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Blazey T, Shaw A, von Morze C. A vendor-neutral EPI sequence for hyperpolarized 13C MRI. Magn Reson Med 2024; 92:772-781. [PMID: 38525658 DOI: 10.1002/mrm.30090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/02/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
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.
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Affiliation(s)
- Tyler Blazey
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA
| | - Ashley Shaw
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA
| | - Cornelius von Morze
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri, USA
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Larson PEZ, Bernard JML, Bankson JA, Bøgh N, Bok RA, Chen AP, Cunningham CH, Gordon J, Hövener JB, Laustsen C, Mayer D, McLean MA, Schilling F, Slater J, Vanderheyden JL, von Morze C, Vigneron DB, Xu D. Current methods for hyperpolarized [1- 13C]pyruvate MRI human studies. Magn Reson Med 2024; 91:2204-2228. [PMID: 38441968 PMCID: PMC10997462 DOI: 10.1002/mrm.29875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/12/2023] [Accepted: 09/06/2023] [Indexed: 03/07/2024]
Abstract
MRI with hyperpolarized (HP) 13C agents, also known as HP 13C MRI, can measure processes such as localized metabolism that is altered in numerous cancers, liver, heart, kidney diseases, and more. It has been translated into human studies during the past 10 years, with recent rapid growth in studies largely based on increasing availability of HP agent preparation methods suitable for use in humans. This paper aims to capture the current successful practices for HP MRI human studies with [1-13C]pyruvate-by far the most commonly used agent, which sits at a key metabolic junction in glycolysis. The paper is divided into four major topic areas: (1) HP 13C-pyruvate preparation; (2) MRI system setup and calibrations; (3) data acquisition and image reconstruction; and (4) data analysis and quantification. In each area, we identified the key components for a successful study, summarized both published studies and current practices, and discuss evidence gaps, strengths, and limitations. This paper is the output of the "HP 13C MRI Consensus Group" as well as the ISMRM Hyperpolarized Media MR and Hyperpolarized Methods and Equipment study groups. It further aims to provide a comprehensive reference for future consensus, building as the field continues to advance human studies with this metabolic imaging modality.
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Affiliation(s)
- Peder EZ Larson
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering,
University of California, San Francisco and University of California, Berkeley, CA
94143, USA
| | - Jenna ML Bernard
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
| | - James A Bankson
- Department of Imaging Physics, MD Anderson Medical Center,
Houston, TX, USA
| | - Nikolaj Bøgh
- The MR Research Center, Department of Clinical Medicine,
Aarhus University, Aarhus, Denmark
| | - Robert A Bok
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
| | | | - Charles H Cunningham
- Physical Sciences, Sunnybrook Research Institute, Toronto,
Ontario, Canada
- Department of Medical Biophysics, University of Toronto,
Toronto, Ontario, Canada
| | - Jeremy Gordon
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
| | - Jan-Bernd Hövener
- Section Biomedical Imaging, Molecular Imaging North
Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University
Medical Center Schleswig-Holstein (UKSH), Kiel University, Am Botanischen Garten 14,
24118, Kiel, Germany
| | - Christoffer Laustsen
- The MR Research Center, Department of Clinical Medicine,
Aarhus University, Aarhus, Denmark
| | - Dirk Mayer
- Department of Diagnostic Radiology and Nuclear Medicine,
University of Maryland School of Medicine, Baltimore, MD, USA
- Greenebaum Cancer Center, University of Maryland School
of Medicine, Baltimore, MD, USA
| | - Mary A McLean
- Department of Radiology, University of Cambridge,
Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of
Cambridge, Li Ka Shing Center, Cambridge, United Kingdom
| | - Franz Schilling
- Department of Nuclear Medicine, School of Medicine,
Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich,
Germany
| | - James Slater
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
| | | | | | - Daniel B Vigneron
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering,
University of California, San Francisco and University of California, Berkeley, CA
94143, USA
| | - Duan Xu
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, CA 94143, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering,
University of California, San Francisco and University of California, Berkeley, CA
94143, USA
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Zaidi M, Ma J, Thomas BP, Peña S, Harrison CE, Chen J, Lin SH, Derner KA, Baxter JD, Liticker J, Malloy CR, Bartnik-Olson B, Park JM. Functional activation of pyruvate dehydrogenase in human brain using hyperpolarized [1- 13 C]pyruvate. Magn Reson Med 2024; 91:1822-1833. [PMID: 38265104 PMCID: PMC10950523 DOI: 10.1002/mrm.30015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE Pyruvate, produced from either glucose, glycogen, or lactate, is the dominant precursor of cerebral oxidative metabolism. Pyruvate dehydrogenase (PDH) flux is a direct measure of cerebral mitochondrial function and metabolism. Detection of [13 C]bicarbonate in the brain from hyperpolarized [1-13 C]pyruvate using carbon-13 (13 C) MRI provides a unique opportunity for assessing PDH flux in vivo. This study is to assess changes in cerebral PDH flux in response to visual stimuli using in vivo 13 C MRS with hyperpolarized [1-13 C]pyruvate. METHODS From seven sedentary adults in good general health, time-resolved [13 C]bicarbonate production was measured in the brain using 90° flip angles with minimal perturbation of its precursors, [1-13 C]pyruvate and [1-13 C]lactate, to test the hypothesis that the appearance of [13 C]bicarbonate signals in the brain reflects the metabolic changes associated with neuronal activation. With a separate group of healthy participants (n = 3), the likelihood of the bolus-injected [1-13 C]pyruvate being converted to [1-13 C]lactate prior to decarboxylation was investigated by measuring [13 C]bicarbonate production with and without [1-13 C]lactate saturation. RESULTS In the course of visual stimulation, the measured [13 C]bicarbonate signal normalized to the total 13 C signal in the visual cortex increased by 17.1% ± 15.9% (p = 0.017), whereas no significant change was detected in [1-13 C]lactate. Proton BOLD fMRI confirmed the regional activation in the visual cortex with the stimuli. Lactate saturation decreased bicarbonate-to-pyruvate ratio by 44.4% ± 9.3% (p < 0.01). CONCLUSION We demonstrated the utility of 13 C MRS with hyperpolarized [1-13 C]pyruvate for assessing the activation of cerebral PDH flux via the detection of [13 C]bicarbonate production.
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Affiliation(s)
- Maheen Zaidi
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
| | - Junjie Ma
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
- GE Precision Healthcare, Jersey City, New Jersey, USA 07302
| | - Binu P. Thomas
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
| | - Salvador Peña
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
| | - Crystal E. Harrison
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
| | - Jun Chen
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
| | - Sung-Han Lin
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
| | - Kelley A. Derner
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
| | - Jeannie D. Baxter
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
| | - Jeff Liticker
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
| | - Craig R. Malloy
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
| | - Brenda Bartnik-Olson
- Department of Radiology, Loma Linda University, Loma Linda, California, USA 92354
| | - Jae Mo Park
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
- Department of Biomedical Engineering, The University of Texas Southwestern Medical Center, Dallas, Texas, USA 75390
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Chen HY, Gordon JW, Dwork N, Chung BT, Riselli A, Sivalokanathan S, Bok RA, Slater JB, Vigneron DB, Abraham MR, Larson PEZ. Probing human heart TCA cycle metabolism and response to glucose load using hyperpolarized [2- 13 C]pyruvate MRS. NMR IN BIOMEDICINE 2024; 37:e5074. [PMID: 38054254 DOI: 10.1002/nbm.5074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION The healthy heart has remarkable metabolic flexibility that permits rapid switching between mitochondrial glucose oxidation and fatty acid oxidation to generate ATP. Loss of metabolic flexibility has been implicated in the genesis of contractile dysfunction seen in cardiomyopathy. Metabolic flexibility has been imaged in experimental models, using hyperpolarized (HP) [2-13 C]pyruvate MRI, which enables interrogation of metabolites that reflect tricarboxylic acid (TCA) cycle flux in cardiac myocytes. This study aimed to develop methods, demonstrate feasibility for [2-13 C]pyruvate MRI in the human heart for the first time, and assess cardiac metabolic flexibility. METHODS Good manufacturing practice [2-13 C]pyruvic acid was polarized in a 5 T polarizer for 2.5-3 h. Following dissolution, quality control parameters of HP pyruvate met all safety and sterility criteria for pharmacy release, prior to administration to study subjects. Three healthy subjects each received two HP injections and MR scans, first under fasting conditions, followed by oral glucose load. A 5 cm axial slab-selective spectroscopy approach was prescribed over the left ventricle and acquired at 3 s intervals on a 3 T clinical MRI scanner. RESULTS The study protocol, which included HP substrate injection, MR scanning, and oral glucose load, was performed safely without adverse events. Key downstream metabolites of [2-13 C]pyruvate metabolism in cardiac myocytes include the glycolytic derivative [2-13 C]lactate, TCA-associated metabolite [5-13 C]glutamate, and [1-13 C]acetylcarnitine, catalyzed by carnitine acetyltransferase (CAT). After glucose load, 13 C-labeling of lactate, glutamate, and acetylcarnitine from 13 C-pyruvate increased by an average of 39.3%, 29.5%, and 114% respectively in the three subjects, which could result from increases in lactate dehydrogenase, pyruvate dehydrogenase, and CAT enzyme activity as well as TCA cycle flux (glucose oxidation). CONCLUSIONS HP [2-13 C]pyruvate imaging is safe and permits noninvasive assessment of TCA cycle intermediates and the acetyl buffer, acetylcarnitine, which is not possible using HP [1-13 C]pyruvate. Cardiac metabolite measurement in the fasting/fed states provides information on cardiac metabolic flexibility and the acetylcarnitine pool.
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Affiliation(s)
- Hsin-Yu Chen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Jeremy W Gordon
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Nicholas Dwork
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Brian T Chung
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Andrew Riselli
- School of Pharmacy, University of California, San Francisco, California, USA
| | | | - Robert A Bok
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - James B Slater
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Daniel B Vigneron
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - M Roselle Abraham
- Division of Cardiology, University of California, San Francisco, California, USA
| | - Peder E Z Larson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
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Liu X, Cui D, Xu D, Bok R, Wang ZJ, Vigneron DB, Larson PEZ, Gordon JW. Dynamic T 2 * relaxometry of hyperpolarized [1- 13 C]pyruvate MRI in the human brain and kidneys. Magn Reson Med 2024; 91:1030-1042. [PMID: 38013217 PMCID: PMC10872504 DOI: 10.1002/mrm.29942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE This study aimed to quantifyT 2 * $$ {T}_2^{\ast } $$ for hyperpolarized [1-13 C]pyruvate and metabolites in the healthy human brain and renal cell carcinoma (RCC) patients at 3 T. METHODS DynamicT 2 * $$ {T}_2^{\ast } $$ values were measured with a metabolite-specific multi-echo spiral sequence. The dynamicT 2 * $$ {T}_2^{\ast } $$ of [1-13 C]pyruvate, [1-13 C]lactate, and 13 C-bicarbonate was estimated in regions of interest in the whole brain, sinus vein, gray matter, and white matter in healthy volunteers, as well as in kidney tumors and the contralateral healthy kidneys in a separate group of RCC patients.T 2 * $$ {T}_2^{\ast } $$ was fit using a mono-exponential function; and metabolism was quantified using pyruvate-to-lactate conversion rate maps and lactate-to-pyruvate ratio maps, which were compared with and without an estimatedT 2 * $$ {T}_2^{\ast } $$ correction. RESULTS TheT 2 * $$ {T}_2^{\ast } $$ of pyruvate was shown to vary during the acquisition, whereas theT 2 * $$ {T}_2^{\ast } $$ of lactate and bicarbonate were relatively constant through time and across the organs studied. TheT 2 * $$ {T}_2^{\ast } $$ of lactate was similar in gray matter (29.75 ± 1.04 ms), white matter (32.89 ± 0.9 ms), healthy kidney (34.61 ± 4.07 ms), and kidney tumor (33.01 ± 2.31 ms); and theT 2 * $$ {T}_2^{\ast } $$ of bicarbonate was different between whole-brain (108.17 ± 14.05 ms) and healthy kidney (58.45 ± 6.63 ms). TheT 2 * $$ {T}_2^{\ast } $$ of pyruvate had similar trends in both brain and RCC studies, reducing from 75.56 ± 2.23 ms to 22.24 ± 1.24 ms in the brain and reducing from 122.72 ± 9.86 ms to 57.38 ± 7.65 ms in the kidneys. CONCLUSION Multi-echo dynamic imaging can quantifyT 2 * $$ {T}_2^{\ast } $$ and metabolism in a single integrated acquisition. Clear differences were observed in theT 2 * $$ {T}_2^{\ast } $$ of metabolites and in their behavior throughout the timecourse.
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Affiliation(s)
- Xiaoxi Liu
- Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Di Cui
- Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Duan Xu
- Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Robert Bok
- Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Zhen J Wang
- Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Daniel B Vigneron
- Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Graduate Program in Bioengineering, University of California, Berkeley and San Francisco, California, USA
| | - Peder E Z Larson
- Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Graduate Program in Bioengineering, University of California, Berkeley and San Francisco, California, USA
| | - Jeremy W Gordon
- Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
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Wodtke P, Grashei M, Schilling F. Quo Vadis Hyperpolarized 13C MRI? Z Med Phys 2023:S0939-3889(23)00120-4. [PMID: 38160135 DOI: 10.1016/j.zemedi.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 01/03/2024]
Abstract
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.
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Affiliation(s)
- Pascal Wodtke
- Department of Nuclear Medicine, TUM School of Medicine and Health, Klinikum rechts der Isar of Technical University of Munich, 81675 Munich, Germany; Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge UK
| | - Martin Grashei
- Department of Nuclear Medicine, TUM School of Medicine and Health, Klinikum rechts der Isar of Technical University of Munich, 81675 Munich, Germany
| | - Franz Schilling
- Department of Nuclear Medicine, TUM School of Medicine and Health, Klinikum rechts der Isar of Technical University of Munich, 81675 Munich, Germany; Munich Institute of Biomedical Engineering, Technical University of Munich, 85748 Garching, Germany; German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany.
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Larson PEZ, Tang S, Liu X, Sinha A, Dwork N, Sivalokanathan S, Liu J, Bok R, Ordovas KG, Slater J, Gordon JW, Abraham MR. Regional quantification of cardiac metabolism with hyperpolarized [1- 13C]-pyruvate CMR evaluated in an oral glucose challenge. J Cardiovasc Magn Reson 2023; 25:77. [PMID: 38093285 PMCID: PMC10720165 DOI: 10.1186/s12968-023-00972-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 10/19/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The heart has metabolic flexibility, which is influenced by fed/fasting states, and pathologies such as myocardial ischemia and hypertrophic cardiomyopathy (HCM). Hyperpolarized (HP) 13C-pyruvate MRI is a promising new tool for non-invasive quantification of myocardial glycolytic and Krebs cycle flux. However, human studies of HP 13C-MRI have yet to demonstrate regional quantification of metabolism, which is important in regional ischemia and HCM patients with asymmetric septal/apical hypertrophy. METHODS We developed and applied methods for whole-heart imaging of 13C-pyruvate, 13C-lactate and 13C-bicarbonate, following intravenous administration of [1-13C]-pyruvate. The image acquisition used an autonomous scanning method including bolus tracking, real-time magnetic field calibrations and metabolite-specific imaging. For quantification of metabolism, we evaluated 13C metabolite images, ratio metrics, and pharmacokinetic modeling to provide measurements of myocardial lactate dehydrogenase (LDH) and pyruvate dehydrogenase (PDH) mediated metabolic conversion in 5 healthy volunteers (fasting & 30 min following oral glucose load). RESULTS We demonstrate whole heart coverage for dynamic measurement of pyruvate-to-lactate conversion via LDH and pyruvate-to-bicarbonate conversion via PDH at a resolution of 6 × 6 × 21 mm3 (13C-pyruvate) and 12 × 12 × 21 mm3 (13C-lactate, 13C-bicarbonate). 13C-pyruvate and 13C-lactate were detected simultaneously in the RV blood pool, immediately after intravenous injection, reflecting LDH activity in blood. In healthy volunteers, myocardial 13C-pyruvate-SNR, 13C-lactate-SNR, 13C-bicarbonate-SNR, 13C-lactate/pyruvate ratio, 13C-pyruvate-to-lactate conversion rate, kPL, and 13C-pyruvate-to-bicarbonate conversion rate, kPB, all had statistically significant increases following oral glucose challenge. kPB, reflecting PDH activity and pyruvate entering the Krebs Cycle, had the highest correlation with blood glucose levels and was statistically significant. CONCLUSIONS We demonstrate first-in-human regional quantifications of cardiac metabolism by HP 13C-pyruvate MRI that aims to reflect LDH and PDH activity.
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Affiliation(s)
- Peder E Z Larson
- Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA.
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, CA, USA.
| | - Shuyu Tang
- Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, CA, USA
- Vista.ai, Palo Alto, CA, USA
| | - Xiaoxi Liu
- Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
| | - Avantika Sinha
- Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
| | - Nicholas Dwork
- Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
- Departments of Bioinformatics and Radiology, University of Colorado School of Medicine, Denver, CO, USA
| | - Sanjay Sivalokanathan
- Division of Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jing Liu
- Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
| | - Robert Bok
- Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
| | - Karen G Ordovas
- Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - James Slater
- Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
| | - Jeremy W Gordon
- Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
| | - M Roselle Abraham
- Cardiology Division, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
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Larson PE, Bernard JM, Bankson JA, Bøgh N, Bok RA, Chen AP, Cunningham CH, Gordon J, Hövener JB, Laustsen C, Mayer D, McLean MA, Schilling F, Slater J, Vanderheyden JL, von Morze C, Vigneron DB, Xu D, Group THCMC. Current Methods for Hyperpolarized [1-13C]pyruvate MRI Human Studies. ARXIV 2023:arXiv:2309.04040v2. [PMID: 37731660 PMCID: PMC10508833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
MRI with hyperpolarized (HP) 13C agents, also known as HP 13C MRI, can measure processes such as localized metabolism that is altered in numerous cancers, liver, heart, kidney diseases, and more. It has been translated into human studies during the past 10 years, with recent rapid growth in studies largely based on increasing availability of hyperpolarized agent preparation methods suitable for use in humans. This paper aims to capture the current successful practices for HP MRI human studies with [1-13C]pyruvate - by far the most commonly used agent, which sits at a key metabolic junction in glycolysis. The paper is divided into four major topic areas: (1) HP 13C-pyruvate preparation, (2) MRI system setup and calibrations, (3) data acquisition and image reconstruction, and (4) data analysis and quantification. In each area, we identified the key components for a successful study, summarized both published studies and current practices, and discuss evidence gaps, strengths, and limitations. This paper is the output of the HP 13C MRI Consensus Group as well as the ISMRM Hyperpolarized Media MR and Hyperpolarized Methods & Equipment study groups. It further aims to provide a comprehensive reference for future consensus building as the field continues to advance human studies with this metabolic imaging modality.
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9
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Larson PEZ, Tang S, Liu X, Sinha A, Dwork N, Sivalokanathan S, Liu J, Bok R, Ordovas KG, Slater J, Gordon JW, Abraham MR. Regional quantification of cardiac metabolism with hyperpolarized [1- 13C]-pyruvate MRI evaluated in an oral glucose challenge. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.16.23297052. [PMID: 37904936 PMCID: PMC10615005 DOI: 10.1101/2023.10.16.23297052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Background The heart has metabolic flexibility, which is influenced by fed/fasting states, and pathologies such as myocardial ischemia and hypertrophic cardiomyopathy (HCM). Hyperpolarized (HP) 13C-pyruvate MRI is a promising new tool for non-invasive quantification of myocardial glycolytic and Krebs cycle flux. However, human studies of HP 13C-MRI have yet to demonstrate regional quantification of metabolism, which is important in regional ischemia and HCM patients with asymmetric septal/apical hypertrophy. Methods We developed and applied methods for whole-heart imaging of 13C-pyruvate, 13C-lactate and 13C-bicarbonate, following intravenous administration of [1-13C]-pyruvate. The image acquisition used an autonomous scanning method including bolus tracking, real-time magnetic field calibrations and metabolite-specific imaging. For quantification of metabolism, we evaluated 13C metabolite images, ratio metrics, and pharmacokinetic modeling to provide measurements of myocardial lactate dehydrogenase (LDH) and pyruvate dehydrogenase (PDH) mediated metabolic conversion in 5 healthy volunteers (fasting & 30 min following oral glucose load). Results We demonstrate whole heart coverage for dynamic measurement of pyruvate-to-lactate conversion via LDH and pyruvate-to-bicarbonate conversion via PDH at a resolution of 6×6×21 mm3 (13C-pyruvate) and 12×12×21 mm3 (13C-lactate, 13C-bicarbonate) . 13C-pyruvate and 13C-lactate were detected simultaneously in the RV blood pool, immediately after intravenous injection, reflecting LDH activity in blood. In healthy volunteers, myocardial 13C-pyruvate-SNR, 13C-lactate-SNR, 13C-bicarbonate-SNR, 13C-lactate/pyruvate ratio, 13C-pyruvate-to-lactate conversion rate, kPL, and 13C-pyruvate-to-bicarbonate conversion rate, kPB, all had statistically significant increases following oral glucose challenge. kPB, reflecting PDH activity and pyruvate entering the Krebs Cycle, had the highest correlation with blood glucose levels and was statistically significant. Conclusions We demonstrate first-in-human regional quantifications of cardiac metabolism by HP 13C-pyruvate MRI that aims to reflect LDH and PDH activity.
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Affiliation(s)
- Peder E Z Larson
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, California, USA
| | - Shuyu Tang
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, California, USA
- Vista.ai, Palo Alto, CA, USA
| | - Xiaoxi Liu
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
| | - Avantika Sinha
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
| | - Nicholas Dwork
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
- Departments of Bioinformatics and Radiology, University of Colorado School of Medicine, Denver, CO, USA
| | - Sanjay Sivalokanathan
- Department of Medicine - Division of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jing Liu
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
| | - Robert Bok
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
| | - Karen G Ordovas
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
| | - James Slater
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
| | - Jeremy W Gordon
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
| | - M Roselle Abraham
- Department of Medicine - Cardiology Division, University of California - San Francisco, San Francisco, California, USA
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10
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Chen HY, Gordon JW, Dwork N, Chung BT, Riselli A, Sivalokanathan S, Bok RA, Slater JB, Vigneron DB, Abraham MR, Larson PE. Probing Human Heart TCA Cycle Metabolism and Response to Glucose Load using Hyperpolarized [2- 13C]Pyruvate MR Spectroscopy. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.16.23297053. [PMID: 37905131 PMCID: PMC10615004 DOI: 10.1101/2023.10.16.23297053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Introduction The normal heart has remarkable metabolic flexibility that permits rapid switching between mitochondrial glucose oxidation and fatty acid (FA) oxidation to generate ATP. Loss of metabolic flexibility has been implicated in the genesis of contractile dysfunction seen in cardiomyopathy. Metabolic flexibility has been imaged in experimental models, using hyperpolarized (HP) [2-13C]pyruvate MRI, which enables interrogation of metabolites that reflect tricarboxylic acid (TCA) cycle flux in cardiac myocytes. This study aimed to develop methods, demonstrate feasibility for [2-13C]pyruvate MRI in the human heart for the first time, and assess cardiac metabolic flexibility. Methods Good Manufacturing Practice [2-13C]pyruvic acid was polarized in a 5T polarizer for 2.5-3 hours. Following dissolution, QC parameters of HP pyruvate met all safety and sterility criteria for pharmacy release, prior to administration to study subjects. Three healthy subjects each received two HP injections and MR scans, first under fasting conditions, followed by oral glucose load. A 5cm axial slab-selective spectroscopy approach was prescribed over the left ventricle and acquired at 3s intervals on a 3T clinical MRI scanner. Results The study protocol which included HP substrate injection, MR scanning and oral glucose load, was performed safely without adverse events. Key downstream metabolites of [2-13C]pyruvate metabolism in cardiac myocytes include the glycolytic derivative [2-13C]lactate, TCA-associated metabolite [5-13C]glutamate, and [1-13C]acetylcarnitine, catalyzed by carnitine acetyltransferase (CAT). After glucose load, 13C-labeling of lactate, glutamate, and acetylcarnitine from 13C-pyruvate increased by 39.3%, 29.5%, and 114%, respectively in the three subjects, that could result from increases in lactate dehydrogenase (LDH), pyruvate dehydrogenase (PDH), and CAT enzyme activity as well as TCA cycle flux (glucose oxidation). Conclusions HP [2-13C]pyruvate imaging is safe and permits non-invasive assessment of TCA cycle intermediates and the acetyl buffer, acetylcarnitine, which is not possible using HP [1-13C]pyruvate. Cardiac metabolite measurement in the fasting/fed states provides information on cardiac metabolic flexibility and the acetylcarnitine pool.
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Affiliation(s)
- Hsin-Yu Chen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States
| | - Jeremy W. Gordon
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States
| | - Nicholas Dwork
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States
| | - Brian T. Chung
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States
| | - Andrew Riselli
- School of Pharmacy, University of California, San Francisco, United States
| | | | - Robert A. Bok
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States
| | - James B. Slater
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States
| | - Daniel B. Vigneron
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States
| | - M. Roselle Abraham
- Division of Cardiology, University of California, San Francisco, United States
| | - Peder E.Z. Larson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, United States
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11
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Liu X, Tang S, Cui D, Bok RA, Chen HY, Gordon JW, Wang ZJ, Larson PEZ. A metabolite specific 3D stack-of-spirals bSSFP sequence for improved bicarbonate imaging in hyperpolarized [1- 13C]Pyruvate MRI. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2023; 353:107518. [PMID: 37402333 PMCID: PMC10498937 DOI: 10.1016/j.jmr.2023.107518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/06/2023]
Abstract
13C-bicarbonate is a crucial measure of pyruvate oxidation and TCA cycle flux, but is challenging to measure due to its relatively low concentration and thus will greatly benefit from improved signal-to-noise ratio (SNR). To address this, we developed and investigated the feasibility of a 3D stack-of-spirals metabolite-specific balanced steady-state free precession (MS-bSSFP) sequence for improving the SNR and spatial resolution of dynamic 13C-bicarbonate imaging in hyperpolarized [1-13C]pyruvate studies. The bicarbonate MS-bSSFP sequence was evaluated by simulations, phantoms studies, preclinical studies on five rats, brain studies on two healthy volunteers and renal study on one renal cell carcinoma patient. The simulations and phantom results showed that the bicarbonate-specific pulse had minimal perturbation of other metabolites (<1%). In the animal studies, the MS-bSSFP sequence provided an approximately 2.6-3 × improvement in 13C-bicarbonate SNR compared to a metabolite-specific gradient echo (MS-GRE) sequence without altering the bicarbonate or pyruvate kinetics, and the shorter spiral readout in the MS-bSSFP approach reduced blurring. Using the SNR ratio between MS-bSSFP and MS-GRE, the T2 values of bicarbonate and lactate in the rat kidneys were estimated as 0.5 s and 1.1 s, respectively. The in-vivo feasibility of bicarbonate MS-bSSFP sequence was demonstrated in two human brain studies and one renal study. These studies demonstrate the potential of the sequence for in-vivo applications, laying the foundation for future studies to observe this relatively low concentration metabolite with high-quality images and improve measurements of pyruvate oxidation.
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Affiliation(s)
- Xiaoxi Liu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | | | - Di Cui
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Robert A Bok
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Hsin-Yu Chen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Jeremy W Gordon
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Zhen J Wang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Peder E Z Larson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Graduate Program in Bioengineering, University of California, Berkeley and San Francisco, San Francisco, CA, USA.
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12
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Initial Experience on Hyperpolarized [1-13C]Pyruvate MRI Multicenter Reproducibility—Are Multicenter Trials Feasible? Tomography 2022; 8:585-595. [PMID: 35314625 PMCID: PMC8938827 DOI: 10.3390/tomography8020048] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 12/31/2022] Open
Abstract
Background: Magnetic resonance imaging (MRI) with hyperpolarized [1-13C]pyruvate allows real-time and pathway specific clinical detection of otherwise unimageable in vivo metabolism. However, the comparability between sites and protocols is unknown. Here, we provide initial experiences on the agreement of hyperpolarized MRI between sites and protocols by repeated imaging of same healthy volunteers in Europe and the US. Methods: Three healthy volunteers traveled for repeated multicenter brain MRI exams with hyperpolarized [1-13C]pyruvate within one year. First, multisite agreement was assessed with the same echo-planar imaging protocol at both sites. Then, this was compared to a variable resolution echo-planar imaging protocol. In total, 12 examinations were performed. Common metrics of 13C-pyruvate to 13C-lactate conversion were calculated, including the kPL, a model-based kinetic rate constant, and its model-free equivalents. Repeatability was evaluated with intraclass correlation coefficients (ICC) for absolute agreement computed using two-way random effects models. Results: The mean kPL across all examinations in the multisite comparison was 0.024 ± 0.0016 s−1. The ICC of the kPL was 0.83 (p = 0.14) between sites and 0.7 (p = 0.09) between examinations of the same volunteer at any of the two sites. For the model-free metrics, the lactate Z-score had similar site-to-site ICC, while it was considerably lower for the lactate-to-pyruvate ratio. Conclusions: Estimation of metabolic conversion from hyperpolarized [1-13C]pyruvate to lactate using model-based metrics such as kPL suggests close agreement between sites and examinations in volunteers. Our initial results support harmonization of protocols, support multicenter studies, and inform their design.
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Ma J, Malloy CR, Pena S, Harrison CE, Ratnakar J, Zaha VG, Park JM. Dual-phase imaging of cardiac metabolism using hyperpolarized pyruvate. Magn Reson Med 2022; 87:302-311. [PMID: 34617626 PMCID: PMC8616832 DOI: 10.1002/mrm.29042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/19/2021] [Accepted: 09/21/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Previous cardiac imaging studies using hyperpolarized (HP) [1-13 C]pyruvate were acquired at end-diastole (ED). Little is known about the interaction between cardiac cycle and metabolite content in the myocardium. In this study, we compared images of HP pyruvate and products at end-systole (ES) and ED. METHODS A dual-phase 13 C MRI sequence was implemented to acquire two sequential HP images within a single cardiac cycle at ES and ED during successive R-R intervals in an interleaved manner. Each healthy volunteer (N = 3) received two injections of HP [1-13 C]pyruvate for the dual-phase imaging on the short-axis and the vertical long-axis planes. Spatial distribution of HP 13 C metabolites at each cardiac phase was correlated to multiphase 1 H MRI to confirm the mechanical changes. Ratios of myocardial HP metabolites were compared between ES and ED. Segmental analysis was performed on the midcavity short-axis plane. RESULTS In addition to mechanical changes, metabolic profiles of the heart detected by HP [1-13 C]pyruvate differed between ES and ED. The myocardial signal of [13 C]bicarbonate relative to [1-13 C]lactate was significantly smaller at ED than the ratio at ES (p < .05), particularly in mid-anterior and mid-inferoseptal segments. The distinct metabolic profiles in the myocardium likely reflect the technical aspects of the imaging approach such as the coronary flow in addition to the cyclical changes in metabolism. CONCLUSION The study demonstrates that metabolic profiles of the heart, measured by HP [1-13 C]pyruvate, are affected by the cardiac cycle in which that the data are acquired.
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Affiliation(s)
- Junjie Ma
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas TX USA 75390
| | - Craig R. Malloy
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas TX USA 75390
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas TX USA 75390
- Radiology, The University of Texas Southwestern Medical Center, Dallas TX USA 75390
| | - Salvador Pena
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas TX USA 75390
| | - Crystal E. Harrison
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas TX USA 75390
| | - James Ratnakar
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas TX USA 75390
| | - Vlad G. Zaha
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas TX USA 75390
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas TX USA 75390
| | - Jae Mo Park
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas TX USA 75390
- Radiology, The University of Texas Southwestern Medical Center, Dallas TX USA 75390
- Electrical and Computer Engineering, The University of Texas at Dallas, Richardson TX USA 75080
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14
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Park JM, Harrison CE, Ma J, Chen J, Ratnakar J, Zun Z, Liticker J, Reed GD, Chhabra A, Haller RG, Jue T, Malloy CR. Hyperpolarized 13C MR Spectroscopy Depicts in Vivo Effect of Exercise on Pyruvate Metabolism in Human Skeletal Muscle. Radiology 2021; 300:626-632. [PMID: 34156298 DOI: 10.1148/radiol.2021204500] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Pyruvate dehydrogenase (PDH) and lactate dehydrogenase are essential for adenosine triphosphate production in skeletal muscle. At the onset of exercise, oxidation of glucose and glycogen is quickly enabled by dephosphorylation of PDH. However, direct measurement of PDH flux in exercising human muscle is daunting, and the net effect of covalent modification and other control mechanisms on PDH flux has not been assessed. Purpose To demonstrate the feasibility of assessing PDH activation and changes in pyruvate metabolism in human skeletal muscle after the onset of exercise using carbon 13 (13C) MRI with hyperpolarized (HP) [1-13C]-pyruvate. Materials and Methods For this prospective study, sedentary adults in good general health (mean age, 42 years ± 18 [standard deviation]; six men) were recruited from August 2019 to September 2020. Subgroups of the participants were injected with HP [1-13C]-pyruvate at resting, during plantar flexion exercise, or 5 minutes after exercise during recovery. In parallel, hydrogen 1 arterial spin labeling MRI was performed to estimate muscle tissue perfusion. An unpaired t test was used for comparing 13C data among the states. Results At rest, HP [1-13C]-lactate and [1-13C]-alanine were detected in calf muscle, but [13C]-bicarbonate was negligible. During moderate flexion-extension exercise, total HP 13C signals (tC) increased 2.8-fold because of increased muscle perfusion (P = .005), and HP [1-13C]-lactate-to-tC ratio increased 1.7-fold (P = .04). HP [13C]-bicarbonate-to-tC ratio increased 8.4-fold (P = .002) and returned to the resting level 5 minutes after exercise, whereas the lactate-to-tC ratio continued to increase to 2.3-fold as compared with resting (P = .008). Conclusion Lactate and bicarbonate production from hyperpolarized (HP) [1-carbon 13 {13C}]-pyruvate in skeletal muscle rapidly reflected the onset and the termination of exercise. These results demonstrate the feasibility of imaging skeletal muscle metabolism using HP [1-13C]-pyruvate MRI and the sensitivity of in vivo pyruvate metabolism to exercise states. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Jae Mo Park
- From the Advanced Imaging Research Center (J.M.P., C.E.H., J.M., J.C., J.R., J.L., G.D.R., A.C., C.R.M.), Department of Radiology (J.M.P., A.C., C.R.M.), Department of Neurology and Neurotherapeutics (R.G.H.), and Department of Internal Medicine (C.R.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8568; Department of Electrical and Computer Engineering, University of Texas at Dallas, Dallas, Tex (J.M.P.); Department of Diagnostic Imaging and Radiology, Developing Brain Institute, Children's National Hospital, Washington, DC (Z.Z.); Department of Pediatrics and Radiology, George Washington University, Washington, DC (Z.Z.); GE Healthcare, Dallas, Tex (G.D.R.); Department of Biochemistry and Molecular Medicine, University of California, Davis, Davis, Calif (T.J.); and Veterans Affairs North Texas Healthcare System, Dallas, Tex (C.R.M.)
| | - Crystal E Harrison
- From the Advanced Imaging Research Center (J.M.P., C.E.H., J.M., J.C., J.R., J.L., G.D.R., A.C., C.R.M.), Department of Radiology (J.M.P., A.C., C.R.M.), Department of Neurology and Neurotherapeutics (R.G.H.), and Department of Internal Medicine (C.R.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8568; Department of Electrical and Computer Engineering, University of Texas at Dallas, Dallas, Tex (J.M.P.); Department of Diagnostic Imaging and Radiology, Developing Brain Institute, Children's National Hospital, Washington, DC (Z.Z.); Department of Pediatrics and Radiology, George Washington University, Washington, DC (Z.Z.); GE Healthcare, Dallas, Tex (G.D.R.); Department of Biochemistry and Molecular Medicine, University of California, Davis, Davis, Calif (T.J.); and Veterans Affairs North Texas Healthcare System, Dallas, Tex (C.R.M.)
| | - Junjie Ma
- From the Advanced Imaging Research Center (J.M.P., C.E.H., J.M., J.C., J.R., J.L., G.D.R., A.C., C.R.M.), Department of Radiology (J.M.P., A.C., C.R.M.), Department of Neurology and Neurotherapeutics (R.G.H.), and Department of Internal Medicine (C.R.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8568; Department of Electrical and Computer Engineering, University of Texas at Dallas, Dallas, Tex (J.M.P.); Department of Diagnostic Imaging and Radiology, Developing Brain Institute, Children's National Hospital, Washington, DC (Z.Z.); Department of Pediatrics and Radiology, George Washington University, Washington, DC (Z.Z.); GE Healthcare, Dallas, Tex (G.D.R.); Department of Biochemistry and Molecular Medicine, University of California, Davis, Davis, Calif (T.J.); and Veterans Affairs North Texas Healthcare System, Dallas, Tex (C.R.M.)
| | - Jun Chen
- From the Advanced Imaging Research Center (J.M.P., C.E.H., J.M., J.C., J.R., J.L., G.D.R., A.C., C.R.M.), Department of Radiology (J.M.P., A.C., C.R.M.), Department of Neurology and Neurotherapeutics (R.G.H.), and Department of Internal Medicine (C.R.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8568; Department of Electrical and Computer Engineering, University of Texas at Dallas, Dallas, Tex (J.M.P.); Department of Diagnostic Imaging and Radiology, Developing Brain Institute, Children's National Hospital, Washington, DC (Z.Z.); Department of Pediatrics and Radiology, George Washington University, Washington, DC (Z.Z.); GE Healthcare, Dallas, Tex (G.D.R.); Department of Biochemistry and Molecular Medicine, University of California, Davis, Davis, Calif (T.J.); and Veterans Affairs North Texas Healthcare System, Dallas, Tex (C.R.M.)
| | - James Ratnakar
- From the Advanced Imaging Research Center (J.M.P., C.E.H., J.M., J.C., J.R., J.L., G.D.R., A.C., C.R.M.), Department of Radiology (J.M.P., A.C., C.R.M.), Department of Neurology and Neurotherapeutics (R.G.H.), and Department of Internal Medicine (C.R.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8568; Department of Electrical and Computer Engineering, University of Texas at Dallas, Dallas, Tex (J.M.P.); Department of Diagnostic Imaging and Radiology, Developing Brain Institute, Children's National Hospital, Washington, DC (Z.Z.); Department of Pediatrics and Radiology, George Washington University, Washington, DC (Z.Z.); GE Healthcare, Dallas, Tex (G.D.R.); Department of Biochemistry and Molecular Medicine, University of California, Davis, Davis, Calif (T.J.); and Veterans Affairs North Texas Healthcare System, Dallas, Tex (C.R.M.)
| | - Zungho Zun
- From the Advanced Imaging Research Center (J.M.P., C.E.H., J.M., J.C., J.R., J.L., G.D.R., A.C., C.R.M.), Department of Radiology (J.M.P., A.C., C.R.M.), Department of Neurology and Neurotherapeutics (R.G.H.), and Department of Internal Medicine (C.R.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8568; Department of Electrical and Computer Engineering, University of Texas at Dallas, Dallas, Tex (J.M.P.); Department of Diagnostic Imaging and Radiology, Developing Brain Institute, Children's National Hospital, Washington, DC (Z.Z.); Department of Pediatrics and Radiology, George Washington University, Washington, DC (Z.Z.); GE Healthcare, Dallas, Tex (G.D.R.); Department of Biochemistry and Molecular Medicine, University of California, Davis, Davis, Calif (T.J.); and Veterans Affairs North Texas Healthcare System, Dallas, Tex (C.R.M.)
| | - Jeff Liticker
- From the Advanced Imaging Research Center (J.M.P., C.E.H., J.M., J.C., J.R., J.L., G.D.R., A.C., C.R.M.), Department of Radiology (J.M.P., A.C., C.R.M.), Department of Neurology and Neurotherapeutics (R.G.H.), and Department of Internal Medicine (C.R.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8568; Department of Electrical and Computer Engineering, University of Texas at Dallas, Dallas, Tex (J.M.P.); Department of Diagnostic Imaging and Radiology, Developing Brain Institute, Children's National Hospital, Washington, DC (Z.Z.); Department of Pediatrics and Radiology, George Washington University, Washington, DC (Z.Z.); GE Healthcare, Dallas, Tex (G.D.R.); Department of Biochemistry and Molecular Medicine, University of California, Davis, Davis, Calif (T.J.); and Veterans Affairs North Texas Healthcare System, Dallas, Tex (C.R.M.)
| | - Galen D Reed
- From the Advanced Imaging Research Center (J.M.P., C.E.H., J.M., J.C., J.R., J.L., G.D.R., A.C., C.R.M.), Department of Radiology (J.M.P., A.C., C.R.M.), Department of Neurology and Neurotherapeutics (R.G.H.), and Department of Internal Medicine (C.R.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8568; Department of Electrical and Computer Engineering, University of Texas at Dallas, Dallas, Tex (J.M.P.); Department of Diagnostic Imaging and Radiology, Developing Brain Institute, Children's National Hospital, Washington, DC (Z.Z.); Department of Pediatrics and Radiology, George Washington University, Washington, DC (Z.Z.); GE Healthcare, Dallas, Tex (G.D.R.); Department of Biochemistry and Molecular Medicine, University of California, Davis, Davis, Calif (T.J.); and Veterans Affairs North Texas Healthcare System, Dallas, Tex (C.R.M.)
| | - Avneesh Chhabra
- From the Advanced Imaging Research Center (J.M.P., C.E.H., J.M., J.C., J.R., J.L., G.D.R., A.C., C.R.M.), Department of Radiology (J.M.P., A.C., C.R.M.), Department of Neurology and Neurotherapeutics (R.G.H.), and Department of Internal Medicine (C.R.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8568; Department of Electrical and Computer Engineering, University of Texas at Dallas, Dallas, Tex (J.M.P.); Department of Diagnostic Imaging and Radiology, Developing Brain Institute, Children's National Hospital, Washington, DC (Z.Z.); Department of Pediatrics and Radiology, George Washington University, Washington, DC (Z.Z.); GE Healthcare, Dallas, Tex (G.D.R.); Department of Biochemistry and Molecular Medicine, University of California, Davis, Davis, Calif (T.J.); and Veterans Affairs North Texas Healthcare System, Dallas, Tex (C.R.M.)
| | - Ronald G Haller
- From the Advanced Imaging Research Center (J.M.P., C.E.H., J.M., J.C., J.R., J.L., G.D.R., A.C., C.R.M.), Department of Radiology (J.M.P., A.C., C.R.M.), Department of Neurology and Neurotherapeutics (R.G.H.), and Department of Internal Medicine (C.R.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8568; Department of Electrical and Computer Engineering, University of Texas at Dallas, Dallas, Tex (J.M.P.); Department of Diagnostic Imaging and Radiology, Developing Brain Institute, Children's National Hospital, Washington, DC (Z.Z.); Department of Pediatrics and Radiology, George Washington University, Washington, DC (Z.Z.); GE Healthcare, Dallas, Tex (G.D.R.); Department of Biochemistry and Molecular Medicine, University of California, Davis, Davis, Calif (T.J.); and Veterans Affairs North Texas Healthcare System, Dallas, Tex (C.R.M.)
| | - Thomas Jue
- From the Advanced Imaging Research Center (J.M.P., C.E.H., J.M., J.C., J.R., J.L., G.D.R., A.C., C.R.M.), Department of Radiology (J.M.P., A.C., C.R.M.), Department of Neurology and Neurotherapeutics (R.G.H.), and Department of Internal Medicine (C.R.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8568; Department of Electrical and Computer Engineering, University of Texas at Dallas, Dallas, Tex (J.M.P.); Department of Diagnostic Imaging and Radiology, Developing Brain Institute, Children's National Hospital, Washington, DC (Z.Z.); Department of Pediatrics and Radiology, George Washington University, Washington, DC (Z.Z.); GE Healthcare, Dallas, Tex (G.D.R.); Department of Biochemistry and Molecular Medicine, University of California, Davis, Davis, Calif (T.J.); and Veterans Affairs North Texas Healthcare System, Dallas, Tex (C.R.M.)
| | - Craig R Malloy
- From the Advanced Imaging Research Center (J.M.P., C.E.H., J.M., J.C., J.R., J.L., G.D.R., A.C., C.R.M.), Department of Radiology (J.M.P., A.C., C.R.M.), Department of Neurology and Neurotherapeutics (R.G.H.), and Department of Internal Medicine (C.R.M.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8568; Department of Electrical and Computer Engineering, University of Texas at Dallas, Dallas, Tex (J.M.P.); Department of Diagnostic Imaging and Radiology, Developing Brain Institute, Children's National Hospital, Washington, DC (Z.Z.); Department of Pediatrics and Radiology, George Washington University, Washington, DC (Z.Z.); GE Healthcare, Dallas, Tex (G.D.R.); Department of Biochemistry and Molecular Medicine, University of California, Davis, Davis, Calif (T.J.); and Veterans Affairs North Texas Healthcare System, Dallas, Tex (C.R.M.)
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