Clinical Practice Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Mar 22, 2018; 8(1): 20-26
Published online Mar 22, 2018. doi: 10.5498/wjp.v8.i1.20
Repeatability of two-dimensional chemical shift imaging multivoxel proton magnetic resonance spectroscopy for measuring human cerebral choline-containing compounds
Basant K Puri, Mary Egan, Fintan Wallis, Philip Jakeman
Basant K Puri, Department of Medicine, Hammersmith Hospital, Imperial College London, London W12 0HS, United Kingdom
Mary Egan, Fintan Wallis, Department of Radiology, University Hospital Limerick, Limerick V94 YVH0, Ireland
Philip Jakeman, Centre for Interventions in Infection, Inflammation and Immunity, University of Limerick, Limerick V94 PX58, Ireland
Author contributions: All authors contributed to the design of the study and to data collection; Puri BK analysed the data and drafted the first version of the paper; all authors reviewed, critically revised and approved the final version.
Institutional review board statement: The study was approved by the Research Ethics Committee of the institution within which the work was undertaken (Limerick University Hospital) and it confirmed to the provisions of the Declaration of Helsinki in 1995 (as revised in Edinburgh in 2000).
Informed consent statement: All subjects gave written informed consent.
Conflict-of-interest statement: None to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Basant K Puri, MA, PhD, MB, BChir, MSc, MMath, FRCPsych, FRSB, Professor, Department of Medicine, Imperial College London, Imaging Directorate, Block A, Level 1, Hammersmith Hospital, Du Cane Road, London W12 0HS, United Kingdom.
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Received: September 24, 2017
Peer-review started: October 2, 2017
First decision: November 27, 2017
Revised: December 17, 2017
Accepted: January 7, 2018
Article in press: January 7, 2018
Published online: March 22, 2018

To investigate the repeatability of proton magnetic resonance spectroscopy in the in vivo measurement of human cerebral levels of choline-containing compounds (Cho).


Two consecutive scans were carried out in six healthy resting subjects at a magnetic field strength of 1.5 T. On each occasion, neurospectroscopy data were collected from 64 voxels using the same 2D chemical shift imaging (CSI) sequence. The data were analyzed in the same way, using the same software, to obtain the values for each voxel of the ratio of Cho to creatine. The Wilcoxon related-samples signed-rank test, coefficient of variation (CV), repeatability coefficient (RC), and intraclass correlation coefficient (ICC) were used to assess the repeatability.


The CV ranged from 2.75% to 33.99%, while the minimum RC was 5.68%. There was excellent reproducibility, as judged by significant ICC values, in 26 voxels. Just three voxels showed significant differences according to the Wilcoxon related-samples signed-rank test.


It is therefore concluded that when CSI multivoxel proton neurospectroscopy is used to measure cerebral choline-containing compounds at 1.5 T, the reproducibility is highly acceptable.

Keywords: Cerebral metabolites, Chemical shift imaging, Choline, Neurospectroscopy, Neuropsychiatric disorders

Core tip: Proton neurospectroscopy is a powerful tool allowing the assessment of cerebral metabolites. As such, it is increasingly being introduced into the practice of psychiatry for the investigation of cerebral choline-containing compounds in patients, as well as being used as a research tool. However, it is important to establish the reproducibility of this sensitive technique. In the present study, we show that this technique (using 2D chemical shift imaging) gives a level of reproducibility that is highly acceptable. These results should further encourage the use of this technique, which, in principle, is available on all standard MRI scanners, in psychiatric practice.