Assessment of Glucose Metabolism In Vivo in the Human Frontal Lobe Using Interleaved 1H and 13C MRS at 7T: Toward Clinical Translation

Background Mitochondrial dysfunction and abnormal cerebral energy metabolism are implicated in many neuropsychiatric and neurodegenerative disorders. 13C magnetic resonance spectroscopy (MRS), combined with 13C-labeled substrate infusion, offers a non-ionizing, minimally invasive method for assessing fluxes through the main cerebral energy metabolism pathways. However, its human application at 7 T has not been fully established, especially within the frontal lobe. Purpose To explore a clinically translatable interleaved 1H/13C MRS protocol for quantification of cerebral glucose uptake and downstream metabolism at 7 T, and to estimate the tricarboxylic acid (TCA) cycle flux (VTCA) for validation. Study Type Prospective. Population Three young healthy volunteers. Field Strength/Sequence 7T; ACE-STEAM (indirect 1H-[13C]) and ISIS-DEPT (direct 13C-[1H]). Assessment ACE-STEAM and ISIS-DEPT were applied to acquire the time-resolved spectra in the frontal lobe. 13C-labeled glucose, glutamate, and glutamine fractional enrichment time courses were quantified to estimate VTCA through the one-compartment model. Statistical Tests The relative estimated fitting uncertainties (EFUs) were reported for the processed spectra. Nonlinear least squares minimization was used for flux fitting of 13C traces. Uncertainty of the estimated metabolic fluxes was evaluated using Monte-Carlo simulations. Results [1-13C]-glucose (GlcC1) was detected immediately on 13C MR spectra, followed by 13C-labeled GluH4 and GlnH4 and then GlxH3 can be quantified on 1H MR spectra. End-of-infusion mean enrichments were 17% (GluH4), 13% (GlnH4), and 7% (GlxH3). Brain glucose concentration ranged 1.86-2.94 mM, with 61% of the mean enrichment in C1. Group-average VTCA was 0.66 {+/-} 0.07 mol/g/min. Data Conclusion This interleaved 1H/13C MRS protocol enables minimally invasive quantification of cerebral metabolic fluxes, may provide a useful framework for investigating neuropsychiatric and neurodegenerative diseases at 7 T. Evidence Level 1. Technical Efficacy Stage 1.