translational Research Institute, Woolloongabba, Australia 30Bangor Imaging Unit, School of Psychology, Bangor University, Bangor, Wales 31Canon Medical Research USA, Mayfield Village, Ohio 32Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California 33GE Healthcare, Berlin, Germany 34Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania 35Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, England 36Centre for Preclinical Imaging, Institute of Translational Medicine, University of Liverpool, Liverpool, England 37Department of Neurology, University of New Mexico, Albuquerque, New Mexico 38MR R&D, Siemens Healthineers, Malvern, Pennsylvania 39Innovative Biodiagnostics, Winnipeg, Canada 40Department of Radiology, Duke University Medical Center, Durham, North Carolina 41Molecular and Clinical Sciences, St George’s University of London, London, England