Repeatability of multinuclear interleaved acquisitions with nuclear Overhauser enhancement effect in dynamic experiments in the calf muscle at 3T

Purpose: To evaluate the repeatability of multinuclear interleaved H-1/P-31 NMR dynamic acquisitions in skeletal muscle and the impact of nuclear Overhauser enhancement (nOe) on the P-31 results at 3T in exercise-recovery and ischemiahyperemia paradigms. Methods: A H-1/P-31 interleaved pulse sequence was used to measure every 2.5 s a perfusion-weighted image, a T-2* map, a P-31 spectrum and 32 H-1 spectra sensitive to deoxymyoglobin. 21 subjects performed a plantar flexion exercise and after recovery underwent an 8-min lower leg ischemia. The procedure was repeated in visit 2 with 12 subjects. An additional exercise bout without H-1 excitation was appended to visit 1. Individual H-1 RF pulse nOe was measured at rest in every visit. Results: Repeatability scores (coefficient of variation, Bland-Altman analysis) were similar to those found in the literature using similar mono-nuclear acquisitions. |Pi]/ [PCr], pH drop, creatine rephosphorylation rate (tPCr), maximum perfusion, time to peak perfusion, and blood flow post-exercise showed high reliability (intraclass correlation coefficient > 0.7), whereas hemodynamic results from reactive hyperemia showed higher repeatability. After accounting for nOe, which increased Pi and PCr signal-to-noise ratio by 30%, no differences in P-31 results were observed between interleaved and P-31 MRS-only acquisitions. tPCr was unaffected by nOe. Conclusion: The method shows good repeatability for both paradigms while simultaneously providing multiple dynamic data sets on a clinical scanner. The nOe effects were accounted for on a per-subject and per-visit basis using a short P-31 reference scan. This multiparametric approach has a multitude of applications for the study of oxygen utilization and ATP turnover in the muscle.