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.
Telephone: +44-79-08769879 Fax: +44-14-42266388
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
Research background

In vivo magnetic resonance proton spectroscopy studies of the brain can be used to measure Cho. In contrast to the commonly used method of SVS, CSI is a multi-voxel technique. Thus, compared with SVS, 2D-CSI allows larger areas of the brain to be studied, so that areas showing abnormal signals and also those appearing normal in structural MRI can be included. Compared with 3D-CSI, 2D-CSI is more resistant to motion artefact, which can be a problem when scanning the brain, and image quality is better at a usual clinical magnetic field strength of 1.5 T or 3 T.

Research motivation

Brain choline is particularly abundant in phosphatidylcholine membrane phospholipid molecules; Cho take part in membrane biosynthesis and breakdown. Thus, measurement of Cho has clinical and research value. For example, in chronic fatigue syndrome (also known as myalgic encephalomyelitis or systemic exertion intolerance disease), which is of unknown etiology, the first systematic proton neurospectroscopy study showed a significantly higher level of Cho in the occipital cortex in patients compared with matched healthy controls, and also loss of the spatial variation of Cho that is normally expected. This finding, which was essentially confirmed later by another group in respect of the basal ganglia, suggests that this disorder is associated with abnormal phospholipid metabolism in neuroglial membranes and has led to the suggestion of a potential therapeutic approach. A second example is dyslexia, also of unknown etiology, in which the first systematic proton neurospectroscopy study revealed decreased Cho in the left temporo-parietal lobe. This finding could have resulted from reduced left temporo-parietal phospholipid metabolism, which would be consistent with the findings from the first systematic 31-phosphorus neurospectroscopy study of dyslexia. In turn, this has led to suggestions of potential therapeutic interventions. 2D-CSI may also be useful clinically in evaluating patients with acute onset of neuropsychiatric symptoms. Another important clinical use of 2D-CSI is in relation to grading gliomas. It is therefore important to ascertain the reproducibility of 2D-CSI.

Research objective

The aim of this study was to investigate the repeatability of proton magnetic resonance spectroscopy 2D-CSI in the in vivo measurement of human cerebral levels of Cho.

Research methods

A repeated-measures study in six individuals was carried out using a 1.5-T Siemens Symphony TIM scanner and a standard head matrix coil. Proton spectra were acquired using a 64-voxel 2D-CSI spin-echo spectroscopy sequence. Spectral analysis was carried out using the Siemens spectroscopy task card. The main endpoint was the ratio of Cho to Cr for each voxel. The CV, RC, and ICC were used to assess the repeatability. There have been no previous studies of the repeatability of proton neurospectroscopy 2D-CSI in the in vivo measurement of human cerebral levels of Cho at a magnetic field strength of 1.5 T.

Research results

There was a minimum voxel RC of over 5%, which compared favorably with previous studies of the liver; the present results were all the more impressive given the much more heterogeneous nature of the brain compared with hepatic tissue. Twenty-six voxels had an ICC which was statistically significant, indicating a high level of agreement for these voxels. Just three voxels had median Cho to Cr ratios which were significantly different between scans. These three voxels were located in sulcal brain regions. Thus the poor reproducibility in these three voxels might be a function of “bleeding” in the neurospectroscopy data acquisition.

Research conclusions

In this first study of its type, the reproducibility of proton magnetic resonance spectroscopy in the in vivo measurement of human cerebral levels of Cho at a field strength of 1.5 T using 2D-CSI has been found to be very acceptable. Overall, the present findings should further encourage the use of this technique in psychiatric clinical practice as well as in research studies of neuropsychiatric disorders.

Research perspectives

Overall, the results of this study are highly encouraging for the use of this technique in neuropsychiatric research and clinical practice. Further studies should be carried out to determine whether sulcal voxels should routinely be omitted from longitudinal comparison studies.