Making the 'virtual biopsy' a reality with MR spectroscopy
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Making the 'virtual biopsy' a reality with MR spectroscopy

December 04, 2018
MRI
From the November 2018 issue of HealthCare Business News magazine

Neurological diseases affect as many as one billion people worldwide and are a major cause of disability and human suffering. Diagnosis is often complex and the time window for effective therapy may be limited.

MR imaging, with its excellent soft-tissue contrast, is commonly the modality of choice for the detection of brain lesions. The morphological details and the sensitivity to changes in content and physical properties of water are exquisite. However, conventional MR is not able to detect changes in cell density, cell type, or biochemical composition, all of which can be investigated by MR spectroscopy.

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Furthermore, lesions of different underlying pathophysiology often present with similar MR appearance. Accordingly, MR and MR spectroscopy are complementary tools for diagnosis and monitoring of disease progression and response to therapy.

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 examinations in selected patients. Over 60,000 papers have been published that utilize MR spectroscopy in human studies, of which studies in the brain are over 20,000.

These studies cover a large range of neurological disorders including brain tumors, cerebral abscesses, seizures, Alzheimer’s disease, metabolic disorders, brain injury, multiple sclerosis, chronic pain, neurotoxicity, hypoxia, neuropsychiatric diseases such as schizophrenia, depression, and bipolar disorder, and even early diagnosis of liver disease.

The noninvasive and quantitative nature of MR spectroscopy renders it an excellent endpoint for drug clinical trials. In longitudinal studies, the exams can be repeated often with no consequence to the patient or the clinical target, unlike biopsy or other invasive measures.

As a direct or surrogate biomarker, MR spectroscopy provides greater sensitivity when measuring the effects of medications that can be readily compared and correlated to other clinical measures. Four hundred eighty-eight registered studies were found on ClinicalTrials.gov that utilize MR spectroscopy as part of the study description or intervention.

MR spectroscopy is available across every major MR scanner vendor including GE Healthcare, Siemens Healthineers, Philips, Canon (formerly Toshiba), and Hitachi. While hard numbers are not available, an examination of the MR systems at BWH shows that 90 percent of them have MR spectroscopy capability. Similarly, nearly every major academic medical center has research staff involved in MR spectroscopy.

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