Metabolite ratios to assumed stable creatine level may confound the quantification of proton brain MR spectroscopy

Belinda S.Y. Li, Hao Wang, Oded Gonen

Research output: Contribution to journalArticlepeer-review

115 Scopus citations


In localized brain proton MR spectroscopy (1H-MRS), metabolites' levels are often expressed as ratios, rather than as absolute concentrations. Frequently, their denominator is the creatine [Cr], which level is explicitly assumed to be stable in normal as well as in many pathologic states. The rationale is that ratios self-correct for imager and localization method differences, gain instabilities, regional susceptibility variations and partial volume effects. The implicit assumption is that these benefits are worth their costw-w propagation of the individual variation of each of the ratio's components. To test this hypothesis, absolute levels of N-acetylaspartate [NAA], choline [Cho] and [Cr] were quantified in various regions of the brains of 8 volunteers, using 3-dimensional (3D) 1H-MRS at 1.5 T. The results show that in over 50% of ∼2000 voxels examined, [NAA]/[Cr] and [Cho]/[Cr] exhibited higher coefficients of variations (CV) than [NAA] and [Cho] individually. Furthermore, in ∼33% of these voxels, the ratios' CVs exceeded even the combined constituents' CVs. Consequently, basing metabolite quantification on ratios and assuming stable [Cr] introduces more variability into 1H-MRS than it prevents. Therefore, its cost exceeds the benefit.

Original languageEnglish (US)
Pages (from-to)923-928
Number of pages6
JournalMagnetic Resonance Imaging
Issue number8
StatePublished - Oct 2003
Externally publishedYes

ASJC Scopus subject areas

  • Biophysics
  • Biomedical Engineering
  • Radiology Nuclear Medicine and imaging


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