Magnetic resonance spectroscopy (MRS) provides a powerful, in vivo method for evaluating the metabolic profile of the brain or other organs, noninvasively. Metabolite levels can be estimated from the size of the characteristic peaks (or sets of peaks) for each metabolite, but in order to derive quantitative estimates of the metabolite levels, it is necessary to calibrate the signal from each metabolite against that from a reference standard. A number of calibration methods have been suggested for MRS, but the two most widely used methods involve scaling either to the unsuppressed water peak or to the signal arising from the Creatine peak.

There is an ongoing debate about the best calibration standard to use for quantitative MRS, but each has its merits, and it may be the case that different scaling methods might be preferred to address different clinical or research questions. In the present response to the commentary by Ostojic,1 we aim to discuss the relative merits of each method within the context of pediatric MRS studies, and particularly of our study published recently in Pediatric Research entitled “Altered brain metabolism contributes to executive function deficits in school-aged children born very preterm.”2

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