Chapter 5.1 – Single Voxel MR Spectroscopy in the Spinal Cord: Technical Challenges and Clinical Applications

MR spectroscopy is an extremely valuable tool for assessing tissue biochemistry in vivo. Its use in the spinal cord presents several technical challenges due to geometrical, anatomical, and physiological constraints that have restricted its clinical application. With references to the limited literature available, issues relating to coil selection, patient immobilization, sequence choice, and placement of voxels of interest for single-voxel MRS studies in the spinal cord are discussed here. The importance of a reliable shimming routine is underlined, as well as cardiac gating. The selection of acquisition parameters is examined and postprocessing techniques are reviewed. Methods providing a quantitative estimation of metabolite concentrations are presented and potential pitfalls in interpretation discussed. Finally, suggestions are given to implement a robust protocol for single-voxel MRS in the cervical spinal cord.