Applications of Whole Organ MRSI - Brain & Body
Sarah Nelson1

1Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States

Synopsis

MR spectroscopic imaging (MRSI) makes it possible to study changes in metabolism that are associated with disease progression and response to therapy. Advances in MR hardware and software have provided new opportunities for obtaining data in a clinical feasible time and have therefore opened the door to a much broader range of applications than was previously considered. These applications will be demonstrated and future opportunities described.

Highlights

· Applications of H-1 MRSI to the evaluation of patients with neurological and psychiatric diseases

· Assessment of tumor aggressiveness and treatment response for body and brain cancers

· Potential for using hyperpolarized C-13 MR metabolic imaging for patient studies of the brain and body

Target Audience:

Radiologists and MR scientists who are interested in using MRSI.

Objectives:

Attendees will become familiar with the types of information that can be obtained from patients using MRSI and its relevance in clinical decision-making.

Purpose:

MR spectroscopic imaging (MRSI) makes it possible to study changes in metabolism that are associated with disease progression and response to therapy. Advances in MR hardware and software have provided new opportunities for obtaining data in a clinical feasible time and have therefore opened the door to a much broader range of applications than was previously considered. H-1 MRSI is the most widely applied methodology and can be integrated into a multi-parametric imaging examination. This has been applied to characterize disease and for detecting detect response to therapy. Another potentially valuable but still emerging technique is hyperpolarized C-13 MRSI. Initial patient studies that have been obtained using this technology will be reviewed in the context of future clinical applications.

Methods:

Volumetric localization is important for studying the spatial variations in metabolite signals and allowing serial evaluation of how these change. Reducing the acquisition time and increasing the coverage obtained for whole organ studies requires the use of echo planar and parallel imaging methodologies. While these have been developed in individual institutions and demonstrated to be reliable for patient studies, they are not yet widely available as commercial products. Moving forward with clinical applications requires that the information obtained is recognized as being important for obtaining a complete picture of the status of individual patients. Despite the exquisite detail and superior contrast obtained using conventional MR imaging, there are an increasing number of circumstances where having metabolic imaging data would be beneficial for interpreting the changes observed due to disease progression and treatment effects. H-1 MRSI and hyperpolarized C-13 MRSI are two methodologies that can provide such information. The H-1 MRSI techniques that have been used to image brain cancer are also relevant and have been applied to study neurological and psychiatric diseases. Examples are Multiple Sclerosis, Parkinsons’s disease, traumatic brain injury, depression and schizophrenia.

Results

The references given below provide present recent applications of MRSI and include descriptions of how metabolic data can contribute to the assessment of cancer, neurological and psychiatric diseases. The most common organs that have been studied are the brain, breast, prostate and liver. A key application for H-1 MRSI is the evaluation of brain, breast and prostate cancer. These have been shown to assist in defining tumor aggressiveness, targeting biopsy and surgical sampling for accurate diagnosis, defining the target for radiation or other focal therapies and assessing treatment effects. Integrating such data with genomic signatures that reflect the evolution of specific mutation profiles is important for tailoring therapies to individual patients. Hyperpolarized C-13 MR metabolic imaging can add to this picture by providing assessments of enzyme activity rather than steady state metabolite levels.

Discussion

The critical role of metabolic reprogramming in defining disease progression, selecting therapies and assessing treatment response is being recognized for a broad range of clinical applications. The MRSI methods being developed are able to evaluate steady state metabolic levels and dynamic enzymatic processes. Importantly they can be integrated into standard clinical examinations and uses many of the same techniques for localization and evaluation. The challenges associated with clinical applications are the need to enhance the availability of state of the art H-1 MRSI and to expand upon the capabilities of hyperprolarized C-13 MRSI.

Acknowledgements

No acknowledgement found.

References

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Proc. Intl. Soc. Mag. Reson. Med. 24 (2016)