Testing the reliability of novel Voxel Placement approaches for Magnetic Resonance Spectroscopy

<jats:p>Background: Single-voxel magnetic resonance spectroscopy (MRS) is a non-invasive method for measuring clinically and cognitively relevant metabolites. Reliable measurements require precise voxel placement across sessions and participants. We developed a scanner-console-based approach to improve voxel placement precision. Methods: In a crossover design (n=7; six sessions each), we compared test-retest reliability of three voxel placement methods in a reference benchmark (left parietal cortex) and a technically challenging region (left ventromedial prefrontal cortex). Methods included (1) conventional anatomy-based placement, (2) mask-guided real-time positioning (MGRP), and (3) semiautomated session-locked voxel repositioning (SSVR). Resting-state MRS data were acquired using PRESS and MEGA-PRESS. Within-subject reliability of voxel placement and metabolite concentrations, namely, total N-acetylaspartate (tNAA), total Creatine (tCr), GABA (gamma-aminobutyric acid), and Glx (glutamate + glutamine) are reported using the coefficient of variation (CV), the intraclass correlation coefficient (ICC), minimal detectable change (MDC), and the spatial overlap. Results: SSVR markedly improved voxel placement reliability, increasing spatial overlap (up to 88%) and achieving near-perfect geometric reproducibility (ICC = 0.99) compared to conventional anatomy-based placement and MGRP. SSVR improved tissue composition consistency and reduced metabolite variability in the technically challenging region (variability reduction of ~70% tCr, ~59% tNAA, and ~51% Glx) while further refining already stable measurements in the benchmark region (tNAA from ~15% to ~10%). Conclusion: Both MGRP and SSVR improved voxel placement and metabolite measurement reproducibility compared with conventional anatomy-based placement. SSVR further enhanced within-subject reproducibility across repeated sessions, particularly in the technically challenging region, providing a robust approach for longitudinal single-voxel MRS studies.</jats:p>