Neuro protocol

Brain MR Spectroscopy

Brain MR spectroscopy for tumor characterization, assessment of tumor aggressiveness, distinguishing tumor recurrence from radiation necrosis, and detection of biochemical changes. Includes single-voxel (SVS) and chemical shift imaging (CSI) spectroscopy sequences at TE 135 ms, planned off a 3D FLAIR SPACE acquisition.

neurobrainspectroscopyMRStumor characterizationtumor recurrenceradiation necrosissingle voxelCSIFLAIR SPACEwithout contrast

For protocol planning and internal reference only. Follow institutional MRI safety screening, contrast, dosage, and GFR policies.

Decision supportContrast GuidanceDefault contrast approach and conditional indications.

No routine contrast guidance listed for this noncontrast protocol.

Acquisition listSequencesRequired and conditional series for the exam.

Sequence	Plane	Phase	Required	Notes
Localizer	Any	noncontrast	Yes	-
Sagittal T2 FLAIR SPACE 3D	sagittal	noncontrast	Yes	Slice thickness 1.2 mm. Cover the entire brain from left to right and from the top of the brain through C2. Align parallel with the longitudinal fissure. Midline slice through the aqueduct.
SVS_SE_135 (lesion)	axial	noncontrast	Yes	Single voxel spectroscopy, TE 135 ms. Place voxel on the lesion in all three planes. Decrease voxel size to fit the mass; do not reduce below 10 mm. Avoid sulci and skull.
SVS_SE_135 (contralateral reference)	axial	noncontrast	Yes	Single voxel spectroscopy, TE 135 ms. Place voxel on the contralateral side of the brain as a reference. Repeat for each mass if multiple lesions are present.
CSI_SE_135	axial	noncontrast	Yes	Chemical shift imaging, TE 135 ms. The mass must be entirely inside a single voxel within the white square marker in all three planes.
Axial T2 HASTE	axial	noncontrast	Conditional	Optional fast localizer if better planning views are needed.
Coronal T2 HASTE	coronal	noncontrast	Conditional	Optional fast localizer if better planning views are needed.
Sagittal T2 HASTE	sagittal	noncontrast	Conditional	Optional fast localizer if better planning views are needed.
Axial 3D T1 +C	axial	postcontrast	Conditional	Acquire only when unable to plan adequately from the Sagittal FLAIR SPACE 3D.

PositioningSlice PlanningPlane-specific planning instructions and guide images for technologists.

sagittal

Sagittal FLAIR SPACE 3D planning

Cover the entire brain from left to right and from the top of the brain through C2.
Align parallel with the longitudinal fissure.
Ensure the midline slice passes through the aqueduct.
After acquisition, reformat the 3D volume in coronal and axial planes for spectroscopy voxel positioning.

SVS voxel placement

Plan voxel placement using the reformatted coronal and axial views from the FLAIR SPACE 3D.
Place the SVS voxel on the lesion in all three planes.
Decrease voxel size to fit the mass; minimum voxel size is 10 mm.
Avoid sulci and skull.
Place a second SVS voxel on the contralateral side as a reference.
If multiple masses are present, acquire additional SVS series for each mass.

CSI voxel placement

The mass must be positioned entirely inside a single voxel within the white square marker in all three planes.

Anatomic extentCoverage RulesMinimum coverage expectations and alignment rules.

sagittal

FLAIR SPACE 3D field of view

Cover the entire brain from left to right and from the top of the brain through C2.

TechniqueSuggested Technique SpecificationsPlane-level vendor-neutral guidance from the source protocol.

sagittal

slice thickness flair space: 1.2 mm

Conditional workflowSpecial SituationsAdjustments for contrast, hardware, and protocol-specific conditions.

Unable to plan from Sagittal FLAIR SPACE 3D

Acquire optional Axial T2 HASTE, Coronal T2 HASTE, and Sagittal T2 HASTE for additional planning views.
Alternatively, acquire Axial 3D T1 postcontrast for planning if the lesion is enhancing.

Multiple brain masses

Acquire additional SVS_SE_135 series for each mass.

Future detailAdvancedSource-backed scanner, vendor, and site-specific notes when available.

Scanner variant

Siemens spectroscopy post-processing

Siemens

From the browser, select the spectroscopy series and click the table icon.
Go to the Application tab and select Spectroscopy.
Select the bottom-right square to add Lac (lactate): click Add, select Lac from the list, click Select, click Ok, click Apply, then close.
In the Patient tab, select Save Data.
Select 'Result' and 3 reference images. Right-click on the table, select Result table, click Ok.
In the Patient tab, select Save Data, click Ok.
Repeat for all 135 series.
Select the correct single voxel before running interactive post-processing (place the blue box on the area of interest).