Proton MRS (1H MRS) provides noninvasive, quantitative metabolite profiles of tissue and has been shown to aid the clinical management of several brain diseases. Although most modern clinical MR scanners support MRS capabilities, routine use is largely restricted to specialized centers with good access to MR research support. Widespread adoption has been slow for several reasons, and technical challenges toward obtaining reliable good‐quality results have been identified as a contributing factor. Considerable progress has been made by the research community to address many of these challenges, and in this paper a consensus is presented on deficiencies in widely available MRS methodology and validated improvements that are currently in routine use at several clinical research institutions. In particular, the localization error for the PRESS localization sequence was found to be unacceptably high at 3 T, and use of the semi‐adiabatic localization by adiabatic selective refocusing sequence is a recommended solution. Incorporation of simulated metabolite basis sets into analysis routines is recommended for reliably capturing the full spectral detail available from short TE acquisitions. In addition, the importance of achieving a highly homogenous static magnetic field (B0) in the acquisition region is emphasized, and the limitations of current methods and hardware are discussed. Most recommendations require only software improvements, greatly enhancing the capabilities of clinical MRS on existing hardware. Implementation of these recommendations should strengthen current clinical applications and advance progress toward developing and validating new MRS biomarkers for clinical use.

Functional magnetic resonance imaging (fMRI) was used to localize brain areas active during manipulation of complex objects. In one experiment subjects were required to manipulate complex objects for exploring their macrogeometric features as compared to manipulation of a simple smooth object (a sphere). In a second experiment subjects were asked to manipulate complex objects and to silently name them upon recognition as compared to manipulation of complex not recognizable objects without covert naming. Manipulation of complex objects resulted in an activation of ventral premotor cortex [Brodmann's area (BA) 44], of a region in the intraparietal sulcus (most probably corresponding to the anterior intraparietal area in the monkey), of area SII and of a sector of the superior parietal lobule. When the objects were covertly named additional activations were found in the opercular part of BA 44 and in the pars triangularis of the inferior frontal gyrus (BA 45). We suggest that a fronto-parietal circuit for manipulation of objects exists in humans and involves basically the same areas as in the monkey. It is proposed that area SII analyses the intrinsic object characteristics whilst the superior parietal lobule is related to kinaesthesia.

A strategy for using tissue water as a concentration standard in 1 H magnetic resonance spectroscopic imaging studies on the brain is presented, and the potential errors that may arise when the method is used are examined. The sensitivity of the method to errors in estimates of the different water compartment relaxation times is shown to be small at short echo times (TEs). Using data from healthy human subjects, it is shown that different image segmentation approaches that are commonly used to account for partial volume effects (SPM2, FSL's FAST, and K-means) lead to different estimates of metabolite levels, particularly in gray matter (GM), owing primarily to variability in the estimates of the cerebrospinal fluid (CSF) fraction. While consistency does not necessarily validate a method, a multispectral segmentation approach using FAST yielded the lowest intersubject variability in the estimates of GM metabolites. The mean GM and white matter (WM) levels of N-acetyl groups (NAc, primarily N-acetylaspartate), choline (Ch), and creatine (Cr) obtained in these subjects using the described method with The unsuppressed "internal" water signal was introduced as a concentration reference for single-voxel proton magnetic resonance spectroscopy ( 1 H-MRS) of the brain over a decade ago (1-4). However, to our knowledge, a detailed description of how this method could be applied to spectroscopic imaging (SI), or an examination of its potential sources of error has yet to be reported. In the majority of SI studies that reported "absolute" metabolite concentrations, the metabolite signals were converted to moles per liter or kilograms of tissue using either external metabolite solutions (5-7) or ventricle water (8,9), and relatively few groups have reported using internal water (10,11). The principal advantage of using internal water in SI studies is that certain factors and potential sources of error that need to be considered when using external concentration references (e.g., RF homogeneity, coil loading, or the SI point spread function (PSF)) are obviated, since the water and metabolite signals come from the same voxel and are acquired in essentially the same way.The major assumptions when using internal water, on the other hand, are that the water densities and signal relaxation times of gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) in the region of interest (ROI) can be reliably estimated and, furthermore, do not change significantly among the studied groups. Moreover, it is essential that the volume fractions of these tissues and CSF in each SI voxel are accurately measured. Measuring partial volume effects is also a requirement when using external referencing methods, but the demand on accuracy is greater when using internal water. This is because only the signal from the combined GM-WM fraction of the total water, in which the detectable metabolites are exclusively located, is used as the concentration reference. The observed water signal, however, arises from a combination of the GM, WM, and CS...

Improved data acquisition and processing strategies for blood oxygenatlon level-dependent (BOlO)-conlrast funcllona1 magnetie resonaneo imaging (fMRI), wllich enhance the functional eontrast-to-nolse ratio (CNR) by sampllng multiple echo limes In a single shot, are descrlbed. The dependence of Ihe CNR on Ti, Ihe image encoding time, and Ihe number of samplod oeho titnes are Investigated for exponentia1 fitting, echo summation, welghled echo summation, and averaglng of corrolalion maps oblainod at different echo limes. The mothod is validated In vlvo using visual stimulation and turbo proton echoplanar speelroseopie imaging (turbo-PEPSI), a new single-shot multi-slice MR spoclroscoplc Imaging teehnlque, whlch acqulres up 10 12 consocutive ochoplanar images wlth echo limes ranging from 1210213 msec. Quantitative Ti-mapplng slgnificanUy increasos Ihe measured extent of aetivatJon and the mean correlalion coefficient compared wilh convenlional echoplanar imaging. The sensltlvity gain with echo summation, wllicll is compulationally efficiet:'lt provides similar sensitivity as fitting. For all data processing methods sensltivlty is optimum wh on echo limes IIp 10 3.2 T 2 are sampled. This molhodology has implications for comparing functional sonsitivity at different magnetie field strengths and between braln regions with different magnetic field inhomogeneitics.

A large body of published work shows that proton (hydrogen 1 [ 1 H]) magnetic resonance (MR) spectroscopy has evolved from a research tool into a clinical neuroimaging modality. Herein, the authors present a summary of brain disorders in which MR spectroscopy has an impact on patient management, together with a critical consideration of common data acquisition and processing procedures. The article documents the impact of 1 H MR spectroscopy in the clinical evaluation of disorders of the central nervous system. The clinical usefulness of 1 H MR spectroscopy has been established for brain neoplasms, neonatal and pediatric disorders (hypoxia-ischemia, inherited metabolic diseases, and traumatic brain injury), demyelinating disorders, and infectious brain lesions. The growing list of disorders for which 1 H MR spectroscopy may contribute to patient management extends to neurodegenerative diseases, epilepsy, and stroke. To facilitate expanded clinical acceptance and standardization of MR spectroscopy methodology, guidelines are provided for data acquisition and analysis, quality assessment, and interpretation. Finally, the authors offer recommendations to expedite the use of robust MR spectroscopy methodology in the clinical setting, including incorporation of technical advances on clinical units.q RSNA, 2014 Online supplemental material is available for this article. G.O. (e-mail: gulin@cmrr.umn.edu). 2 The complete list of authors and affiliations is at the end of this article.q RSNA, 2014 Note: This copy is for your personal non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights. Radiology H MR Spectrum of the Brain: Metabolites and Their Biomarker PotentialMR spectroscopy provides a very different basic "readout" than MR imaging, namely a spectrum rather than an techniques were developed. These early localization techniques included pointresolved spectroscopy (PRESS) (1,2) and stimulated echo acquisition mode (STEAM) (3), methods that are now widely used in clinical MR spectroscopy applications.Preliminary studies revealed large differences in metabolite levels in acute stroke (4), chronic multiple sclerosis (5), and brain tumors compared with healthy brain (6). Although this work stimulated a surge of interest in 1 H MR spectroscopy for diagnosing and assessing CNS disorders during the early days of the "Decade of the Brain" (1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999), many suboptimal patient studies (7) and the lack of consistent guidelines have led to a situation where, 20 years later, MR spectroscopy is still considered an "investigational technique" by some medical professionals and health care organizations. However, the ability to make an early, noninvasive diagnosis or to increase confidence in a suspected diagnosis is highly valued by patients and clinicians alike. As a result, an increasing number of imaging centers are incorporating MR spectroscopy into their clinical protocols for brain...

It has been shown in nonhuman primates that the posterior parietal cortex is involved in coordination of arm and eye movements in space, whereas the anterior intraparietal area in the anterior lateral bank of the intraparietal sulcus plays a crucial role in fine finger movements, such as grasping. In this study we show by optoelectronic movement recordings that patients with cortical lesions involving the anterior lateral bank of the intraparietal sulcus have selective deficits in the coordination of finger movements required for object grasping, whereas reaching is much less disturbed. Patients with parietal lesions sparing the cortex lining the anterior intraparietal sulcus showed intact grasping behavior. Complementary evidence was obtained from functional MRI in normal control subjects showing a specific activation of the anterior lateral bank of the intraparietal sulcus during grasping. In conclusion, this combined lesion and activation study suggests that the anterior lateral bank of the intraparietal sulcus, possibly including the human homologue of the anterior intraparietal area, mediates the processing of sensorimotor integration of precisely tuned finger movements in humans.

We introduce a fast and robust spatial-spectral encoding method, which enables acquisition of high resolution short echo time (

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