Water-suppression cycling 3-T cardiac <sup>1</sup> H-MRS detects altered creatine and choline in patients with aortic or mitral stenosis.
Rider, Oliver J
NMR in biomedicine
John Wiley and Sons
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Ding, B., Peterzan, M., Mózes, F. E., Rider, O. J., Valkovič, L., & Rodgers, C. (2021). Water-suppression cycling 3-T cardiac <sup>1</sup> H-MRS detects altered creatine and choline in patients with aortic or mitral stenosis.. NMR in biomedicine, 34 (7), e4513. https://doi.org/10.1002/nbm.4513
Cardiac proton spectroscopy (¹H-MRS) is widely used to quantify lipids. Other metabolites, e.g. creatine and choline, are clinically relevant but more challenging to quantify because of their low concentrations (~10 mmol/L) and because of cardiac motion. To quantify cardiac creatine and choline, we added water-suppression cycling (‘WSC’) to two single voxel spectroscopy sequences (STEAM and PRESS). WSC introduces controlled residual water signals that alternate between positive and negative phase from transient to transient, enabling robust phase and frequency correction. Moreover, a particular weighted sum of transients eliminates residual water signals without baseline distortion. We compared WSC and the vendor’s standard “WET” water-suppression in phantoms. Next, we tested repeatability in 10 volunteers (7 male; 29.3±4.0 years; BMI 23.7±4.1 kg/m2). Fat fraction, creatine concentration and choline concentration when quantified by STEAM-WET were 0.30±0.11%, 29.6±7.0 μmol/g and 7.9±6.7 μmol/g respectively; and when quantified by PRESS-WSC they were 0.30±0.15%, 31.5±3.1 μmol/g and 8.3±4.4 μmol/g respectively. Compared to STEAM-WET, PRESS-WSC gave spectra whose fitting quality expressed by Cramér-Rao bounds improved by 26% for creatine and 32% for choline. Repeatability of metabolite concentration measurements improved by 72% for creatine and 40% for choline. We also compared STEAM-WET and PRESS-WSC in 13 patients with severe symptomatic aortic or mitral stenosis indicated for valve replacement surgery (10 men; 75.9±6.3 years; BMI 27.4±4.3 kg/m2). Spectra were of analysable quality in 8 patients for STEAM-WET, and 9 for PRESS-WSC. We observed comparable lipid concentrations to those in healthy volunteers, significantly reduced creatine concentrations, and a trend towards decreased choline concentrations. We conclude that PRESS-WSC offers improved performance and reproducibility for quantification of cardiac lipids, creatine and choline concentrations in healthy volunteers at 3T. It also offers improved performance compared to STEAM-WET for detecting altered creatine and choline concentrations in patients with valve disease.
BD is currently funded by Gates Cambridge Trust. MAP was supported by a British Heart Foundation Clinical Research Training Fellowship [FS/15/80/31803]. FEM was funded by a UK Medical Research Council Doctoral Training Award (MR/K501256/1), a Scatcherd European Scholarship and the RDM Scholars Programme. OR is supported by a British Heart Foundation Intermediate Fellowship. LV acknowledges support of the Slovak Grant Agencies VEGA [2/0003/20] and APVV [#19-0032]. CTR is funded by a Sir Henry Dale Fellowship from the Wellcome Trust and the Royal Society [098436/Z/12/B]. We acknowledge support from the Oxford NIHR BRC, and the Cambridge NIHR BRC (BRC-1215-20014). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
Wellcome Trust (Unknown)
Wellcome Trust (098436/Z/12/B)
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External DOI: https://doi.org/10.1002/nbm.4513
This record's URL: https://www.repository.cam.ac.uk/handle/1810/318587
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