Advanced methods in deuterium metabolic imaging

Abstract Background Deuterium metabolic imaging (DMI) has recently been established as a versatile MR-based technique for in vivo mapping of glucose and other metabolic pathways using safe, non-ionizing 2 H-labeled tracers. Objective In this review, methodological advances in DMI over the past decade are summarized, spanning hardware, acquisition, reconstruction, and quantification. Approach and Outline Developments in multinuclear system modifications and dual-tuned head and body coils that enable 3D DMI at clinical and ultra-high field strengths are outlined. Efficient spatial–spectral encoding strategies and balanced steady-state-free-precession-based MRSI, which improve SNR efficiency and spatiotemporal resolution, are reviewed together with temporally interleaved 1 H/ 2 H acquisitions that integrate DMI into standard MRI workflows. Indirect 1 H-observed deuterium detection (QELT) is described as a complementary approach for sites without multinuclear hardware. On the reconstruction side, model-based, low-rank and AI-driven methods are highlighted for de-noising, accelerated sampling, and robust spectral–temporal fitting. Outlook Current strategies for concentration estimation, kinetic modeling, and treatment of label loss are discussed, positioning DMI as a promising complement to FDG-PET and 13 C-MRS for studying metabolism in neurological, oncological and systemic disease.