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

  • Martinos Center for Biomedical Imaging, Department of Radiology Massachusetts General Hospital, Harvard Medical School Boston Massachusetts
  • Department of Radiology Johns Hopkins University School of Medicine Baltimore Maryland
  • Department of Psychiatry & Robarts Research Institute, University of Western Ontario, London, Ontario, Canada;
  • U.O. Neuroradiologia, Fondazione IRCCS Istituto Neurologico Carlo Besta Milano Italy
  • Department of Radiology, Center for Magnetic Resonance Research University of Minnesota Minneapolis Minnesota
  • Department of Biochemistry University of Cambridge Cambridge England
  • Department of Neurology, Hoglund Brain Imaging Center University of Kansas Medical Center Kansas City Kansas
  • Center for Biomedical Imaging Ecole Polytechnique Federale de Lausanne Lausanne Switzerland
  • School of Health Sciences Purdue University West Lafayette Indiana
  • Department of Radiology Massachusetts General Hospital, Harvard Medical School Boston Massachusetts
  • High Field MR Center, Department of Biomedical imaging and Image‐Guided Therapy Medical University of Vienna Vienna Austria
  • Laboratory for Functional and Metabolic Imaging, Center for Biomedical Imaging Ecole Polytechnique Federale de Lausanne Lausanne Switzerland
  • Fortis Memorial Research Institute Gurugram, Haryana India
  • Department of Radiology and Nuclear Medicine Radboud University Medical Center Nijmegen the Netherlands
  • Max Planck Institute for Biological Cybernetics Tuebingen Germany
  • Department of Radiology University of Pittsburgh Pittsburgh Pennsylvania
  • Department of Pediatrics University of Geneva Geneva Switzerland
  • Stanford Radiological Sciences Lab Stanford California
  • Department of Radiology Mayo Clinic Rochester Minnesota
  • School of Psychological Science University of Bristol Bristol England
  • Department of Obstetrics, University Medical Centre Utrecht, Utrecht, the Netherlands.
  • Departments of Radiology and Biomedical Research University of Bern Bern Switzerland
  • Philips Healthcare Best the Netherlands
  • CRUK Cancer Imaging Centre Institute of Cancer Research and Royal Marsden Hospital London England
  • Center for Clinical Spectroscopy, Brigham and Women’s Hospital Harvard University Medical School Boston Massachusetts
  • Department of Radiology University of Miami Miami Florida
  • DVA Medical Center and Department of Radiology and Biomedical Imaging University of California San Francisco San Francisco California
  • Translational Research Institute Woolloongabba Australia
  • Bangor Imaging Unit, School of Psychology Bangor University Bangor Wales
  • Canon Medical Research USA Mayfield Village Ohio
  • Department of Radiology and Biomedical Imaging University of California San Francisco San Francisco California
  • GE Healthcare Berlin Germany
  • Department of Neurology University of Pittsburgh Pittsburgh Pennsylvania
  • Centre for Preclinical Imaging, Institute of Translational Medicine University of Liverpool Liverpool England
  • Department of Neurology University of New Mexico Albuquerque 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