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Magnetic Resonance Spectroscopy (MRS) Explained

Magnetic resonance spectroscopy (MRS) is a non-invasive diagnostic method that analyzes the chemical composition of body tissues, revealing metabolic changes without surgery or radiation.

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Things worth knowing about "Magnetic resonance spectroscopy"

Magnetic resonance spectroscopy (MRS) is a non-invasive diagnostic method that analyzes the chemical composition of body tissues, revealing metabolic changes without surgery or radiation.

What is Magnetic Resonance Spectroscopy?

Magnetic resonance spectroscopy (MRS) is a non-invasive diagnostic technique based on the same physical principles as magnetic resonance imaging (MRI). While conventional MRI produces detailed images of anatomical structures, MRS goes a step further by providing information about the biochemical composition of tissues. It allows clinicians to measure metabolites and chemical compounds within a specific region of the body without any surgical procedure.

How It Works

MRS exploits the phenomenon of nuclear magnetic resonance (NMR). Certain atomic nuclei – most commonly hydrogen nuclei (¹H), but also phosphorus (³¹P) and carbon (¹³C) – align themselves within a strong magnetic field. When excited by a radiofrequency pulse, these nuclei emit signals as they return to their resting state. The chemical shift of these signals, measured in ppm (parts per million), is unique to each chemical compound, enabling its identification and quantification.

Key Metabolites in Proton MRS

N-Acetylaspartate (NAA): Marker of neuronal integrity and density
Choline (Cho): Indicator of cell membrane turnover and cell proliferation
Creatine (Cr): Marker of energy metabolism, often used as an internal reference
Lactate: Sign of anaerobic metabolism, e.g., in tumors or ischemia
Glutamate and Glutamine: Neurotransmitter metabolism
Myoinositol: Marker of glial cell activity and osmotic regulation

Clinical Applications

MRS is used across a wide range of medical specialties:

Neurology and Neuroradiology

The most common application is in the brain. MRS assists in the diagnosis and monitoring of:

Brain tumors (e.g., distinguishing glioma from metastasis)
Dementia (e.g., reduced NAA in Alzheimer disease)
Multiple sclerosis
Epilepsy
Stroke and ischemic lesions
Hepatic encephalopathy

Oncology

In cancer diagnostics, MRS enables the characterization of tumors, particularly in the prostate (elevated choline, reduced citrate) and the breast. It can help differentiate benign from malignant lesions, supporting clinical decision-making.

Metabolic Disorders

In inherited metabolic diseases such as phenylketonuria, MRS can detect characteristic metabolite patterns that support diagnosis and monitoring of treatment response.

Muscle and Liver Disease

Phosphorus MRS (³¹P-MRS) is used to evaluate energy metabolism in muscle tissue and to quantify liver fat content in conditions such as hepatic steatosis.

How the Examination Is Performed

MRS is performed on a standard MRI scanner, typically with a field strength of 1.5 Tesla or 3 Tesla. Higher field strengths improve the signal-to-noise ratio and enable better spectral resolution. Two main acquisition methods are used:

Single-voxel spectroscopy (SVS): Measurement from a single, defined tissue volume (voxel)
Chemical shift imaging (CSI) / multivoxel spectroscopy: Simultaneous acquisition from multiple voxels across a larger region

The examination is painless and radiation-free for the patient. It generally takes longer than a standard MRI scan. Contraindications are the same as for MRI (e.g., cardiac pacemakers, metallic implants).

Interpretation of Results

Analysis of MRS data requires specialized expertise. Results are presented as a spectrum, in which the signal intensities of individual metabolites are plotted against their chemical shift (in ppm). Changes in metabolite ratios – for example, an elevated choline-to-NAA ratio in brain tumors – provide important diagnostic information that complements conventional MRI findings.

Advantages and Limitations

Advantages

Non-invasive and radiation-free
Provides functional and biochemical information not accessible by other imaging methods
Can be combined with standard MRI examinations in a single session

Limitations

Relatively low spatial resolution compared to MRI
Susceptible to motion artifacts and magnetic field inhomogeneities
Interpretation requires specialized training and expertise
Longer examination times
Not available in all radiology departments

References

Castillo M., Kwock L., Mukherji S.K. - Clinical applications of proton MR spectroscopy. American Journal of Neuroradiology, 1996.
Ross B., Michaelis T. - Clinical applications of magnetic resonance spectroscopy. Magnetic Resonance Quarterly, 1994.
Oz G. et al. - Clinical proton MR spectroscopy in central nervous system disorders. Radiology, 2014.

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