Quantitative magnetic resonance spectroscopy in the entire human cervical spinal cord and beyond at 3T

Quantitative magnetic resonance spectroscopy (MRS) amends differential diagnostics of neurological pathology. However, due to technical challenges, it has rarely been applied to the spinal cord and has mainly been restricted to the very upper part of the cervical spine. In this work, an improved acquisition protocol is proposed that takes technical problems as strong magnetic field inhomogeneities, pulsatile flow of the cerebrospinal fluid (CSF), and small voxel size into account. For that purpose, inner-volume saturated point-resolved spectroscopy sequence (PRESS) localization, ECG triggering, and localized higher-order shimming and F-0 determination, based on high-resolution cardiac-triggered static magnetic field B-0 mapping, are combined. For inner-volume saturation a highly selective T-1- and B-1-insensitive outer-volume suppression (OVS) sequence based on broadband RF pulses with polynomial-phase response (PPR) is used. Validation is performed in healthy volunteers and patients with multiple sclerosis and intramedullary tumors. The applicability of spinal cord MRS is extended to the entire cervical spine. Spectral quality and its consistency are improved. In addition, high quality MRS patient data from a lesion that occluded the spinal canal in the thoracic spinal cord could be acquired. A quantitative analysis of patient spectra and spectra from healthy volunteers at different positions along the spinal cord underlines the diagnostic value of spinal cord MRS.