Exploratory Multisite MR Spectroscopic Imaging Shows White Matter Neuroaxonal Loss Associated with Complications of Type 1 Diabetes in Children

Abstract

BACKGROUND AND PURPOSE: Type 1 diabetes affects over 200,000 children in the United States and is associated with an increased risk of cognitive dysfunction. Prior single-site, single-voxel MRS case reports and studies have identified associations between reduced NAA/Cr, a marker of neuroaxonal loss, and type 1 diabetes. However, NAA/Cr differences among children with various disease complications or across different brain tissues remain unclear. To better understand this phenomenon and the role of MRS in characterizing it, we conducted a multisite pilot study.

Spatiospectral image processing workflow considerations for advanced MR spectroscopy of the brain

“…Additionally, the quality of spectra for assessing water-soluble metabolites can be impacted by other structures in the brain, namely dural lipids which can produce large spectral distortions under 2.0 ppm. Using this framework, we demonstrate how spatiospectral processing allowed the identification and removal of CSI voxels affected by lipid interference as described by [7] in the T1D cohort.…”

“…Additionally, we note that a reliable spatiospectral framework opens the door for the development of new image processing routines for MRS and especially CSI. For instance, CSI suffers from known spatial biases, distortions, and nonlinearities as well as lower signal-to-noise ratios than SVS and interscanner variability [6], [7]. We hope that the introduction of this framework will spur image processing innovation in this field to overcome these challenges for more robust imaging and subsequent biological inference.…”

“…To demonstrate the utility of the proposed workflow across various types of studies, we used data from two different cohorts. The first was a group of children with type 1 diabetes (T1D) as described in [7]. Briefly, in 25 children, 6-14 years of age, with T1D across 3 sites, we acquired T1w MRI and axial 2-dimensional CSI at the level of the basal ganglia.…”

“…We use the spatial overlap of the CSI grid with tissue segmentations performed on T1w MRI to facilitate the identification of metabolites weighted by each tissue across multiple imaging sites in the T1D cohort. The full study details are as described in [7].…”

“…This is largely due to the fragmented workflow and software landscape available to researchers, raising the barrier for existing neuroimaging investigators to make the jump from MRI to MRS. Thus, here we describe considerations taken by recent studies to improve the access of MRS to traditional neuroimaging researchers and consolidate them into a proposed workflow for future MRS studies [7].…”