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Magnetic resonance (MR) imaging has a key role in the management of many childhood tumours. There is increasing interest in extending these investigations to MR techniques that give information on tumour biology in vivo. Magnetic resonance spectroscopy (MRS) is one such method and it provides information on tissue biochemistry. Promising results have been obtained from many preclinical and clinical studies, leading to an expectation that MRS will play a valuable clinical role. However, the role of MRS is not yet well defined and there is a paucity of data from multi-centre clinical trials. In this article we concentrate on MRS in paediatric oncology and provide some general guidance on current applications and outline areas that need to be developed further.
MRS FUNDAMENTALS, DATA ACQUISITION AND ANALYSIS
Certain atomic nuclei (eg, 1H, 31P and 13C) possess a magnetic moment and when placed in a strong magnetic field will resonate at a particular radiofrequency that subtly depends upon the chemical environment. In MR spectroscopy, the frequencies and intensities of these resonances are measured and represented graphically in an MR spectrum. The most commonly available method clinically is 1H MRS, and the 1H spectrum is a biochemical profile of the small mobile metabolites and macromolecules present in the tissue. 1H MRS can be performed with a standard clinical MRI scanner as part of a conventional MRI investigation. An example 1H spectrum from normal brain is given in figure 1. The horizontal scale, in units of parts per million (ppm), represents signal frequency adjusted to be invariant to the strength of the magnetic field of the MR scanner. Each metabolite is identified by one or more peaks at specific ppm values with the areas under the peaks being proportional to the metabolite concentration. The main metabolites observed are N-acetyl aspartate (NAA), …
Funding: All authors are active members of the Children’s Cancer and Leukaemia Group’s Functional Imaging Group.
Competing interests: The Functional Imaging Group’s meetings have received part funding from MR scanner manufacturers.
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