MRS: a noninvasive window into cardiac metabolism

Ewijk, Petronella A. van; Schrauwen‐Hinderling, Vera B.; Bekkers, Sebastiaan C.A.M.; Glatz, Jan F. C.; Wildberger, Joachim E.; Kooi, M. Eline

doi:10.1002/nbm.3320

Cited by 27 publications

(34 citation statements)

References 255 publications

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“…Proton MR spectroscopy (MRS) has proven a valuable tool to study cardiac metabolism . It has been shown that myocardial triglyceride (TG) levels are dependent on age, diet, and circadian rhythm in healthy subjects.…”

Section: Introductionmentioning

confidence: 99%

Navigator‐free metabolite‐cycled proton spectroscopy of the heart

Peereboom

Gastl

Füetterer

et al. 2019

Magnetic Resonance in Med

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Twitter: @CMR_ZurichPurpose: Respiratory gating in cardiac water-suppressed (WS) proton spectroscopy leads to long and unpredictable scan times. Metabolite cycling allows to perform frequency and phase correction on the water signal and, hence, offers an approach to navigator-free cardiac spectroscopy with fixed scan time. The objective of the present study was to develop and implement navigator-free metabolite-cycled cardiac proton spectroscopy (MC nonav) and compare it with standard navigator-gated WS (WS nav) and navigator-free WS (WS nonav) measurements for the assessment of triglyceride-to-water ratios (TG/W) and creatine-to-water ratios (CR/W) in the intraventricular septum of the in vivo heart. Methods: Navigator-free metabolite-cycled spectroscopy was implemented on a clinical 1.5T system. In vivo measurements were performed on 10 young and 5 older healthy volunteers to assess signal-to-noise ratio efficiency as well as TG/W and CR/W and the relative Cramér-Rao lower bounds for CR. The performance of the metabolite-cycled sequence was verified using simulations. Results: On average, scan times of MC nonav were 3.4 times shorter compared with WS nav, while no significant bias for TG/W was observed (coefficient of variation = 14.0%). signal-to-noise ratio efficiency of both TG and CR increased for MC nonav compared with WS nav. Relative Cramér-Rao lower bounds of CR decreased for MC nonav. Overall spectral quality was found comparable between MC nonav and WS nav, while it was inferior for WS nonav. Conclusion: Navigator-free metabolite-cycled cardiac proton spectroscopy offers 3.4-fold accelerated assessment of TG/W and CR/W in the heart with preserved spectral quality when compared with navigator-gated WS scans. K E Y W O R D S1 H-MRS, cardiac spectroscopy, creatine, metabolite cycling, respiratory motion compensation, triglyceride 1 | INTRODUCTION Proton MR spectroscopy (MRS) has proven a valuable tool to study cardiac metabolism. 1 It has been shown that myocardial triglyceride (TG) levels are dependent on age, 2 diet, 3 and circadian rhythm 4 in healthy subjects. Both fatty acid usage and total creatine (CR) levels tend to decrease as a function of heart failure severity, 5 where distinctions can be made between different types of cardiomyopathy. 6 Other diseases such as diabetes type 2 7 and aortic stenosis 8 also show effects on myocardial TG levels.Although proton MRS is not a new method for cardiac research, its transition to the clinic has not succeeded so far. The lack of clinical translation is partly related to motion effects 796 | PEEREBOOM Et al.

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Section: Introductionmentioning

confidence: 99%

Navigator‐free metabolite‐cycled proton spectroscopy of the heart

Peereboom

Gastl

Füetterer

et al. 2019

Magnetic Resonance in Med

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“… 5 reported average water peak linewidths of 8.6 Hz (1.5 Hz) and 10.7 Hz (0.4 Hz) at 1.5 T, respectively; however, at this field strength, linewidths are expected to be approximately half the widths of those observed at 3 T. The narrow linewidth at 3 T in this study was achieved via: (1) a small voxel size; (2) the use of IVS for robust localisation to the interventricular septum; (3) a sophisticated image-based B 0 shimming strategy; and (4) a non-water suppressed MRS sequence in conjunction with ECG triggering and navigator respiratory-motion tracking, which allowed for prospective and retrospective motion correction, as well as frequency alignment and phase correction during post-processing. Moreover, the measurements shown here were acquired on a 3 T system, while most 1 H CMRS studies so far were performed at 1.5T 1 . The increased field strength results in a higher SNR and thus counteracts SNR loss resulting from the small voxel size.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac magnetic resonance spectroscopy (CMRS) is becoming increasingly popular as a non-invasive probe of myocardial metabolism 1 , permitting healthy and pathological conditions to be studied using different endogenous nuclei. Of these, phosphorus ( 31 P) is the most widely investigated, reflecting the crucial role of phosphorus metabolites in myocardial energetics.…”

Section: Introductionmentioning

confidence: 99%

“…However, proton ( 1 H) CMRS is starting to play a larger role in clinical research, as it permits visualisation of important molecular species including triglycerides and creatine (Cr). While the Cr resonance is an important clinical target, myocardial triglycerides are arguably of greater interest, as the healthy human heart obtains approximately 70% of its energy from oxidation of long-chain fatty acids 1 . Furthermore, elevated lipid concentrations in the heart are associated with type 2 diabetes mellitus 2 , 3 and obesity 4 , as well as impaired diastolic function 2 , 5 and a number of other disease conditions 6 , 7 .…”

Section: Introductionmentioning

confidence: 99%

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Non-Water-Suppressed 1H MR Spectroscopy with Orientational Prior Knowledge Shows Potential for Separating Intra- and Extramyocellular Lipid Signals in Human Myocardium

Fillmer

Höck

Cameron

et al. 2017

Sci Rep

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Conditions such as type II diabetes are linked with elevated lipid levels in the heart, and significantly increased risk of heart failure; however, metabolic processes underlying the development of cardiac disease in type II diabetes are not fully understood. Here we present a non-invasive method for in vivo investigation of cardiac lipid metabolism: namely, IVS-McPRESS. This technique uses metabolite-cycled, non-water suppressed 1H cardiac magnetic resonance spectroscopy with prospective and retrospective motion correction. High-quality IVS-McPRESS data acquired from healthy volunteers allowed us to investigate the frequency shift of extramyocellular lipid signals, which depends on the myocardial fibre orientation. Assuming consistent voxel positioning relative to myofibres, the myofibre angle with the magnetic field was derived from the voxel orientation. For separation and individual analysis of intra- and extramyocellular lipid signals, the angle myocardial fibres in the spectroscopy voxel take with the magnetic field should be within ±24.5°. Metabolite and lipid concentrations were analysed with respect to BMI. Significant correlations between BMI and unsaturated fatty acids in intramyocellular lipids, and methylene groups in extramyocellular lipids were found. The proposed IVS-McPRESS technique enables non-invasive investigation of cardiac lipid metabolism and may thus be a useful tool to study healthy and pathological conditions.

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“…MAGNETIC RESONANCE SPECTROSCOPY (MRS) has shown promising evidence as a noninvasive tool to gain valuable insights into cardiac metabolism of in vivo healthy and diseased hearts . Proton MRS ( 1 H‐MRS) allows quantifying myocardial triglyceride (TG) and creatine (CR) content .…”

mentioning

confidence: 99%

Retrospective phase‐based gating for cardiac proton spectroscopy with fixed scan time

Gastl

Peereboom

Füetterer

et al. 2019

Magnetic Resonance Imaging

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Background Respiratory motion is a major limiting factor for spectral quality and duration of in vivo proton MR spectroscopy of the heart. Prospective navigator gating is frequently applied to minimize the effects of respiratory motion, but scan durations are subject‐dependent and hence difficult to predict. Purpose To implement cardiac proton MRS with fixed scan time by employing retrospective phase‐based gating and to compare the proposed method to conventional navigator‐gated MRS. Study Type Prospective. Subjects Eighteen healthy volunteers (29.7 ± 7.8 years). Field Strength/Sequence 1.5, navigator‐gated (16 averages without, 96 with water suppression [WS]) data acquisition as reference and navigator‐free data acquisition with a fixed scan time (48 without WS, 304 with WS), cardiac‐triggered point‐resolved spectroscopy (PRESS). Assessment Navigator‐free data acquisition with retrospective phase‐based gating was compared with prospective navigator‐gating. Navigator‐free acquisition was repeated in 10 subjects to assess reproducibility. Scan time was assessed for prospective and retrospective gating. Retrospective phase‐based gating was performed using a threshold based on the standard deviation (SD) of individual water (W) and triglyceride (TG) phases. Statistical Tests T‐tests and Bland–Altman analysis. Results The duration of the prospective navigator‐gated scans ranged from 6:09 minutes to 21:50 minutes (mean 10:05 ± 3:46 min, gating efficiency 40.4 ± 10.5%), while data acquisition for retrospective phase‐based gating had a fixed scan time of 11:44 minutes. Retrospective phase‐based gating using a threshold of 1 × SD yielded a gating efficiency of 72.7 ± 4.3% and a coefficient of variation (CoV) of triglyceride‐to‐water ratios of 9.8% compared with the navigated reference. The intrasubject reproducibility of retrospective gating revealed a CoV of 9.5%. Data Conclusion Cardiac proton MRS employing retrospective phase‐based gating is feasible and provides reproducible assessment of TG/W in a fixed scan time. Since scan time is independent of respiratory motion, retrospective phase‐based gating offers an approach to motion compensation with predictable exam time for proton MRS of the heart. Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1973–1981.

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MRS: a noninvasive window into cardiac metabolism

Cited by 27 publications

References 255 publications

Navigator‐free metabolite‐cycled proton spectroscopy of the heart

Navigator‐free metabolite‐cycled proton spectroscopy of the heart

Non-Water-Suppressed 1H MR Spectroscopy with Orientational Prior Knowledge Shows Potential for Separating Intra- and Extramyocellular Lipid Signals in Human Myocardium

Retrospective phase‐based gating for cardiac proton spectroscopy with fixed scan time

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