(1985) Proceedings of the National Academy of Sciences of the United States of America. In vivo solvent-suppressed localized hydrogen nuclear magnetic resonance spectroscopy: a window to metabolism?. Bottomley PA, Edelstein WA, Foster TH, Adams WA. Cammisa M, Scarabino T, Bertolino A, Popolizio T, Salvolini U: Progressi in RM. A review of chemical issues in 1H NMR spectroscopy: N-acetyl-L-aspartate, creatine and choline.
doi:10.1038/nm.2682 - Free text at pubmed - Pubmed citation 2-hydroxyglutarate detection by magnetic resonance spectroscopy in IDH-mutated patients with gliomas. Leigh syndrome: elevated choline, reduced NAA and occasionally elevated lactate.Markedly reduced myo-inositol, and to a lesser degree choline.
In the setting of gliomas, choline will be elevated beyond the margins of contrast enhancement in keeping with cellular infiltration. As the grade increases, NAA and creatine decrease and choline, lipids and lactate increase. MRS can help increase our ability to predict grade.
MR spectra can be acquired from any "NMR-active" nucleus, which is a nucleus possessing non-zero spin: protons, carbon-13 and phosphorus-31 are the most commonly encountered, and in clinical practice essentially only proton spectra (which enable the resolution of metabolite profiles in vivo) are encountered. The technique is identical to that of nuclear magnetic resonance (NMR) as used in analytical chemistry, but the community commonly refers to in vivo NMR as MRS to avoid confusion (and, arguably, the word "nuclear"). This results in slightly different resonant frequencies, which in turn return a slightly different signal. The basic principle that enables MR spectroscopy (MRS) is that the distribution of electrons within an atom cause nuclei in different molecules to experience a slightly different magnetic field.