Advanced Hyperpolarized [sup.13]C Metabolic Imaging Protocol for Patients with Gliomas: A Comprehensive Multimodal MRI Approach

• Published in: Cancers 2024-01, Vol.16 (2)
• Main Authors: Autry, Adam W, Vaziri, Sana, Gordon, Jeremy W, Chen, Hsin-Yu, Kim, Yaewon, Dang, Duy, LaFontaine, Marisa, Noeske, Ralph, Bok, Robert, Villanueva-Meyer, Javier E, Clarke, Jennifer L, Oberheim Bush, Nancy Ann, Chang, Susan M, Xu, Duan, Lupo, Janine M, Larson, Peder E. Z, Vigneron, Daniel B, Li, Yan
• Format: Article
• Language: English
• Subjects: Antimitotic agents; Antineoplastic agents; Care and treatment; Gliomas; Industrial equipment and supplies industry; Magnetic resonance imaging; Physiological aspects; Resveratrol; Tracers (Biology)
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers16020354

Dynamic hyperpolarized carbon-13 (HP-[sup.13]C) MRI is a novel molecular imaging technique that allows for real-time in vivo imaging of glycolysis and oxidative phosphorylation using [1-[sup.13]C]pyruvate as a non-radioactive and non-toxic metabolic probe. While HP-[sup.13]C MRI has recently demonstrated the potential to capture Warburg-related metabolic dysregulation in patients with progressive/treatment-naïve high-grade gliomas, further improvement in methodologies is still necessary to help monitor disease status and evaluate early predictors of therapeutic response. To this end, a multimodal [sup.1]H/HP-[sup.13]C MRI protocol was implemented in this study, which incorporated advanced brain tumor MR acquisitions and improved HP-[sup.13]C metabolic imaging methodologies for the serial monitoring of patients with glioma over the course of clinical treatment. This study aimed to implement a multimodal [sup.1]H/HP-[sup.13]C imaging protocol to augment the serial monitoring of patients with glioma, while simultaneously pursuing methods for improving the robustness of HP-[sup.13]C metabolic data. A total of 100 [sup.1]H/HP [1-[sup.13]C]-pyruvate MR examinations (104 HP-[sup.13]C datasets) were acquired from 42 patients according to the comprehensive multimodal glioma imaging protocol. Serial data coverage, accuracy of frequency reference, and acquisition delay were evaluated using a mixed-effects model to account for multiple exams per patient. Serial atlas-based HP-[sup.13]C MRI demonstrated consistency in volumetric coverage measured by inter-exam dice coefficients (0.977 ± 0.008, mean ± SD; four patients/11 exams). The atlas-derived prescription provided significantly improved data quality compared to manually prescribed acquisitions (n = 26/78; p = 0.04). The water-based method for referencing [1-[sup.13]C]-pyruvate center frequency significantly reduced off-resonance excitation relative to the coil-embedded [[sup.13]C]-urea phantom (4.1 ± 3.7 Hz vs. 9.9 ± 10.7 Hz; p = 0.0007). Significantly improved capture of tracer inflow was achieved with the 2-s versus 5-s HP-[sup.13]C MRI acquisition delay (p = 0.007). This study demonstrated the implementation of a comprehensive multimodal [sup.1]H/HP-[sup.13]C MR protocol emphasizing the monitoring of steady-state/dynamic metabolism in patients with glioma.