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Global Translational Medicine Deep learning by NMR-biochemical

hypomyelination and congenital cataract (high glucose other diseases affecting the brain. MRS also examines
peak, low valine, lysine, and tyrosine peaks), Krabbe disease the metabolism of other human organs. The role of MRS
(globoid cell leukodystrophy) (low NAA peak), X-linked in medical diagnosis and therapeutic planning is not yet
adrenoleukodystrophy (X-ALD) and cerebral X-linked established for clinical trials or clinical practice. Now,
adrenoleukodystrophy (cALD) (low NAA/Cr and Glx/Cr, advanced techniques of high-resolution MRI and MRSI
high MI/Cr and Cho/Cr ratio), mitochondrial disorders favor routine clinical practice with the following evidence
(Kearns‑Sayre syndrome, Leigh’s syndrome, mitochondrial in the literature. Still, MRI with MRSI use remains
encephalomyopathy, lactic acidosis, and stroke-like inconclusive as per new guidelines.
episodes [MELAS]) (low Cr peak), Alexander disease i. At Massachusetts, Tuft’s Agency on Healthcare
(ALX, AxD, and demyelinogenic leukodystrophy) (elevated Research and Quality (AHRQ) indicated concern
Glx/tCr ratios), megalencephalic leukoencephalopathy about diagnostic thinking and therapeutic decision-
with subcortical cysts (low NAA, low Cr peaks), wasted making in light of the paucity of high-quality evidence.
white matter disease (leukoencephalopathy childhood Still, MRS spectra interpretation is not standardized.
ataxia with central hypomyelination [CACH]/vanishing MRS technical feasibility, study plan flaws of
white matter [VWM] syndrome) (low NAA peak), and inadequate sample size, retrospective design, and
neuroborreliosis (low NAA peak, high mI/Cr, Lipid/Cr and other limitations bias the results and decision-making.
Cho/Cr ratios, and normal NAA/Cr and Lac/Cr ratios). A review of MRS of brain tumors by Blue Cross Blue
While MRI findings are inconclusive in deciding the Shield Association Technology Evaluation Center
change in treatment, MRS becomes mandatory in disease (2003) indicated that weak evidence is insufficient to
[67]
monitoring and evaluation by MRS-based spectromics draw conclusions on MRSI use on health outcomes .
in the following diseases: (i) cancers of breast, prostate, Centers for Medicare and Medicaid Services (CMS)
colon, esophagus, liver, brain, and bone tissues; (ii) coma has concluded that there is insufficient support to
and cerebrovascular diseases/injuries and disorders; deem MRS reasonable and necessary for diagnosing
(iii) cognitive disorders, movement disorders, and brain lesions. As a result, CMS maintained its decision
dementia (frontotemporal dementia, vascular dementia, of the non-coverage of MRS-based diagnosis of brain
[67]
Alzheimer’s disease with Lewy bodies, motor neuron lesions on the national scale .
disease, Huntington’s disease (HD), motor neuron disease, ii. Patients with neuroborreliosis disease showed non-
and Parkinson’s disease/Parkinsonian syndromes); specific MRS changes in assessing central nervous
1
(iv) psychiatric disorders (autism disorder, attention-deficit/ system tissue damage. In H-MRS, a point-resolved
hyperactivity disorder, bipolar disorder, schizophrenia, spectroscopic sequence (PRESS) was used by placing
3
emotional dysregulation, depression, and obsessive- an 8 cm voxel box on the NAWM region of the frontal
[68]
compulsive disorder); (v) MS; (vi) dermatomyositis; lobe .
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(vii) hepatic steatosis in liver donor survivors; (viii) central iii. The H-MRS was described for epilepsy surgery as
nervous system with autoimmune rheumatic diseases; a research tool with a correlation of ipsilateral MRS
(ix) esophagus squamous cell carcinoma; (x) mesial abnormality as a good outcome. However, prospective
temporal sclerosis; (xi) primary central nervous system studies on both localized and non-localized ictal
(CNS) lymphoma lesions; (xii) epilepsy juvenile myoclonic scalp electroencephalopathy in MRI-negative patients
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epilepsy, mesial lobe epilepsy, and temporal lobe need validation. Furthermore, H-MRS is an adjunct
epilepsy; (xiii) hepatic encephalopathy; (xiv) migraine to MRI characterization of brain tumors to convince
[69]
pathophysiology; (xv) head trauma; (xvi) low back policymakers .
pain; (xvii) hepatic carcinoma; (xviii) liver cirrhosis; iv. Male fragile X syndrome (FRAX) patients are at
(xix) Lyme neuroborreliosis; (xx) mucopolysaccharidosis; risk of significant cognitive and behavioral deficits,
(xxi) radiation encephalopathy; (xxii) polymyositis; specifically those that impact executive prefrontal
(xxiii) sport injuries; (xxiv) substance abuse disorders; and systems. The cholinergic system damage secondary
(xxv) brain trauma injury. to FRAX mental retardation shows protein deficiency
and contributes to cognitive behavior impairments.
All these diseases need evidence of MRS metabolite The H-MRS showed a low choline/Cr ratio in the right
1
specificity and accuracy, as reported in recent years and dorsolateral prefrontal cortex in male FRAX versus
summarized below. controls, with a negative correlation to intelligence
Now, MRS is an established as non-invasive analytical and age in the left cortex. The donepezil improved
technique to study metabolite changes in depression, cognitive-behavioral function . The author believes
[70]
Alzheimer’s disease, stroke, seizures, brain tumors, and that biochemical-MRI neuroimaging approach has

Volume 2 Issue 3 (2023) 14 https://doi.org/10.36922/gtm.337