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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Relic of the Past or Clinical Compass? Re-Evaluating the Diagnostic Utility of Proton Magnetic Resonance Spectroscopy (1H-MRS) in Encephalitis and Infectious CNS Diseases

  • Maciej Naumowicz1
  • Radosław Zawadzki1
  • Joanna Zajkowska2
  • Bożena Kubas1
  1. 1Department of Radiology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland
  2. 2Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, Zurawia 14, 15-540 Białystok, Poland
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Abstract

Neuroimaging of inflammatory and infectious CNS diseases using conventional MRI has limitations, such as the challenging differential diagnosis of visible lesions, as well as the absence of neuroimaging abnormalities despite severe symptoms. The aim of this review is to evaluate the diagnostic utility of proton magnetic resonance spectroscopy (1H-MRS) as a complementary method in inflammatory conditions and CNS infections of viral, bacterial, autoimmune, parasitic, or fungal etiology. We searched the PubMed, Web of Science, and Scopus databases, including studies and case reports evaluating 1H-MRS across age groups in the acute, subacute, and chronic phases of CNS disorders. The review demonstrates that MRS can serve as a valuable, non-invasive method capable of revealing metabolic abnormalities within normal-appearing brain tissue on conventional MRI. Furthermore, 1H-MRS detects specific metabolites-including cytosolic amino acids, acetate, and succinate in bacterial abscesses, trehalose in fungal lesions, and guanidinoacetate in tuberculomas-assisting in their differentiation from neoplastic lesions. Neurometabolite levels may correlate with clinical status, symptom severity, and cognitive deficits, while longitudinal observations enable monitoring of disease progression and treatment response. Although 1H-MRS is limited by spectral overlap, it represents a valuable complement to conventional MRI; however, further longitudinal studies on larger patient cohorts are required.

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Cite

BibTeXRIS
BibTeX
@article{naumowicz2026relic,
  title = {{Relic of the Past or Clinical Compass? Re-Evaluating the Diagnostic Utility of Proton Magnetic Resonance Spectroscopy (1H-MRS) in Encephalitis and Infectious CNS Diseases}},
  author = {Maciej Naumowicz and Radosław Zawadzki and Joanna Zajkowska and Bożena Kubas},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = nov,
  doi = {10.3390/jcm15218543},
  url = {https://www.mdpi.com/2077-0383/15/21/8543},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Relic of the Past or Clinical Compass? Re-Evaluating the Diagnostic Utility of Proton Magnetic Resonance Spectroscopy (1H-MRS) in Encephalitis and Infectious CNS Diseases
AU  - Maciej Naumowicz
AU  - Radosław Zawadzki
AU  - Joanna Zajkowska
AU  - Bożena Kubas
PY  - 2026
DA  - 2026/11/02
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218543
UR  - https://www.mdpi.com/2077-0383/15/21/8543
AB  - Neuroimaging of inflammatory and infectious CNS diseases using conventional MRI has limitations, such as the challenging differential diagnosis of visible lesions, as well as the absence of neuroimaging abnormalities despite severe symptoms. The aim of this review is to evaluate the diagnostic utility of proton magnetic resonance spectroscopy (1H-MRS) as a complementary method in inflammatory conditions and CNS infections of viral, bacterial, autoimmune, parasitic, or fungal etiology. We searched the PubMed, Web of Science, and Scopus databases, including studies and case reports evaluating 1H-MRS across age groups in the acute, subacute, and chronic phases of CNS disorders. The review demonstrates that MRS can serve as a valuable, non-invasive method capable of revealing metabolic abnormalities within normal-appearing brain tissue on conventional MRI. Furthermore, 1H-MRS detects specific metabolites-including cytosolic amino acids, acetate, and succinate in bacterial abscesses, trehalose in fungal lesions, and guanidinoacetate in tuberculomas-assisting in their differentiation from neoplastic lesions. Neurometabolite levels may correlate with clinical status, symptom severity, and cognitive deficits, while longitudinal observations enable monitoring of disease progression and treatment response. Although 1H-MRS is limited by spectral overlap, it represents a valuable complement to conventional MRI; however, further longitudinal studies on larger patient cohorts are required.
SN  - 2077-0383
ER  -