Brain (1)H-MR spectroscopy in clinical neuroimaging at 3T

After more than 10 years of use, clinical neuroimaging spectroscopy has proven to be invaluable in the MRI assessment of several brain diseases. The metabolic characterization of diverse brain lesions and pathological conditions is well established by spectroscopy studies at 1.5 T, but recently, an increase in the number of 3T magnets has noticeably improved routine neuroimaging in general. For brain proton spectroscopy, the use of higher magnetic fields has been promising in terms of increasing the signal/noise ratio across the spectrum and widening the frequency bandwidth to allow clearer separation of peaks that are otherwise too close to each other at 1.5 T, especially glutamate, glutamine and gamma-aminobutyric acid (GABA). The individual detection and quantification of these metabolites will add more details to the characterization of brain diseases, and allow the inclusion of more brain pathologies. Moreover, the ongoing advances in dedicated hardware and integrated software have led to more accurate and automated postprocessing, offering neuroradiologists a more user-friendly interface. This is an up to date review of the main clinical applications of brain proton MR spectroscopy that are potentially improved at 3T, taking into account the peculiarities of higher magnetic fields. It is based on both the literature and our own clinical experience, starting from July 2005 and including more than 250 scans at 3T (unpublished material), and emphasizes, for every indication, a practical approach to brain MRS to achieve the optimal clinical impact.