MR Spectroscopy - New Metabolites

Proton MR spectroscopic techniques have been widely used to characterise abnormalities in major brain metabolites N-acetyl-aspartate, choline-containing compounds, creatine, myo-inositol and lactate in a wide range of disorders. Changes in these metabolites were found to be characteristic of patterns of tissue damage, and also showed prognostic value, but rarely enable individual diagnosis. By contrast, detection of metabolites that are not normally present in the healthy brain offer the precise detection of primary (inherited) or acquired faulty metabolic pathways and some key examples will be discussed. More recently, spectroscopic editing techniques became available on clinical scanner platforms that allow the detection of new metabolites of interest including GABA, a particular disease relevant neurotransmitter, glutathione (GSH), a marker of antioxidative capacity, and 2-hydroxyglutaric acid (2HG) an important oncometabolite. 2HG e.g. has been shown to be an accurate marker of IDH-mutated gliomas and can thus be considered the first example of non-invasive molecular ‘radiogenomics’ of a brain tumour. Regional GABA levels have potential as mechanistic biomarker of brain network states that may guide neuromodulatory treatment. Reliable detection and quantification of these metabolites at clinical field strengths remains challenging but there is real potential for these metabolites to support personalised care that will be reviewed. Translational challenges that need to be addressed for individualized brain metabolic profiling to inform personalised healthcare will be highlighted. Lastly, non-proton spectroscopic techniques to detect the metabolic flux of hyperpolarised molecules such as pyruvate will be discussed as an emerging experimental technique.

Acknowledgements

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References

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