Proton Magnetic Resonance Spectroscopy for Pediatric Neuroimaging: Key Concepts for Practice

Magnetic resonance spectroscopy (MRS) of the brain provides the clinician an in vivo neurochemical assessment within the clinical magnetic resonance imaging setting. This information can yield specificity when addressing questions pertaining to brain health and metabolism while characterizing disease and injury, evaluating treatment response, and prognosticating outcome. Proton MRS techniques can be useful in narrowing the diagnostic differential and capturing time-sensitive information for the continually developing pediatric brain. This paper provides a review of key proton MRS topics relevant for usage in pediatric populations. We discuss magnetic field strength, pediatric-sized head coils, water suppression techniques, localization pulse sequences, post-processing methods, analysis, and interpretation. These elements all require special consideration, particularly for the immature brain. We introduce the fundamentals of spectral editing. Finally, we present illustrative examples employing proton MRS in clinical practice to begin to synthesize these concepts into practical application.