Intracellular acidosis, mainly due to lactic acid accumulation, has been regarded as the major contributor of skeletal muscle fatigue and may be a contributing factor across many musculoskeletal disorders, such as peripheral arterial disease (PAD), Duchenne dystrophy and Becker dystrophy, primary mitochondrial disorders, diabetes mellitus, and cardiovascular disease. Hence, an imaging biomarker capable of inferring the underlying acidification during varying exercise conditions could be valuable in assessing the efficacy of potential therapy options. Here, we demonstrate the feasibility of indirect detection of acidification in exercised skeletal muscle using creatine CEST.
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