Methodological consensus on clinical proton MRS of the brain: review and recommendations

Research output: Contribution to journalReview articlepeer-review


  • Ovidiu Andronesi
  • Peter B. Barker
  • Robert Bartha
  • Alberto Bizzi
  • Patrick J. Bolan
  • Kevin M. Brindle
  • In‐young Choi
  • Cristina Cudalbu
  • Ulrike Dydak
  • Uzay E. Emir
  • Ramon G. Gonzalez
  • Stephan Gruber
  • Rolf Gruetter
  • Rakesh K. Gupta
  • Arend Heerschap
  • Anke Henning
  • Hoby P. Hetherington
  • Petra S. Huppi
  • Ralph E. Hurd
  • Kejal Kantarci
  • Risto A Kauppinen
  • Dennis W. J. Klomp
  • Roland Kreis
  • Marijn J. Kruiskamp
  • Martin O. Leach
  • Alexander P. Lin
  • Peter R. Luijten
  • Małgorzata Marjańska
  • Andrew A. Maudsley
  • Dieter J. Meyerhoff
  • Carolyn E. Mountford
  • Paul G. Mullins
  • James B. Murdoch
  • Sarah J. Nelson
  • Ralph Noeske
  • Gülin Öz
  • Julie W. Pan
  • Harish Poptani
  • Stefan Posse
  • Eva‐maria Ratai
  • Nouha Salibi
  • Tom W. J. Scheenen
  • Ian C. P. Smith
  • Brian J. Soher
  • Ivan Tkáč
  • Daniel B. Vigneron
  • Franklyn A. Howe

External organisations

  • Harvard Medical School
  • University of Maryland, Baltimore
  • University of Western Ontario
  • Istituto Neurologico Carlo Besta
  • University of Minnesota
  • University of Cambridge
  • University of Kansas
  • Ecole Polytechnique Federale de Lausanne
  • School of Health Sciences Purdue University West Lafayette Indiana
  • University of Vienna
  • Fortis Memorial Research Institute Gurugram, Haryana India
  • Radboud University
  • Max Planck Institute for Biological Cybernetics Tuebingen Germany
  • University of Pittsburgh
  • University of Geneva
  • Stanford Radiological Sciences Lab Stanford California
  • Mayo Clinic
  • University of Bristol
  • University Medical Center Utrecht
  • University of Bern
  • Philips Healthcare Best the Netherlands
  • CRUK Cancer Imaging Centre Institute of Cancer Research and Royal Marsden Hospital London England
  • University of Miami
  • University of California, San Francisco
  • Translational Research Institute Woolloongabba Australia
  • Bangor University
  • Canon Medical Research USA Mayfield Village Ohio
  • GE Healthcare Berlin Germany
  • University of Liverpool
  • University of New Mexico
  • MR R&D, Siemens Healthineers Malvern Pennsylvania
  • Innovative Biodiagnostics Winnipeg Canada
  • Department of Radiology Duke University Medical Center Durham North Carolina
  • Molecular and Clinical Sciences St George’s University of London London England


Proton MRS (1H MRS) provides noninvasive, quantitative metabolite profiles of tissue and has been shown to aid the clinical management of several brain diseases. Although most modern clinical MR scanners support MRS capabilities, routine use is largely restricted to specialized centers with good access to MR research support. Widespread adoption has been slow for several reasons, and technical challenges toward obtaining reliable good-quality results have been identified as a contributing factor. Considerable progress has been made by the research community to address many of these challenges, and in this paper a consensus is presented on deficiencies in widely available MRS methodology and validated improvements that are currently in routine use at several clinical research institutions. In particular, the localization error for the PRESS localization sequence was found to be unacceptably high at 3 T, and use of the semi-adiabatic localization by adiabatic selective refocusing sequence is a recommended solution. Incorporation of simulated metabolite basis sets into analysis routines is recommended for reliably capturing the full spectral detail available from short TE acquisitions. In addition, the importance of achieving a highly homogenous static magnetic field (B0) in the acquisition region is emphasized, and the limitations of current methods and hardware are discussed. Most recommendations require only software improvements, greatly enhancing the capabilities of clinical MRS on existing hardware. Implementation of these recommendations should strengthen current clinical applications and advance progress toward developing and validating new MRS biomarkers for clinical use.

Bibliographic note

© 2019 International Society for Magnetic Resonance in Medicine.


Original languageEnglish
Pages (from-to)527-550
Number of pages24
JournalMagnetic Resonance in Medicine
Issue number2
Early online date28 Mar 2019
Publication statusPublished - Aug 2019


  • MRS, brain, consensus, metabolites, semi-LASER, shimming