Purpose To evaluate the reproducibility of spectroscopic measurements from the anterior cingulate (AC) and the dorsolateral prefrontal cortex (DLPFC) regions at 7 T using a 32-channel head coil. Materials and Methods Spectra were acquired in four healthy subjects each scanned twice using a STEAM sequence, and a MEGA-PRESS-IVS sequence for GABA editing. STEAM spectra were quantified using LCModel, whereas MEGA-PRESS-IVS data were analyzed using peak integrals determined using in-house software. Mean coefficient of variation (CV) and mean absolute difference between visits were calculated. Results For the AC STEAM dataset, the mean CV between visits was 6.2% for prominent metabolites such as NAA, tCr, and tCho and 6.3% for low SNR metabolites such as Glu, Gln, and GABA. The mean CV between visits for the DLPFC STEAM dataset was 8.5% for high prominent metabolites and 21% for lower SNR metabolites. In the AC, the reproducibility measures for GABA were superior for STEAM compared to MEGA-PRESS-IVS (mean CV of 3.5% versus 13.6%), but the opposite pattern was observed in the DLPFC region (mean CV of 16.2% versus 13.4%). Conclusion 7 T MRS of the AC and DLPFC using both short TE STEAM and MEGA-PRESS-IVS sequences provide excellent reproducibility of twelve metabolites, including GABA.

The major excitatory and inhibitory neurotransmitters, glutamate (Glu) and gamma-aminobutyric acid (GABA), respectively, are implicated in the pathophysiology of schizophrenia. N-acetyl-aspartyl-glutamate (NAAG), a neuropeptide that modulates the Glu system, may also be altered in schizophrenia. This study investigated GABA, Glu + glutamine (Glx), and NAAG levels in younger and older subjects with schizophrenia. Forty-one subjects, 21 with chronic schizophrenia and 20 healthy controls, participated in this study. Proton magnetic resonance spectroscopy ((1)H-MRS) was used to measure GABA, Glx, and NAAG levels in the anterior cingulate (AC) and centrum semiovale (CSO) regions. NAAG in the CSO was higher in younger schizophrenia subjects compared with younger control subjects. The opposite pattern was observed in the older groups. Glx was reduced in the schizophrenia group irrespective of age group and brain region. There was a trend for reduced AC GABA in older schizophrenia subjects compared with older control subjects. Poor attention performance was correlated to lower AC GABA levels in both groups. Higher levels of CSO NAAG were associated with greater negative symptom severity in schizophrenia. These results provide support for altered glutamatergic and GABAergic function associated with illness course and cognitive and negative symptoms in schizophrenia. The study also highlights the importance of studies that combine MRS measurements of NAAG, GABA, and Glu for a more comprehensive neurochemical characterization of schizophrenia.

Gamma-butyric acid (GABA) dysfunction has been implicated in the pathophysiology of schizophrenia and its cognitive deficits. Proton magnetic resonance spectroscopy (MRS) was used to test the hypothesis that older participants with schizophrenia have lower anterior cingulate GABA levels compared to older control participants. One-hundred and forty-five participants completed this study. For detection of GABA, spectra were acquired from the medial frontal/anterior cingulate cortex using a macromolecule-suppressed MEGA-PRESS sequence. Patients were evaluated for psychopathology and all participants completed neuropsychological tests of working memory, processing speed, and functional capacity. GABA levels were significantly lower in the older participants with schizophrenia(n=31) compared to the older control(n=37) group (p=0.003) but not between the younger control(n=40) and schizophrenia (n=29) groups (p=0.994). Age strongly predicted GABA levels in the schizophrenia group accounting for 42% of the variance, but the effect of age was less in the control group accounting for 5.7% of the variance. GABA levels were specifically related to working memory but not processing speed performance, functional capacity, or positive or negative symptom severity. This is the largest MRS study of GABA in schizophrenia and the first to examine GABA without macromolecule contamination, a potentially significant issue in previous studies. GABA levels more rapidly declined with advancing age in the schizophrenia compared to the control group. Interventions targeted at halting the decline or increasing GABA levels may improve functional outcomes and quality of life as patients with schizophrenia age.

Various lines of evidence suggest that brain bioenergetics and mitochondrial function may be altered in schizophrenia. On the basis of prior phosphorus-31 (31P)-magnetic resonance spectroscopy (MRS), post-mortem and preclinical studies, this study was designed to test the hypothesis that abnormal glycolysis leads to elevated lactate concentrations in subjects with schizophrenia. The high sensitivity of 7 Tesla proton (1H)-MRS was used to measure brain lactate levels in vivo. Twenty-nine controls and 27 participants with schizophrenia completed the study. MRS scanning was conducted on a Philips ‘Achieva' 7T scanner, and spectra were acquired from a voxel in the anterior cingulate cortex. Patients were assessed for psychiatric symptom severity, and all participants completed the MATRICS Consensus Cognitive Battery (MCCB) and University of California, San Diego Performance-Based Skills Assessment (UPSA). The relationship between lactate, psychiatric symptom severity, MCCB and UPSA was examined. Lactate was significantly higher in patients compared with controls (P=0.013). Higher lactate was associated with lower MCCB (r=−0.36, P=0.01) and UPSA total scores (r=−0.43, P=0.001). We believe this is the first study to report elevated in vivo cerebral lactate levels in schizophrenia. Elevated lactate levels in schizophrenia may reflect increased anaerobic glycolysis possibly because of mitochondrial dysfunction. This study also suggests that altered cerebral bioenergetics contribute to cognitive and functional impairments in schizophrenia.

In vivo measurement of neurotransmitters and modulators is now feasible with advanced proton magnetic resonance spectroscopy (1H-MRS) techniques. This review provides a basic tutorial of MRS, describes the methods available to measure brain glutamate, glutamine, γ-aminobutyric acid, glutathione, N-acetylaspartylglutamate, glycine, and serine at magnetic field strengths of 3Tesla or higher, and summarizes the neurochemical findings in schizophrenia. Overall, 1H-MRS holds great promise for producing biomarkers that can serve as treatment targets, prediction of disease onset, or illness exacerbation in schizophrenia and other brain diseases.

Purpose: To examine the precision of glutamate detection using a very short echo time (TE) phase rotation STEAM (PR-STEAM) sequence.Materials and Methods: Spectrosopic data were acquired from the anterior cingulate gyrus in nine healthy adults using 6.5-msec TE PR-STEAM, 40-msec TE PRESS, 72-msec TE STEAM, and TE-Averaging with an effective TE of 105 msec on a clinical 3T magnetic resonance imaging (MRI) system. All data were quantified using LCModel and reported as ratios relative to total creatine.Results: Glutamate Cramer-Rao lower bounds were less than 8% for all sequences. The 6.5-msec TE PR-STEAM identified glutamate with the greatest precision (coefficient of variation [CV] of 7.1%), followed by TE-Averaging (CV of 8.9%), 40-msec TE PRESS (CV of 11.9%), and 72-msec TE STEAM (CV of 13.8%). Conclusion:In the absence of spectral editing, glutamate is best detected in the human brain at 3T using very short TEs.

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The levels of several brain metabolites were investigated in the anterior (ACC) and posterior cingulate cortex (PCC) in 13 healthy controls (HC) and 13 patients with mild cognitive impairment (MCI) using single-voxel magnetic resonance spectroscopy (MRS) at 7T. Levels of γ-aminobutyric acid (GABA), glutamate (Glu), glutathione (GSH), N-acetylaspartylglutamate (NAAG), N-acetylaspartate (NAA), and myo-inositol (mI) were quantified relative to total creatine (tCr). The effect of diagnosis on metabolite levels, and relationships between metabolite levels and memory and executive function, correcting for age, were investigated. MCI patients showed significantly decreased GABA/tCr (ACC, PCC), Glu/tCr (PCC), and NAA/tCr (PCC), and significantly increased mI/tCr (ACC). In the combined group, worse episodic verbal memory performance was correlated with lower Glu/tCr (PCC), lower NAA/tCr (PCC), and higher mI/tCr (ACC, PCC). Worse verbal fluency performance was correlated with lower GSH/tCr (PCC). In summary, MCI is associated with decreased GABA and glutamate, most consistently in the PCC. Further studies in larger patient samples should be undertaken to determine the utility of 7T MRS in detecting MCI-related neurochemical changes.