Accuracy and clinical utility of quantitative proton magnetic resonance spectroscopy (MRS) on phantom and chronic cerebral ischemia

We quantified the concentration of metabolites observed by proton MRS using the tissue water signal as an internal standard. A phantom containing known concentrations of NAA (10 mM) and Cr (5 mM) was used for the study of methodological accuracy. Clinical utility was evaluated by the measurement of patients with severe stenosis or obstruction of the unilateral internal carotid artery. The concentration of tissue water was compensated using a proton-density weighted image measured with a water bag attached to the head. The calculated concentrations of NAA and Cr in the phantom were 9.2 mM (SD: 1.2) and 5.6 mM (SD: 0.7), respectively. On the ischemic side of the brain, the concentrations of NAA and Cr were lower than on the opposite side, but the concentration of choline (Cho) was almost the same on the two sides. The NAA/Cr ratio showed no statistically significant differences between the two sides, because the concentration of Cr was shown to be decreased in the ischemic area. We consider that quantitative evaluation of proton MRS might reveal changes in single metabolites clearly, thereby facilitating understanding of the results of proton MRS. (author)