Petra Hnilicová1, Michal Považan2, Bernhard Strasser2, Ovidiu C Andronesi3, Dušan Dobrota1, Siegfried Trattnig2, and Wolfgang Bogner2
1Department of Medical Biochemistry, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia, 2Department of Biomedical Imaging and Image-guided Therapy, MR Center of Excellence, Medical University of Vienna, Vienna, Austria, 3Department of Radiology, Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, United States
Synopsis
In vivo
assessment of neurotransmitter levels can improve the understanding of several pathological
processes. For non-invasive GABA+ and Glx mapping in vivo within one scan, we applied
a spiral-encoded GABA-edited MEGA-LASER 3D-MRSI sequence with real time
corrections, achieving the ~3 cc nominal resolution in ~20 minutes. Via test-retest assessment in 14 healthy volunteers (7 men/7 women) we confirmed the measurement reproducibility and inter- and intra-subject variability of
GABA+ and Glx ratios and thus validated that our method may
be used in (pre)clinical studies of neurotransmitters alterations in the brain
at 3T.
Purpose
In several
neurological, psychiatric and developmental disorders there is an evidence of
alternations in neurotransmitter concentrations in the brain,
1, 2
especially in the most abundant excitatory and inhibitory neurotransmitters: Glutamate
(Glu) and Gamma-aminobutyric acid (GABA), respectively.
1, 3 The
goal of this study was to estimate the measurement reproducibility of our fast
and robust GABA-edited 3D-MRSI method and to validate its feasibility for
(pre)clinical neurotransmitters studies.
Methods
The study was performed on a 3T whole-body
MR scanner (TIM Trio
®, Siemens Healthcare, Erlangen, Germany)
using a 32-channel head coil (Siemens Healthcare, Erlangen, Germany) for
signal reception. To ensure accurate and reproducible
slice positioning we used auto-align and for identical VOI (80×85×60 mm
3)
placement 3D T
1-weighted MPRAGE images in three orthogonal directions. For
spectroscopic measurements we applied a spiral-encoded GABA-edited
MEGA-LASER 3D-MRSI sequence with real-time correction
for motions, frequency, and scanner instability artefacts.
4,5 During
GABA-editing we applied 60 Hz Gaussian pulses refocusing resonances at 1.9
ppm (EDIT-ON) and symmetrically at 7.5
ppm (EDIT-OFF) using 68 ms echo time.
We achieved GABA
+ (GABA plus macromolecule contamination) and Glx (Glu
plus Glutamine contamination) 3D-mapping with ~3 cc nominal resolution in
~20 min. Fourteen healthy volunteers (age
30 ± 5 years; 7 men and 7 women) were scanned twice with a gap of ≤ 30
minutes for assessing the inter- and intra-subject variability. Measured MR data were finally processed
employing LCModel, Matlab, Bash, and MINC software, and statistically evaluated
using SPSS package.
Results
For spectral quantification were used two LCModel-fitted
data sets, for EDIT-OFF and for DIFF (difference spectrum; subtraction
of EDIT-ON and EDIT-OFF) spectrum (Fig. 1). Over all
quantified voxels, we achieved FWHM and SNR mean values in
the range of 7.2 - 10.1 Hz and 13.7 - 19.4,
respectively (Fig. 2). In test-retest
intra-subject variability evaluation we found low coefficient of variations (CV: mean of medians)
and high intraclass correlation coefficients (ICC: mean) for GABA
+
ratios (GABA
+/tCr
and GABA
+/tNAA): CV
~8% / ICC >0.75, as well as Glx ratios (Glx/tCr and Glx/tNAA): CV ~6% / ICC >0.70. Likewise, there were low inter-subject median CV
values for GABA
+
ratios (~8%) as well as for Glx ratios (~6%). Finally, for all quantification-referencing
combination the Bland-Altman plots of test-retest reproducibility
investigations across the VOI in all fourteen subjects were displayed on
Figure 3.
Discussion
Our spiral-encoding GABA-LASER sequence with real-time
artefact correction enables fast metabolites 3D-mapping with minimal voxel size, high SNR, better localization accuracy, and high spectral quality. Furthermore, the intra- and inter-subject CV quantification for the
repeated scans for GABA
+ and Glx ratios in the voxel by
voxel comparison across the whole VOI suggest that our GABA-edited 3D MRSI
measurements were highly reproducible. A high degree of reliability between test-retest
measurements was also confirmed using ICC analysis. Accordingly, our Bland-Altman plots showed the high
95% agreement of repeatedly measured GABA
+ and Glx ratios.
Conclusion
In vivo
assessment of GABA
+ and Glx levels using our spiral-encoded
GABA-edited MEGA-LASER sequence provides highly reproducible 3D mapping of
these neurotransmitters and thus can improve the understanding of several
neurological as well as psychiatric disorders.
Acknowledgements
This study
was supported by the Austrian Science Fund (FWF): KLI-61 and the FFG Bridge
Early Stage Grant #846505, by the Slovak Research and Development Agency under
the contract No. APVV-14-0088, and by project "Increasing Opportunities for Career
Growth in Research and Development in the Field of Medical Sciences",
ITMS: 26110230067, co-funded from EU sources and European Social Fund. References
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