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Chemical Exchange Saturation Transfer (CEST) MRI is a new technology that can detect low (millimolar) concentrations of natural non-metallic magnetic marker molecules through the presence of groups with exchangeable protons, such as hydroxyls (OH), amides (NH) and amines (NH2). These protons interact with the water protons detected in MRI through physical exchange, generally referred to in the field as ”chemical exchange”. These protons have a certain resonance frequency, meaning that you get enhancement of sensitivity with high specificity.

Specifik Work

CEST agents are often divided into paramagnetic or diamagnetic agents. Our group’s main research is geared towards diamagnetic agents; either exogenous, as in using natural sugar as a biomarker in tumours (GlucoCEST) (see figure 1 from 7T Lund), or endogenous where we look at the increase of amide protons in tumours (APTw) and the change in concentration of glycosaminogycans (GagCEST) in early osteoarthritis.

Figure 1. An image showing a patient with astrocytoma. To the left is a dynamic contrast enhanced (DCE) area under the curve (AUC) image and to the right is a dynamic glucose enhanced (DGE) AUC image.

Figure 1. An image showing a patient with astrocytoma. To the left is a dynamic contrast enhanced (DCE) area under the curve (AUC) image and to the right is a dynamic glucose enhanced (DGE) AUC image.



Our specific aims are:


To investigate the mechanism of glucoCEST contrast in human volunteers and brain tumour patients and obtaining physiological parameters related to perfusion, permeability and metabolism

To develop, optimize and standardize a clinical MRI (3 Tesla) protocol for reproducible intravenous D-glucose imaging in brain tumours 

Expand the current studies to include prostate cancer, first in animal models at 9.4 Tesla and then in patients at 3 Tesla


To further develop, implement and optimize APTw MRI on our clinical 3 Tesla Siemens scanner.

To evaluate the clinical value of APTw MRI in identifying non-Gd-enhancing high-grade gliomas.

To quantify the accuracy of APTw MRI in distinguishing pseudoprogression from true tumor progression in gliobastomas treated with chemoradiation therapy


To Implement and optimize a gagCEST protocol for use at ultra-high field 7T

To validate the method’s sensitivity to cartilage glycosaminoglycan content using suitable phantoms and excised cartilage samples

To use gagCEST in longitudinal studies in cohorts of patients with osteoarthritis or at risk of developing osteoarthritis. GagCEST will then be valuable tool in our efforts to learn more about the early stages of the disease and how it develops over time.


The research towards our aim is conduced by a network of scientists, both locally in Lund/Malmö and at other sites.  

The National and International collaboration sites are:


University Hospital of Linköping - PI Prof. Peter Lundberg


Johns Hopkins University Medical School, Baltimore, US - PI Jinyuan Zhou

F.M. Kirby Research Center, Kennedy Krieger Institute, Baltimore, US - PI Prof. Peter van Zijl


Key References


Xu X, Yadav NN, Knutsson L, Hua J, Kalyani R, Hall E, Laterra J, Blakeley J, Strowd R, Pomper M, Barker P, Chan K, Liu G, McMahon M, Stevens RD, van Zijl PCM. Dynamic Glucose-Enhanced (DGE) MRI: Translation to Human Scanning and First Results in Glioma Patients. Tomography. 2015 Dec;1(2):105-114.

Knutsson L, Xu J, Ahlgren A, van Zijl PCM. Chemical Exchange Saturation Transfer and Arterial Spin Labeling: How Similar Pulse Sequences detect Different Phenomena. Magn Reson Med. 2018 Oct;80(4):1320-1340

Knutsson L, Seidemo A, Rydhög Scherman A, Markenroth Bloch K, Kalyani RR, Andersen M, Sundgren PC, Wirestam R, Helms G, van Zijl PCM, Xu X. Arterial Input Functions and Tissue Response Curves in Dynamic Glucose-Enhanced (DGE) Imaging: Comparison Between glucoCEST and Blood Glucose Sampling in Humans. Tomography. 2018 Dec;4(4):164-171. doi: 10.18383/j.tom.2018.00025

Zhou J, Heo HY, Knutsson L, van Zijl PCM, Jiang S. APT-Weighted MRI: Techniques, Current Neuro Applications, and Challenging Issues. J Magn Reson Imaging. 2019 Jan 20. doi: 10.1002/jmri.26645

Knutsson L, Sundgren P. Clinical Utility of Amid Proton Transfer Imaging in Patients with Brain Tumours. Magnetom Flash. Issue nr 71. 2/2018. 52-55


For more information about our CEST research please contact:

Linda Knutsson, Ph.D.
Professor, Medical Radiation Physics, Lund University, Lund, Sweden
Adjunct Associate Professor, Radiology, Johns Hopkins School of Medicine, Baltimore, US
Work Phone: + 46 46 17 85 47
SE Mobile: +46 76 785 44 24
US Mobile: +1 410 782 0728

e-mail: linda [dot] knutsson [at] med [dot] lu [dot] se (linda[dot]knutsson[at]med[dot]lu[dot]se)  LU research portal profile: Linda Knutsson




Group Leader

Linda Knutsson, Ph.D. 

e-mail: linda [dot] knutsson [at] med [dot] lu [dot] se (linda[dot]knutsson[at]med[dot]lu[dot]se) 

LU research portal profile:Linda Knutsson




Jonas Svensson, Ph.D. 
Associate Professor

e-mail: jonas [dot] svensson [at] med [dot] lu [dot] se (jonas[dot]svensson[at]med[dot]lu[dot]se) 

LU research portal profile: Jonas Svensson



Gunther Helms, Ph.D.
Associate Professor

e-mail: gunther [dot] helms [at] med [dot] lu [dot] se (gunther[dot]helms[at]med[dot]lu[dot]se) 

LU research portal profile: Gunther Helms



Pernilla Peterson, Ph.D. 

e-mail: pernilla [dot] peterson [at] med [dot] lu [dot] se (pernilla[dot]peterson[at]med[dot]lu[dot]se) 

LU research portal profile: Pernilla Peterson



Anna Rydhög, Ph.D.

e-mail: anna [dot] rydhog [at] med [dot] lu [dot] se (anna[dot]rydhog[at]med[dot]lu[dot]se) 

LU research portal profile: Anna Rydhög



Doctoral Students

Anina Seidemo, M.Sc.

e-mail: anina [dot] seidemo [at] med [dot] lu [dot] se (anina[dot]seidemo[at]med[dot]lu[dot]se) 

LU research portal profile: Anina Seidemo



Research Assistants

Patrick Michael Lehmann, M.Sc.


patrickmichael [dot] lehmann [at] gmail [dot] com (patrickmichael[dot]lehmann[at]gmail[dot]com)