Metabolic MR imaging at ultrahigh field using MR signals such as sodium (23Na) and oxygen (17O) advances medical imaging beyond the current paradigm of anatomical description to metabolic bioscales. Diseases with long prodromes, including neurodegenerative diseases such as Alzheimer's disease and musculoskeletal diseases such as osteoarthritis, will be reviewed for human applications. Sensitive detection of early pathology prior to anatomic changes allows these quantitative parameters to serve as objective outcome measures for evaluating clinical trials of early interventions. Eliminating the need for subjective outcome measures of clinical disease severity would revolutionize drug discovery for early intervention.
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