Page 47 - GTM-2-3

Global Translational Medicine Deep learning by NMR-biochemical

the potential to design treatment for FRAX and subtypes (MSA-C) and spinocerebellar ataxia type 2
other genetic disorders based on neurometabolite (SCA2) with no difference from normal controls. The
intervention for treatment efficacy. cerebellar lactate peak in SCA-2 patients was distinct
v. Proton endorectal MRI with H-MRSI of prostate due to cerebellar degeneration, while no Lac peak was
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cancer lesions showed a high Gleason score toward evident in MSA-C or control subjects .
[75]
an increased (Cho+Cr)/Cit ratio and large tumor viii. The 3T MRI with H-MRSI measured the increased
1
volume. For detecting prostate cancer, proton-MRS- Cho, Lac, and NAA/tCr ratio and decreased NAA and
visible Cit peak and citrate concentration in semen choline/NAA ratio at peritumoral tissues in GBM to
or prostatic secretions showed better results over assess the post-resection response in the contralateral
[71]
prostate-specific antigen testing . The 3D chemical- brain at 3 – 5 weeks of post‑Gliadel therapy and
shift imaging (CSI) spin-echo sequence with MRS of surgery plan before radiation therapy . The H-MRSI
1
[76]
biopsy from proven prostate carcinoma was used for localizes different regions showing heterogeneous
DL, along with tumor volume and voxels per slice responses after being given Gliadel treatment. The
counts. The MRS differentiated marginally T2 and author suggests that MRS metabolic indicators can
T3 tumor stages. MRI with MRS slightly improved monitor pre-surgery and postsurgery resection after
the tumor staging with no advantage in diagnosis and Gliadel implantation to assess the tumor regression
tumor staging over MRI alone . and gauze the chemotherapy efficacy.
[72]
vi. MRS is a technique for diagnosis and monitoring ix. Clinical MRS in MS showed metabolic changes at
cancer of the prostate, colon, breast, cervix, pancreas, MS lesion sites, and multi-centered clinical trials
and esophagus organs. The 3D MRS has emerged of MS incorporated MRS into their MRI imaging
as a new and sensitive tool in metabolic evaluation, diffusion tensor DTI protocols to quantify the
specifically for assessing the loss of Cit and elevated effect of therapeutic intervention on MS tissue
ratio of Cho/Cit of prostate cancer . American damage [77,78] .
[73]
College of Radiology Imaging Network (ACRIN) x. Biomarkers of disc degeneration and discogenic back
considers MRSI a routine diagnostic technique. MRS pain are not available. In frozen discectomy disc samples,
has high diagnostic accuracy. However, randomized quantitative ex vivo H HRMAS MRS measured low
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controlled large-scale trial studies are needed . proteoglycan/collagen and proteoglycan/lactate
[73]
vii. Mucopolysaccharidosis (MPS) patients show a ratios and high lactate/collagen ratio as biochemical
poor correlation between enzyme levels, urine markers associated with discogenic back pain versus
mucopolysaccharides (GAG), and neuroimaging scoliosis conditions. Several MRS-visible metabolites,
findings. The semi-automated and automated such as proteoglycan, collagen, and lactate, may serve
segmentation techniques analyzed the T2-FLAIR as metabolic markers of disc degeneration-associated
brain images for several MRI variables of normalized back pain .
[79]
cerebral volume (NCV), normalized cerebrospinal xi. MRS-visible biomarkers distinguished the painful discs
fluid volume (NCSFV), normalized ventricular (PD) and quantified the severity of disc degeneration
volume (NVV), and normalized lesion load (NLL). to predict the surgical outcomes in chronic low back
The point-resolved MRS annotation positioned at pain (CLBP) patients. MRS showed disc proteins
white and gray matter showed a positive correlation to (proteoglycan and collagen) and acidic metabolites
age, enzyme levels, urinary GAG, and neuroimaging. (lactate, alanine, propionate) as pain MRS biomarkers
However, metabolite ratios by MRS, MRI-visible NCV, in CLBP versus PD Pfirrmann grade or ratios of acidity
NCSFV, NVV, and enzyme activity or GAG levels metabolites to proteins. MRS correlation with PD may
were poorly correlated to disease duration or the age improve surgical outcomes in CLBP patients. In vivo
of patients. Patients with MPS II showed aggressive MRS may define mechanisms of pain metabolites to
white matter lesion increases that remain non-visible design therapies [80,81] . The author believes that MRS-
by MRI and MRS findings, which neither correlated to derived pain analysis is the first-line method.
enzymatic nor glycosaminoglycan levels . The MRI xii. American College of Radiology (ACR) Guidelines on
[74]
protocol of a sagittal T1-weighted 3D fast low-angle bone tumor musculoskeletal imaging indicate that
shot (3D FLASH) sequence and transverse T2- and MRS may differentiate benign and malignant lesions.
spin-density-weighted turbo spin-echo sequences Still, more efforts are needed .
[82]
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with H-MR 2D CSI sequence at short and long xiii. With ultrahigh MRS availability and access, MRS is a
echo time (TE) MRSI images showed low Cho/Cr, clinical tool in the oncologic management of patients .
[83]
NAA/Cr ratios in multiple system atrophy-cerebellar MRS is still an experimental investigation tool in

Volume 2 Issue 3 (2023) 15 https://doi.org/10.36922/gtm.337