Dual-Echo EPI sequence for integrated distortion correction in 3D time-resolved hyperpolarized 13 C MRI

Quo Vadis Hyperpolarized 13C MRI?

Over the last two decades, hyperpolarized 13C MRI has gained significance in both preclinical and clinical studies, hereby relying on technologies like PHIP-SAH (ParaHydrogen-Induced Polarization-Side Arm Hydrogenation), SABRE (Signal Amplification by Reversible Exchange), and dDNP (dissolution Dynamic Nuclear Polarization), with dDNP being applied in humans. A clinical dDNP polarizer has enabled studies across 24 sites, despite challenges like high cost and slow polarization. Parahydrogen-based techniques like SABRE and PHIP offer faster, more cost-efficient alternatives but require molecule-specific optimization. The focus has been on imaging metabolism of hyperpolarized probes, which requires long T1, high polarization and rapid contrast generation. Efforts to establish novel probes, improve acquisition techniques and enhance data analysis methods including artificial intelligence are ongoing. Potential clinical value of hyperpolarized 13C MRI was demonstrated primarily for treatment response assessment in oncology, but also in cardiology, nephrology, hepatology and CNS characterization. In this review on biomedical hyperpolarized 13C MRI, we summarize important and recent advances in polarization techniques, probe development, acquisition and analysis methods as well as clinical trials. Starting from those we try to sketch a trajectory where the field of biomedical hyperpolarized 13C MRI might go.

Particle-based MR modeling with diffusion, microstructure, and enzymatic reactions

PURPOSE

To develop a novel particle-based in silico MR model and demonstrate applications of this model to signal mechanisms which are affected by the spatial organization of particles, including metabolic reaction kinetics, microstructural effects on diffusion, and radiofrequency (RF) refocusing effects in gradient-echo sequences.

METHODS

The model was developed by integrating a forward solution of the Bloch equations with a Brownian dynamics simulator. Simulation configurations were then designed to model MR signal dynamics of interest, with a primary focus on hyperpolarized 13C MRI methods. Phantom scans and spectrophotometric assays were conducted to validate model results in vitro.

RESULTS

The model accurately reproduced the reaction kinetics of enzyme-mediated conversion of pyruvate to lactate. When varying proportions of restrictive structure were added to the reaction volume, nonlinear changes in the reaction rate measured in vitro were replicated in silico. Modeling of RF refocusing effects characterized the degree of diffusion-weighted contribution from preserved residual magnetization in nonspoiled gradient-echo sequences.

CONCLUSIONS

These results show accurate reproduction of a range of MR signal mechanisms, establishing the model's capability to investigate the multifactorial signal dynamics such as those underlying hyperpolarized 13C MRI data.

A vendor-neutral EPI sequence for hyperpolarized 13C MRI

PURPOSE

To develop a flexible, vendor-neutral EPI sequence for hyperpolarized 13C metabolic imaging.

METHODS

An open-source EPI sequence consisting of a metabolite-specific spectral-spatial RF excitation pulse and a customizable EPI readout was created using the Pulseq framework. To explore the flexibility of our sequence, we tested several versions of the sequence including a symmetric 3D readout with different spatial resolutions for each metabolite (1.0 cm3 and 1.5 cm3). A multichamber phantom constructed with a Shepp-Logan geometry, containing two chambers filled with either natural abundance 13C compounds or hyperpolarized (HP) [1-13C]pyruvate, was used to test each sequence. For experiments involving HP [1-13C]pyruvate, a single chamber was prefilled with nicotinamide adenine dinucleotide hydride and lactate dehydrogenase to facilitate the conversion of [1-13C]pyruvate to [1-13C]lactate. All experiments were performed on a Siemens Prisma 3T scanner.

RESULTS

All the sequence variations localized natural-abundance 13C ethylene glycol and methanol to the appropriate compartment of the multichamber phantom. [1-13C]pyruvate was detectable in both chambers following the injection of HP [1-13C]pyruvate, whereas [1-13C]lactate was only found in the chamber containing nicotinamide adenine dinucleotide hydride and lactate dehydrogenase. The conversion rate from [1-13C]pyruvate to [1-13C]lactate (kPL) was 0.01 s-1 (95% confidence interval [0.00, 0.02]).

CONCLUSION

We have developed and tested a vendor-neutral EPI sequence for imaging HP 13C agents. We have made all of our sequence creation and image reconstruction code freely available online for other investigators to use.

First in-human evaluation of [1-13C]pyruvate in D2O for hyperpolarized MRI of the brain: A safety and feasibility study

PURPOSE

To investigate the safety and value of hyperpolarized (HP) MRI of [1-13C]pyruvate in healthy volunteers using deuterium oxide (D2O) as a solvent.

METHODS

Healthy volunteers (n = 5), were injected with HP [1-13C]pyruvate dissolved in D2O and imaged with a metabolite-specific 3D dual-echo dynamic EPI sequence at 3T at one site (Site 1). Volunteers were monitored following the procedure to assess safety. Image characteristics, including SNR, were compared to data acquired in a separate cohort using water as a solvent (n = 5) at another site (Site 2). The apparent spin-lattice relaxation time (T1) of [1-13C]pyruvate was determined both in vitro and in vivo from a mono-exponential fit to the image intensity at each time point of our dynamic data.

RESULTS

All volunteers completed the study safely and reported no adverse effects. The use of D2O increased the T1 of [1-13C]pyruvate from 66.5 ± 1.6 s to 92.1 ± 5.1 s in vitro, which resulted in an increase in signal by a factor of 1.46 ± 0.03 at the time of injection (90 s after dissolution). The use of D2O also increased the apparent relaxation time of [1-13C]pyruvate by a factor of 1.4 ± 0.2 in vivo. After adjusting for inter-site SNR differences, the use of D2O was shown to increase image SNR by a factor of 2.6 ± 0.2 in humans.

CONCLUSIONS

HP [1-13C]pyruvate in D2O is safe for human imaging and provides an increase in T1 and SNR that may improve image quality.

Evidence of 13 C-lactate oxidation in the human brain from hyperpolarized 13 C-MRI

PURPOSE

To test the hypothesis that lactate oxidation contributes to the  13 $$ {}^{13} $$ C-bicarbonate signal observed in the awake human brain using hyperpolarized  13 $$ {}^{13} $$ C MRI.

METHODS

Healthy human volunteers (N = 6) were scanned twice using hyperpolarized  13 $$ {}^{13} $$ C-MRI, with increased radiofrequency saturation of  13 $$ {}^{13} $$ C-lactate on one set of scans.  13 $$ {}^{13} $$ C-lactate,  13 $$ {}^{13} $$ C-bicarbonate, and  13 $$ {}^{13} $$ C-pyruvate signals for 132 brain regions across each set of scans were compared using a clustered Wilcoxon signed-rank test.

RESULTS

Increased  13 $$ {}^{13} $$ C-lactate radiofrequency saturation resulted in a significantly lower  13 $$ {}^{13} $$ C-bicarbonate signal (p = 0.04). These changes were observed across the majority of brain regions.

CONCLUSION

Radiofrequency saturation of  13 $$ {}^{13} $$ C-lactate leads to a decrease in  13 $$ {}^{13} $$ C-bicarbonate signal, demonstrating that the  13 $$ {}^{13} $$ C-lactate generated from the injected  13 $$ {}^{13} $$ C-pyruvate is being converted back to  13 $$ {}^{13} $$ C-pyruvate and oxidized throughout the human brain.

Task Activation Results in Regional 13 C-Lactate Signal Increase in the Human Brain

Hyperpolarized- 13 C magnetic resonance imaging (HP- 13 C MRI) was used to image changes in 13 C-lactate signal during a visual stimulus condition in comparison to an eyes-closed control condition. Whole-brain 13 C-pyruvate, 13 C-lactate and 13 C-bicarbonate production was imaged in healthy volunteers (N=6, ages 24-33) for the two conditions using two separate hyperpolarized 13 C-pyruvate injections. BOLD-fMRI scans were used to delineate regions of functional activation. 13 C-metabolite signal was normalized by 13 C-metabolite signal from the brainstem and the percentage change in 13 C-metabolite signal conditions was calculated. A one-way Wilcoxon signed-rank test showed a significant increase in 13 C-lactate in regions of activation when compared to the remainder of the brain ( p = 0.02, V = 21). No significant increase was observed in 13 C-pyruvate ( p = 0.11, V = 17) or 13 C-bicarbonate ( p = 0.95, V = 3) signal. The results show an increase in 13 C-lactate production in the activated region that is measurable with HP- 13 C MRI.

Considerations for hyperpolarized 13 C MR at reduced field: Comparing 1.5T versus 3T

PURPOSE

In contrast to conventional MR, signal-to-noise ratio (SNR) is not linearly dependent on field strength in hyperpolarized MR, as polarization is generated outside the MR system. Moreover, field inhomogeneity-induced artifacts and other practical limitations associated with field strengths ≥ $$ \ge $$ 3T are alleviated at lower fields. The potential of hyperpolarized   13 $$ {}^{13} $$ C spectroscopy and imaging at 1.5T versus 3T is demonstrated in silico, in vitro, and in vivo for applications on clinical MR systems.

THEORY AND METHODS

Theoretical noise and SNR behavior at different field strengths are investigated based on simulations. A thorough field comparison between 1.5T and 3T is performed using thermal and hyperpolarized   13 $$ {}^{13} $$ C spectroscopy and imaging. Cardiac in vivo data is obtained in pigs using hyperpolarized [1-   13 $$ {}^{13} $$ C]pyruvate spectroscopy and imaging at 1.5T and 3T.

RESULTS

Based on theoretical considerations and simulations, the SNR of hyperpolarized MR at identical acquisition bandwidths is independent of the field strength for typical coil setups, while adaptively changing the acquisition bandwidth proportional to the static magnetic field allows for net SNR gains of up to 40% at 1.5T compared to 3T. In vitro   13 $$ {}^{13} $$ C data verified these considerations with less than 7% deviation. In vivo feasibility of hyperpolarized [1-   13 $$ {}^{13} $$ C]pyruvate dynamic metabolic spectroscopy and imaging at 1.5T is demonstrated in the pig heart with comparable SNR between 1.5T and 3T while B   0 $$ {}_0 $$ artifacts are noticeably reduced at 1.5T.

CONCLUSION

Hyperpolarized   13 $$ {}^{13} $$ C MR at lower field strengths is favorable in terms of SNR and off-resonance effects, which makes 1.5T a promising alternative to 3T, especially for clinical cardiac metabolic imaging.

Current human brain applications and challenges of dynamic hyperpolarized carbon-13 labeled pyruvate MR metabolic imaging

The ability of hyperpolarized carbon-13 MR metabolic imaging to acquire dynamic metabolic information in real time is crucial to gain mechanistic insights into metabolic pathways, which are complementary to anatomic and other functional imaging methods. This review presents the advantages of this emerging functional imaging technology, describes considerations in clinical translations, and summarizes current human brain applications. Despite rapid development in methodologies, significant technological and physiological related challenges continue to impede broader clinical translation.

Emerging Techniques in Cardiac Magnetic Resonance Imaging

Cardiovascular disease is the leading cause of death and a significant contributor of health care costs. Noninvasive imaging plays an essential role in the management of patients with cardiovascular disease. Cardiac magnetic resonance (MR) can noninvasively assess heart and vascular abnormalities, including biventricular structure/function, blood hemodynamics, myocardial tissue composition, microstructure, perfusion, metabolism, coronary microvascular function, and aortic distensibility/stiffness. Its ability to characterize myocardial tissue composition is unique among alternative imaging modalities in cardiovascular disease. Significant growth in cardiac MR utilization, particularly in Europe in the last decade, has laid the necessary clinical groundwork to position cardiac MR as an important imaging modality in the workup of patients with cardiovascular disease. Although lack of availability, limited training, physician hesitation, and reimbursement issues have hampered widespread clinical adoption of cardiac MR in the United States, growing clinical evidence will ultimately overcome these challenges. Advances in cardiac MR techniques, particularly faster image acquisition, quantitative myocardial tissue characterization, and image analysis have been critical to its growth. In this review article, we discuss recent advances in established and emerging cardiac MR techniques that are expected to strengthen its capability in managing patients with cardiovascular disease. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 1.

Hyperpolarized Metabolic MRI-Acquisition, Reconstruction, and Analysis Methods

Hyperpolarized metabolic MRI with 13C-labeled agents has emerged as a powerful technique for in vivo assessments of real-time metabolism that can be used across scales of cells, tissue slices, animal models, and human subjects. Hyperpolarized contrast agents have unique properties compared to conventional MRI scanning and MRI contrast agents that require specialized imaging methods. Hyperpolarized contrast agents have a limited amount of available signal, irreversible decay back to thermal equilibrium, bolus injection and perfusion kinetics, cellular uptake and metabolic conversion kinetics, and frequency shifts between metabolites. This article describes state-of-the-art methods for hyperpolarized metabolic MRI, summarizing data acquisition, reconstruction, and analysis methods in order to guide the design and execution of studies.

Predicting response to radiotherapy of intracranial metastases with hyperpolarized 13 C MRI

BACKGROUND

Stereotactic radiosurgery (SRS) is used to manage intracranial metastases in a significant fraction of patients. Local progression after SRS can often only be detected with increased volume of enhancement on serial MRI scans which may lag true progression by weeks or months.

METHODS

Patients with intracranial metastases (N = 11) were scanned using hyperpolarized13 C MRI prior to treatment with stereotactic radiosurgery (SRS). The status of each lesion was then recorded at six months post-treatment follow-up (or at the time of death).

RESULTS

The positive predictive value of13 C-lactate signal, measured pre-treatment, for prediction of progression of intracranial metastases at six months post-treatment with SRS was 0.8p < 0.05 , and the AUC from an ROC analysis was 0.77p < 0.05 . The distribution of13 C-lactate z-scores was different for intracranial metastases from different primary cancer types (F = 2.46,p = 0.1 ).

CONCLUSIONS

Hyperpolarized13 C imaging has potential as a method for improving outcomes for patients with intracranial metastases, by identifying patients at high risk of treatment failure with SRS and considering other therapeutic options such as surgery.

Joint image and field map estimation for multi-echo hyperpolarized 13 C metabolic imaging of the heart

PURPOSE

Image reconstruction of metabolic images from hyperpolarized ¹³ C multi-echo data acquisition is sensitive to susceptibility-induced phase offsets, which are particularly challenging in the heart. A model-based framework for joint estimation of metabolite images and field map from echo shift-encoded data is proposed. Using simulations, it is demonstrated that correction of signal spilling due to incorrect decomposition of metabolites and geometrical distortions over a wide range of off-resonance gradients is possible. In vivo feasibility is illustrated using hyperpolarized [1-¹³ C]pyruvate in the pig heart.

METHODS

The model-based reconstruction for multi-echo, multicoil data was implemented as a nonconvex minimization problem jointly optimizing for metabolic images and B₀ . A comprehensive simulation framework for echo shift-encoded hyperpolarized [1-¹³ C]pyruvate imaging was developed and applied to assess reconstruction performance and distortion correction of the proposed method. In vivo data were obtained in four pigs using hyperpolarized [1-¹³ C]pyruvate on a clinical 3T MR system with a six-channel receiver coil. Dynamic images were acquired during suspended ventilation using cardiac-triggered multi-echo single-shot echo-planar imaging in short-axis orientation.

RESULTS

Simulations revealed that off-resonance gradients up to ±0.26 ppm/pixel can be corrected for with reduced signal spilling and geometrical distortions yielding an accuracy of ≥90% in terms of Dice similarity index. In vivo, improved geometrical consistency (10% Dice improvement) compared to image reconstruction without field map correction and with reference to anatomical data was achieved.

CONCLUSION

Joint image and field map estimation allows addressing off-resonance-induced geometrical distortions and metabolite spilling in hyperpolarized ¹³ C metabolic imaging of the heart.

A variable resolution approach for improved acquisition of hyperpolarized 13 C metabolic MRI

PURPOSE

To ameliorate tradeoffs between a fixed spatial resolution and signal-to-noise ratio (SNR) for hyperpolarized 13 C MRI.

METHODS

In MRI, SNR is proportional to voxel volume but retrospective downsampling or voxel averaging only improves SNR by the square root of voxel size. This can be exploited with a metabolite-selective imaging approach that independently encodes each compound, yielding high-resolution images for the injected substrate and coarser resolution images for downstream metabolites, while maintaining adequate SNR for each. To assess the efficacy of this approach, hyperpolarized [1-13 C]pyruvate data were acquired in healthy Sprague-Dawley rats (n = 4) and in two healthy human subjects.

RESULTS

Compared with a constant resolution acquisition, variable-resolution data sets showed improved detectability of metabolites in pre-clinical renal studies with a 3.5-fold, 8.7-fold, and 6.0-fold increase in SNR for lactate, alanine, and bicarbonate data, respectively. Variable-resolution data sets from healthy human subjects showed cardiac structure and neuro-vasculature in the higher resolution pyruvate images (6.0 × 6.0 mm2 for cardiac and 7.5 × 7.5 mm2 for brain) that would otherwise be missed due to partial-volume effects and illustrates the level of detail that can be achieved with hyperpolarized substrates in a clinical setting.

CONCLUSION

We developed a variable-resolution strategy for hyperpolarized 13 C MRI using metabolite-selective imaging and demonstrated that it mitigates tradeoffs between a fixed spatial resolution and SNR for hyperpolarized substrates, providing both high resolution pyruvate and coarse resolution metabolite data sets in a single exam. This technique shows promise to improve future studies by maximizing metabolite SNR while minimizing partial-volume effects from the injected substrate.

Dynamic volumetric hyperpolarized 13 C imaging with multi-echo EPI

PURPOSE

To generate dynamic, volumetric maps of hyperpolarized [1-¹³ C]pyruvate and its metabolic products in vivo.

METHODS

Maps of chemical species were generated with iterative least squares (IDEAL) reconstruction from multiecho echo-planar imaging (EPI) of phantoms of thermally polarized ¹³ C-labeled chemicals and mice injected with hyperpolarized [1-¹³ C]pyruvate on a preclinical 3T scanner. The quality of the IDEAL decomposition of single-shot and multishot phantom images was evaluated using quantitative results from a simple pulse-and-acquire sequence as the gold standard. Time course and area-under-the-curve plots were created to analyze the distribution of metabolites in vivo.

RESULTS

Improved separation of chemical species by IDEAL, evaluated by the amount of residual signal measured for chemicals not present in the phantoms, was observed as the number of EPI shots was increased from one to four. Dynamic three-dimensional metabolite maps of [1-¹³ C]pyruvate,[1-¹³ C]pyruvatehydrate, [1-¹³ C]lactate, [1-¹³ C]bicarbonate, and [1-¹³ C]alanine generated by IDEAL from interleaved multishot multiecho EPI of live mice were used to construct time course and area-under-the-curve graphs for the heart, kidneys, and liver, which showed good agreement with previously published results.

CONCLUSIONS

IDEAL decomposition of multishot multiecho 13C EPI images is a simple, yet robust method for generating high-quality dynamic volumetric maps of hyperpolarized [1-¹³ C]pyruvate and its products in vivo and has potential applications for the assessment of multiorgan metabolic phenomena.

Correlation of hyperpolarized 13 C-MRI data with tissue extract measurements

Hyperpolarized (HP) 13C MRI provides the means to monitor lactate metabolism noninvasively in tumours. Since 13C -lactate signal levels obtained from HP 13C imaging depend on multiple factors, such as the rate of 13C substrate delivery via the vasculature, the expression level of monocarboxylate transporters (MCTs) and lactate dehydrogenase (LDH), and the local lactate pool size, the interpretation of HP 13C metabolic images remains challenging. In this study, ex vivo tissue extract measurements (i.e., NMR isotopomer analysis, western blot analysis) derived from an MDA-MB-231 xenograft model in nude rats were used to test for correlations between the in vivo 13C data and the ex vivo measures. The lactate-to-pyruvate ratio from HP 13C MRI was strongly correlated with [1- 13C ]lactate concentration measured from the extracts using NMR (R = 0.69, p < 0.05), as well as negatively correlated with tumour wet weight (R = -  0.60, p < 0.05). In this tumour model, both MCT1 and MCT4 expressions were positively correlated with wet weight ( ρ = 0.78 and 0.93, respectively, p < 0.01). Lactate pool size and the lactate-to-pyruvate ratio were not significantly correlated.

Fast Imaging for Hyperpolarized MR Metabolic Imaging

MRI with hyperpolarized carbon-13 agents has created a new type of noninvasive, in vivo metabolic imaging that can be applied in cell, animal, and human studies. The use of ¹³ C-labeled agents, primarily [1-¹³ C]pyruvate, enables monitoring of key metabolic pathways with the ability to image substrate and products based on their chemical shift. Over 10 sites worldwide are now performing human studies with this new approach for studies of cancer, heart disease, liver disease, and kidney disease. Hyperpolarized metabolic imaging studies must be performed within several minutes following creation of the hyperpolarized agent due to irreversible decay of the net magnetization back to equilibrium, so fast imaging methods are critical. The imaging methods must include multiple metabolites, separated based on their chemical shift, which are also undergoing rapid metabolic conversion (via label exchange), further exacerbating the challenges of fast imaging. This review describes the state-of-the-art in fast imaging methods for hyperpolarized metabolic imaging. This includes the approach and tradeoffs between three major categories of fast imaging methods-fast spectroscopic imaging, model-based strategies, and metabolite specific imaging-as well additional options of parallel imaging, compressed sensing, tailored RF flip angles, refocused imaging methods, and calibration methods that can improve the scan coverage, speed, signal-to-noise ratio (SNR), resolution, and/or robustness of these studies. To date, these approaches have produced extremely promising initial human imaging results. Improvements to fast hyperpolarized metabolic imaging methods will provide better coverage, SNR, resolution, and reproducibility for future human imaging studies. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 1.

Improved reconstruction stability for chemical shift encoded hyperpolarized 13 C magnetic resonance spectroscopic imaging using k-t spiral acquisitions

PURPOSE

A multiecho, field of view (FOV)-oversampled k-t spiral acquisition and direct iterative decomposition of water and fat with echo asymmetry and least-squares estimation reconstruction is demonstrated to improve the stability of hyperpolarized ¹³ C magnetic resonance spectroscopic imaging (MRSI) in the presence of signal ambiguities attributed to low-SNR (signal-to-noise-ratio) species, local uncertainties in metabolite peaks, and echo-to-echo signal inconsistencies.

THEORY

k-t spiral acquisitions redistribute readout points to be more densely spaced radially in k-space by acquiring an FOV and matrix that are oversampled by η. These more densely spaced spiral turns constitute effective intraspiral echoes and can supplement conventional interspiral echoes to improve spectral separation and reduce spectral cross-talk to better resolve ¹³ C-labeled species for spectroscopic imaging.

METHODS

Digital simulations and imaging phantom experiments were performed for a range of interspiral echo spacings and η using multiecho, k-t spiral acquisitions. Image spectral cross-talk artifacts were evaluated both qualitatively and quantitatively as the percent error in measured metabolite ratios. In vivo murine experiments evaluated the feasibility of multiecho, k-t spiral [1-¹³ C]pyruvate MRSI to reduce spectral cross-talk for 3 scenarios of different expected reconstruction stability.

RESULTS

Digital simulations and imaging phantom experiments both demonstrated reduced or comparable image spectral cross-talk and percent errors in measured metabolite ratios with increasing η and better choices of echo spacings. In vivo images displayed markedly reduced spectral cross-talk in lactate images acquired with η = 7 versus η = 1.

CONCLUSION

The precision of hyperpolarized ¹³ C metabolic imaging and quantification in the presence of low-SNR species, local uncertainties in metabolite resonances, and echo-to-echo signal inconsistencies can be improved with the use of FOV-oversampled k-t spiral acquisitions.

Partial Fourier reconstruction for improved resolution in 3D hyperpolarized 13 C EPI

PURPOSE

Asymmetric in-plane k-space sampling of EPI can reduce the minimum achievable TE in hyperpolarized 13 C with spectral-spatial radio frequency pulses, thereby reducing T 2 * weighting and signal-losses. Partial Fourier image reconstruction exploits the approximate Hermitian symmetry of k-space data and can be applied to asymmetric data sets to synthesize unmeasured data. Here we tested whether the application of partial Fourier image reconstruction would improve spatial resolution from hyperpolarized [1- 13 C ]pyruvate scans in the human brain.

METHODS

Fifteen healthy control subjects were imaged using a volumetric dual-echo echo-planar imaging sequence with spectral-spatial radio frequency excitation. Images were reconstructed by zero-filling as well as with the partial Fourier reconstruction algorithm projection-on-convex-sets. Resulting images were quantitatively evaluated with a no-reference image quality assessment.

RESULTS

The no-reference image sharpness metric agreed with perceived improvements in image resolution and contrast. The [1- 13 C ]lactate images benefitted most, followed by the [1- 13 C ]pyruvate images. The 13 C -bicarbonate images were improved by the smallest degree, likely owing to relatively lower SNR.

CONCLUSIONS

Partial Fourier imaging and reconstruction were shown to improve the sharpness and contrast of human HP 13 C brain data and is a viable method for enhancing resolution.

First-in-human in vivo non-invasive assessment of intra-tumoral metabolic heterogeneity in renal cell carcinoma

Intratumoral genetic heterogeneity and the role of metabolic reprogramming in renal cell carcinoma (RCC) have been extensively documented. However, the distribution of these metabolic changes within the tissue has not been explored. We report on the first-in-human in vivo non-invasive metabolic interrogation of RCC using hyperpolarized carbon-13 (13C) magnetic resonance imaging (HP-MRI) and describe the validation of in vivo lactate metabolic heterogeneity against multi-regional ex vivo mass spectrometry. HP-MRI provides an in vivo assessment of metabolism and provides a novel opportunity to safely and non-invasively assess cancer heterogeneity.

Quantitative myocardial first-pass cardiovascular magnetic resonance perfusion imaging using hyperpolarized [1-13C] pyruvate

BACKGROUND

The feasibility of absolute myocardial blood flow quantification and suitability of hyperpolarized [1-13C] pyruvate as contrast agent for first-pass cardiovascular magnetic resonance (CMR) perfusion measurements are investigated with simulations and demonstrated in vivo in a swine model.

METHODS

A versatile simulation framework for hyperpolarized CMR subject to physical, physiological and technical constraints was developed and applied to investigate experimental conditions for accurate perfusion CMR with hyperpolarized [1-13C] pyruvate. Absolute and semi-quantitative perfusion indices were analyzed with respect to experimental parameter variations and different signal-to-noise ratio (SNR) levels. Absolute myocardial blood flow quantification was implemented with an iterative deconvolution approach based on Fermi functions. To demonstrate in vivo feasibility, velocity-selective excitation with an echo-planar imaging readout was used to acquire dynamic myocardial stress perfusion images in four healthy swine. Arterial input functions were extracted from an additional image slice with conventional excitation that was acquired within the same heartbeat.

RESULTS

Simulations suggest that obtainable SNR and B0 inhomogeneity in vivo are sufficient for the determination of absolute and semi-quantitative perfusion with ≤25% error. It is shown that for expected metabolic conversion rates, metabolic conversion of pyruvate can be neglected over the short duration of acquisition in first-pass perfusion CMR. In vivo measurements suggest that absolute myocardial blood flow quantification using hyperpolarized [1-13C] pyruvate is feasible with an intra-myocardial variability comparable to semi-quantitative perfusion indices.

CONCLUSION

The feasibility of quantitative hyperpolarized first-pass perfusion CMR using [1-13C] pyruvate has been investigated in simulations and demonstrated in swine. Using an approved and metabolically active compound is envisioned to increase the value of hyperpolarized perfusion CMR in patients.

Translation of Carbon-13 EPI for hyperpolarized MR molecular imaging of prostate and brain cancer patients

PURPOSE

To develop and translate a metabolite-specific imaging sequence using a symmetric echo planar readout for clinical hyperpolarized (HP) Carbon-13 (¹³ C) applications.

METHODS

Initial data were acquired from patients with prostate cancer (N = 3) and high-grade brain tumors (N = 3) on a 3T scanner. Samples of [1-¹³ C]pyruvate were polarized for at least 2 h using a 5T SPINlab system operating at 0.8 K. Following injection of the HP substrate, pyruvate, lactate, and bicarbonate (for brain studies) were sequentially excited with a singleband spectral-spatial RF pulse and signal was rapidly encoded with a single-shot echo planar readout on a slice-by-slice basis. Data were acquired dynamically with a temporal resolution of 2 s for prostate studies and 3 s for brain studies.

RESULTS

High pyruvate signal was seen throughout the prostate and brain, with conversion to lactate being shown across studies, whereas bicarbonate production was also detected in the brain. No Nyquist ghost artifacts or obvious geometric distortion from the echo planar readout were observed. The average error in center frequency was 1.2 ± 17.0 and 4.5 ± 1.4 Hz for prostate and brain studies, respectively, below the threshold for spatial shift because of bulk off-resonance.

CONCLUSION

This study demonstrated the feasibility of symmetric EPI to acquire HP ¹³ C metabolite maps in a clinical setting. As an advance over prior single-slice dynamic or single time point volumetric spectroscopic imaging approaches, this metabolite-specific EPI acquisition provided robust whole-organ coverage for brain and prostate studies while retaining high SNR, spatial resolution, and dynamic temporal resolution.

Cardiac applications of hyperpolarised magnetic resonance

Cardiovascular disease is the leading cause of death world-wide. It is increasingly recognised that cardiac pathologies show, or may even be caused by, changes in metabolism, leading to impaired cardiac energetics. The heart turns over 15 times its own weight in ATP every day and thus relies heavily on the availability of substrates and on efficient oxidation to generate this ATP. A number of old and emerging drugs that target different aspects of metabolism are showing promising results with regard to improved cardiac outcomes in patients. A non-invasive imaging technique that could assess the role of different aspects of metabolism in heart disease, as well as measure changes in cardiac energetics due to treatment, would be valuable in the routine clinical care of cardiac patients. Hyperpolarised magnetic resonance spectroscopy and imaging have revolutionised metabolic imaging, allowing real-time metabolic flux assessment in vivo for the first time. In this review we summarise metabolism in the healthy and diseased heart, give an introduction to the hyperpolarisation technique, 'dynamic nuclear polarisation' (DNP), and review the preclinical studies that have thus far explored healthy cardiac metabolism and different models of human heart disease. We furthermore show what advances have been made to translate this technique into the clinic, what technical challenges still remain and what unmet clinical needs and unexplored metabolic substrates still need to be assessed by researchers in this exciting and fast-moving field.

Susceptibility-induced distortion correction in hyperpolarized echo planar imaging

Purpose

Echo planar imaging is an attractive rapid imaging readout that can image hyperpolarized compounds in vivo. By alternating the sign of the phase encoding gradient waveform, spatial offsets arising from uncertain frequency shifts can be determined. We show here that blip‐reversed echo planar imaging can also be used to correct for susceptibility and B₀ inhomogeneity effects that would otherwise produce image‐domain distortion in the heart.

Methods

Previously acquired blip‐reversed cardiac 3D‐Spectral‐Spatial echo planar imaging volumetric timecourses of hyperpolarized [1‐¹³C]pyruvate were distortion corrected by a deformation field estimated by reconstructing signal‐to‐noise ratio (SNR)‐weighted progressively subsampled temporally summed images of each metabolite.

Results

Reconstructing blip‐reversed data as proposed produced volumetric timecourses that overlaid with proton reference images more consistently than without such corrections.

Conclusion

The method proposed may form an attractive method to correct for image‐domain distortions in hyperpolarized echo planar imaging experiments. Magn Reson Med 79:2135–2141, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.