Brain lithium concentrations in bipolar disorder patients: preliminary 7Li magnetic resonance studies at 3 T

Background:This study was conducted to investigate the feasibility of human brain 7Li MRS investigations at a high magnetic field (3 T), and to further explore the relationship between brain and serum lithium measures in lithium-treated bipolar patients. Methods:Eight bipolar disorder type I patients (5 males, 3 females; mean age ± SD = 33 ± 9 years) were studied. A 3-T scanner, using a dual-tuned (1H and 7Li) echoplanar imaging (EPI) compatible radiofrequency (RF) birdcage coil was used. 7Li magnetic resonance spectroscopy (MRS) signal was acquired at the frequency of 49.64 MHz using an imaging selective in vivo spectroscopy (ISIS) sequence (TR = 15 sec, 128 averages), and quantitation was obtained in reference to an external standard. Results:The mean ± SD oral lithium dose was 1265 ± 442 mg/day, and the mean ± SD 12-hour serum level was 0.69 ± 0.19 mEq/L. The measured brain lithium concentrations varied from 0.23 to 0.55 mEq/L (mean ± SD = 0.35 ± 0.11 mEq/L). The brain–serum ratios varied from 0.30 to 0.80 (mean ± SD = 0.52 ± 0.16). Subjects on single daily doses of lithium at bedtime (n = 5) had higher brain–serum lithium ratios compared with those on twice-a-day schedules (n = 3) (0.61 ± 0.12 and 0.37 ± 0.07, respectively; Mann–Whitney U test, Z = −2.24, p = .03). Conclusions:This study demonstrated for the first time the feasibility of 7Li MRS human studies at 3 T. Future studies should examine a possible role for this methodology in investigations of lithium refractoriness and prediction of treatment outcome in bipolar patients.