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Lactate is one of the more important compounds assessed on MR spectroscopy, and resonates at 1.3 ppm chemical shift, with a characteristic double peak at long TEs.
Lactate is, however, superimposed on the lipid band. Using an intermediate TE (e.g. 144 ms) will invert only lactate, allowing it to be distinguished. At higher field strength (3T rather than 1.5T), this inverted peak may be diminished or absent 4.
Normal spectra show no lactate. It is a marker of anaerobic metabolism and is therefore elevated in necrotic areas (e.g. higher grade tumors) and infections (cerebral abscess). Cancer cells produce lactate via glycolysis (Warburg effect) 3. An elevated lactate peak may also be seen in the setting of diffuse axonal injury, which is associated with a worse prognosis 1.
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- 3. Vaupel P & Multhoff G. Revisiting the Warburg Effect: Historical Dogma Versus Current Understanding. J Physiol. 2021;599(6):1745-57. doi:10.1113/JP278810 - Pubmed
- 4. Lange T, Dydak U, Roberts T, Rowley H, Bjeljac M, Boesiger P. Pitfalls in Lactate Measurements at 3T. AJNR Am J Neuroradiol. 2006;27(4):895-901. PMC8133981 - Pubmed