Hyperpolarized 13C MRI: Path to Clinical Translation in Oncology

A data-driven approach for improved quantification of in vivo metabolic conversion rates of hyperpolarized [1-13C]pyruvate

PURPOSE

Accurate quantification of metabolism in hyperpolarized (HP) 13C MRI is essential for clinical applications. However, kinetic model parameters are often confounded by uncertainties in radiofrequency flip angles and other model parameters.

METHODS

A data-driven kinetic fitting approach for HP 13C-pyruvate MRI was proposed that compensates for uncertainties in the B1 + field. We hypothesized that introducing a scaling factor to the flip angle to minimize fit residuals would allow more accurate determination of the pyruvate-to-lactate conversion rate (kPL). Numerical simulations were performed under different conditions (flip angle, kPL, and T1 relaxation), with further testing using HP 13C-pyruvate MRI of rat liver and kidneys.

RESULTS

Simulations showed that the proposed method reduced kPL error from 60% to 1% when the prescribed and actual flip angles differed by 60%. The method also showed robustness to T1 uncertainties, achieving median kPL errors within ±3% even when the assumed T1 was incorrect by up to a factor of 2. In rat studies, better-quality fitting for lactate signals (a 1.4-fold decrease in root mean square error [RMSE] for lactate fit) and tighter kPL distributions (an average of 3.1-fold decrease in kPL standard deviation) were achieved using the proposed method compared with when no correction was applied.

CONCLUSION

The proposed data-driven kinetic fitting approach provided a method to accurately quantify HP 13C-pyruvate metabolism in the presence of B1 + inhomogeneity. This model may also be used to correct for other error sources, such as T1 relaxation and flow, and may prove to be clinically valuable in improving tumor staging or assessing treatment response.

Parahydrogen-Hyperpolarized Propane-d6 Gas Contrast Agent: T1 Relaxation Dynamics and Pilot Millimeter-Scale Ventilation MRI

Hyperpolarized (HP) MRI provides enhanced signals over conventional MRI due to the increase in nuclear spin polarization by orders of magnitude compared to thermal polarization. Therefore, HP MRI can be successfully utilized toward imaging of low-density gases in void spaces, such as human lungs. Specifically, in clinical pulmonary imaging, HP MRI employs a gaseous contrast agent that fills the lungs during inhalation under physiologically relevant conditions prior to imaging. FDA-approved HP 129Xe gas can now be used as the first HP inhalable gaseous contrast agent for functional lung imaging in adults and pediatric patients above 12 years for diagnosis and monitoring responses to the treatment of many pulmonary diseases. However, despite the substantial success of HP 129Xe in research settings, the production and MRI of this novel contrast agent remain expensive and not universally available on clinical MRI scanners. An alternative approach is to deploy a proton-hyperpolarized gas that is cheap and fast to produce and can be detected on any clinical MRI scanner without any modification. Hyperpolarized propane gas has recently emerged as a potential next-generation hyperpolarized inhalable contrast agent. Here, the relaxation dynamics of two deuterated hyperpolarized propane isotopologues have been explored at clinically relevant conditions of 1 atm gas pressure and 0.35 and 1.4 T magnetic fields using pairwise addition of parahydrogen to a corresponding unsaturated precursor over the heterogeneous Rh/TiO2 catalyst. The T1 relaxation time of HP propane-d6 gas (0.91±0.03 s) at 1.4 T was found to be similar to that of HP propane gas (0.81±0.06 s) because the dominating relaxation mechanism is due to the coupling of the nuclear spins to the molecular rotation of these two propane gas isotopologues. Moreover, the effective polarization decay constant increases for HP propane-d6 to 1.35±0.05 s (and for HP propane to 1.35±0.10 s) at 0.35 T, pointing to the likely "partial" presence of the long-lived spin states (LLSS) at this clinically relevant field, corresponding to the intermediate spin-spin coupling regime of the two parahydrogen-derived hyperpolarized sites. Furthermore, the pilot feasibility of rapid lung ventilation imaging with 1 × 1 × 9 mm2 voxel-size spatial resolution using a clinical 0.35 T open MRI scanner was demonstrated by inflating HP propane-d6 gas in excised rabbit lungs, despite the reduction of the HP gas relaxation constant to 0.78 ± 0.02 s in the lungs.

Cell-intrinsic metabolic phenotypes identified in patients with glioblastoma, using mass spectrometry imaging of 13C-labelled glucose metabolism

Transcriptomic studies have attempted to classify glioblastoma (GB) into subtypes that predict survival and have different therapeutic vulnerabilities1-3. Here we identified three metabolic subtypes: glycolytic, oxidative and a mix of glycolytic and oxidative, using mass spectrometry imaging of rapidly excised tumour sections from two patients with GB who were infused with [U-13C]glucose and from spatial transcriptomic analysis of contiguous sections. The phenotypes are not correlated with microenvironmental features, including proliferation rate, immune cell infiltration and vascularization, are retained when patient-derived cells are grown in vitro or as orthotopically implanted xenografts and are robust to changes in oxygen concentration, demonstrating their cell-intrinsic nature. The spatial extent of the regions occupied by cells displaying these distinct metabolic phenotypes is large enough to be detected using clinically applicable metabolic imaging techniques. A limitation of the study is that it is based on only two patient tumours, albeit on multiple sections, and therefore represents a proof-of-concept study.

RASER for Increased Spectral Resolution in Carbon-13 NMR

Precision in nuclear magnetic resonance (NMR) spectroscopy and resolution in magnetic resonance imaging (MRI) are thought to be fundamentally limited by the transverse relaxation time. With the recent advent of radiofrequency amplification by stimulated emission of radiation (RASER), it is becoming apparent that RASERs can break these fundamental limitations and provide significant improvements in the resolution of NMR spectra and the resolution in MRI images. In this article, we show that carbon-13 RASERs can be controlled by changes to the magnetic field homogeneity and the spin coupling network. As illustrative examples of tools commonly employed in high-resolution NMR spectroscopy, we employ the control of magnetic field homogeneity with simple changes to the sample geometry and the spin-coupling network with proton decoupling pulses. These changes control the distance of the NMR system from the RASER threshold. Finally, we demonstrate that the 13C-RASER spectra can be obtained reflecting the usual, thermal NMR spectra without significant distortions except with at least 10-fold narrower spectral-resonance line widths, thereby significantly increasing our precision in determining NMR parameters such as the J-coupling in the spin system. In contrast to 1H RASERs, we discuss how 13C-RASER systems retain the spin information (J-couplings and chemical shifts) with high fidelity.

Reaction of polarizing agent Ox063 with pyruvic acid under standard sample preparation protocol for dissolution dynamic nuclear polarization

Dynamic nuclear polarization is a technique that significantly enhances signal intensity in nuclear magnetic resonance spectroscopy and imaging. In a DNP experiment, a sample of interest is doped with a radical, and microwaves are applied in a strong magnetic field, leading to an increase in nuclear spin polarization. Notably, the potential reactions between the sample and the polarization agent are rarely considered. Hyperpolarized 13C magnetic resonance spectroscopy (MRS) is currently used in clinical trials for various diseases. Herein, we demonstrated that with one of the mostly used DNP systems, pyruvic acid, hyperpolarized with the trityl radical Ox063, the alcohol moieties of the radical undergo esterification during sample preparation, leading to the formation of pyruvate esters on the radical, and that Ox063 has a half-life of ∼30 min in pyruvic acid at room temperature. The biological and physicochemical properties of these derivatives have not yet been studied.

Heteronuclear Parahydrogen-Induced Hyperpolarization via Side Arm Hydrogenation

Nuclear spin hyperpolarization dramatically enhances the sensitivity of nuclear magnetic resonance spectroscopy and imaging. Hyperpolarization of biomolecules (e.g., pyruvate) is of particular interest as it allows one to follow their metabolism, providing a diagnostic tool for various pathologies, including cancer. In this regard, the hyperpolarization of 13C nuclei is especially beneficial due to its typically relatively long hyperpolarization lifetime and the absence of a background signal. Parahydrogen-induced polarization (PHIP) is arguably the most affordable hyperpolarization technique. PHIP exploits the pairwise addition of parahydrogen to an unsaturated substrate. This sets limitations on the range of compounds amenable to direct PHIP hyperpolarization. The range of molecules that can be hyperpolarized with PHIP significantly expanded in 2015 when PHIP by means of side arm hydrogenation (PHIP-SAH) was introduced. Herein, parahydrogen is added to an unsaturated alcoholic moiety of an ester followed by polarization transfer to carboxylate 13C nuclei with a subsequent side arm cleavage. In this review, the recent advances in PHIP-SAH are discussed, including the synthetic methodology to produce isotopically labeled precursors, peculiarities of pairwise addition of parahydrogen to PHIP-SAH precursors, polarization transfer approaches, hyperpolarization lifetime, side arm cleavage, purification of hyperpolarized solution, and, finally, in vitro and in vivo applications.

Quantum life science: biological nano quantum sensors, quantum technology-based hyperpolarized MRI/NMR, quantum biology, and quantum biotechnology

The emerging field of quantum life science combines principles from quantum physics and biology to study fundamental life processes at the molecular level. Quantum mechanics, which describes the properties of small particles, can help explain how quantum phenomena such as tunnelling, superposition, and entanglement may play a role in biological systems. However, capturing these effects in living systems is a formidable challenge, as it involves dealing with dissipation and decoherence caused by the surrounding environment. We overview the current status of the quantum life sciences from technologies and topics in quantum biology. Technologies such as biological nano quantum sensors, quantum technology-based hyperpolarized MRI/NMR, high-speed 2D electronic spectrometers, and computer simulations are being developed to address these challenges. These interdisciplinary fields have the potential to revolutionize our understanding of living organisms and lead to advancements in genetics, molecular biology, medicine, and bioengineering.

Translation of hyperpolarized [13C,15N2]urea MRI for novel human brain perfusion studies

This study developed a new approach to produce sterile, hyperpolarized [13C,15N2]urea as a novel molecular imaging probe and applied it for first-ever healthy brain volunteer studies. Hyperpolarized [13C,15N2]urea, as a small, metabolically inert molecule, offers significant advantages for perfusion imaging due to its endogenous nature and excellent safety profile. The developed methods achieved a hyperpolarized [13C,15N2]urea solution (132 ± 6 mM) with 27.4 ± 5.6% polarization and a T1 = 50.4 ± 0.2 s. In healthy brain volunteer studies, high-resolution 13C imaging captured blood flow with a spatial resolution of 7.76 × 7.76 × 15 (or 10) mm3 over ~1 min following hyperpolarized [13C,15N2]urea injection, visualizing detailed vascular structures. Time-to-peak and centroid analyses showed consistent arterial and venous signal patterns across subjects. Findings suggest hyperpolarized [13C,15N2]urea may have applications beyond brain imaging, including the non-invasive perfusion assessment in various organs, cancer microenvironment, and renal function, paving the way for clinical translation.

Carbon-13 Hyperpolarization of α-Ketocarboxylates with Parahydrogen in Reversible Exchange

Signal Amplification by Reversible Exchange (SABRE) is a relatively simple and fast hyperpolarization technique that has been used to hyperpolarize the α-ketocarboxylate pyruvate, a central metabolite and the leading hyperpolarized MRI contrast agent. In this work, we show that SABRE can readily be extended to hyperpolarize 13C nuclei at natural abundance on many other α-ketocarboxylates. Hyperpolarization is observed and optimized on pyruvate (P13C=17 %) and 2-oxobutyrate (P13C=25 %) with alkyl chains in the R-group, oxaloacetate (P13C=11 %) and alpha-ketoglutarate (P13C=13 %) with carboxylate moieties in the R group, and phenylpyruvate (P13C=2 %) and phenylglyoxylate (P13C=2 %) with phenyl rings in the R-group. New catalytically active SABRE binding motifs of the substrates to the hyperpolarization transfer catalyst - particularly for oxaloacetate - are observed. We experimentally explore the connection between temperature and exchange rates for all of these SABRE systems and develop a theoretical kinetic model, which is used to fit the hyperpolarization build-up and decay during SABRE activity.

Metabolic imaging distinguishes ovarian cancer subtypes and detects their early and variable responses to treatment

High grade serous ovarian cancer displays two metabolic subtypes; a high OXPHOS subtype that shows increased expression of genes encoding electron transport chain components, increased oxygen consumption, and increased chemosensitivity, and a low OXPHOS subtype that exhibits glycolytic metabolism and is more drug resistant. We show here in patient-derived organoids and in the xenografts obtained by their subcutaneous implantation that the low OXPHOS subtype shows higher lactate dehydrogenase activity and monocarboxylate transporter 4 expression than the high OXPHOS subtype and increased lactate labeling in 13C magnetic resonance spectroscopy (MRS) measurements of hyperpolarized [1-13C]pyruvate metabolism. There was no difference between the subtypes in PET measurements of 2-deoxy-2-[fluorine-18]fluoro-D-glucose ([18F]FDG) uptake. Both metabolic imaging techniques could detect the early response to Carboplatin treatment in drug-sensitive high OXPHOS xenografts and no response in drug-resistant in low OXPHOS xenografts. 13C magnetic resonance spectroscopic imaging of hyperpolarized [1-13C]pyruvate metabolism has the potential to be used clinically to distinguish low OXPHOS and high OXPHOS tumor deposits in HGSOC patients and to detect their differential responses to treatment.

MRI detection of free-contrast agent nanoparticles

PURPOSE

The integration of nanotechnology into biomedical imaging has significantly advanced diagnostic and theranostic capabilities. However, nanoparticle detection in imaging relies on functionalization with appropriate probes. In this work, a new approach to visualize free-label nanoparticles using MRI and MRS techniques is described, consisting of detecting by 1H CSI specific proton signals belonging to the components naturally present in most of the nanosystems used in preclinical and clinical research.

METHODS

Three different nanosystems, namely lipid-based micelles, liposomes, and perfluorocarbon-based nanoemulsions, were synthesized, characterized by high resolution NMR and then visualized by 1H CSI at 300 MHz. Subsequently the best 1H CSI performing system was administered to murine models of cancer to evaluate the possibility of tracking the nanosystem by looking at its proton associated signal. Furthermore, an in vitro comparison between 1H CSI and 19F MRI was carried out.

RESULTS

The study successfully demonstrates the feasibility of detecting nanoparticles using MRI/MRS without probe functionalization, employing 1H CSI. Among the nanosystems tested, the perfluorocarbon-based nanoemulsion exhibited the highest SNR. Consequently, it was evaluated in vivo, where its detection was achievable within tumors and inflamed regions via 1H CSI, and in lymph nodes via PRESS.

CONCLUSIONS

These findings present a promising avenue for nanoparticle imaging in biomedical applications, offering potential enhancements to diagnostic and theranostic procedures. This non-invasive approach has the capacity to advance imaging techniques and expand the scope of nanoparticle-based biomedical research. Further exploration is necessary to fully explore the implications and applications of this method.

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.

Spatially constrained hyperpolarized 13C MRI pharmacokinetic rate constant map estimation using a digital brain phantom and a U-Net

Fitting rate constants to Hyperpolarized [1-13C]Pyruvate (HP C13) MRI data is a promising approach for quantifying metabolism in vivo. Current methods typically fit each voxel of the dataset using a least-squares objective. With these methods, each voxel is considered independently, and the spatial relationships are not considered during fitting. In this work, we use a convolutional neural network, a U-Net, with convolutions across the 2D spatial dimensions to estimate pyruvate-to-lactate conversion rate, kPL, maps from dynamic HP C13 datasets. We designed a framework for creating simulated anatomically accurate brain data that matches typical HP C13 characteristics to provide large amounts of data for training with ground truth results. The U-Net is initially trained with the digital phantom data and then further trained with in vivo datasets for regularization. In simulation where ground-truth kPL maps are available, the U-Net outperforms voxel-wise fitting with and without spatiotemporal denoising, particularly for low SNR data. In vivo data was evaluated qualitatively, as no ground truth is available, and before regularization the U-Net predicted kPL maps appear oversmoothed. After further training with in vivo data, the resulting kPL maps appear more realistic. This study demonstrates how to use a U-Net to estimate rate constant maps for HP C13 data, including a comprehensive framework for generating a large amount of anatomically realistic simulated data and an approach for regularization. This simulation and architecture provide a foundation that can be built upon in the future for improved performance.

Lactylation in health and disease: physiological or pathological?

Lactate is an indispensable substance in various cellular physiological functions and plays regulatory roles in different aspects of energy metabolism and signal transduction. Lactylation (Kla), a key pathway through which lactate exerts its functions, has been identified as a novel posttranslational modification (PTM). Research indicates that Kla is an essential balancing mechanism in a variety of organisms and is involved in many key cellular biological processes through different pathways. Kla is closely related to disease development and represents a potential and important new drug target. In line with existing reports, we searched for newly discovered Kla sites on histone and nonhistone proteins; reviewed the regulatory mechanisms of Kla (particularly focusing on the enzymes directly involved in the reversible regulation of Kla, including "writers" (modifying enzymes), "readers" (modification-binding enzymes), and "erasers" (demodifying enzymes); and summarized the crosstalk between different PTMs to help researchers better understand the widespread distribution of Kla and its diverse functions. Furthermore, considering the "double-edged sword" role of Kla in both physiological and pathological contexts, this review highlights the "beneficial" biological functions of Kla in physiological states (energy metabolism, inflammatory responses, cell fate determination, development, etc.) and its "detrimental" pathogenic or inducive effects on pathological processes, particularly malignant tumors and complex nontumor diseases. We also clarify the molecular mechanisms of Kla in health and disease, and discuss its feasibility as a therapeutic target. Finally, we describe the detection technologies for Kla and their potential applications in diagnosis and clinical settings, aiming to provide new insights for the treatment of various diseases and to accelerate translation from laboratory research to clinical practice.

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.

Three-dimensional radial echo-planar spectroscopic imaging for hyperpolarized 13C MRSI in vivo

PURPOSE

To demonstrate the feasibility of 3D echo-planar spectroscopic imaging (EPSI) technique with rapid volumetric radial k-space sampling for hyperpolarized (HP) 13C magnetic resonance spectroscopic imaging (MRSI) in vivo.

METHODS

A radial EPSI (rEPSI) was implemented on a 3 T clinical PET/MR system. To enable volumetric coverage, the sinusoidal shaped readout gradients per k-t-spoke were rotated along the three spatial dimensions in a golden-angle like manner. A distance-weighted, density-compensated gridding reconstruction was used, also in cases with undersampling of spokes in k-space. Measurements without and with HP 13C-labeled substances were performed in phantoms and rats using a double-resonant 13C/1H volume resonator with 72 mm inner diameter.

RESULTS

Phantom measurements demonstrated the feasibility of the implemented rEPSI sequence, as well as the robustness to undersampling in k-space up to a factor of 5 without advanced reconstruction techniques. Applied to measurements with HP [1-13C]pyruvate in a tumor-bearing rat, we obtained well-resolved MRSI datasets with a large matrix size of 123 voxels covering the whole imaging FOV of (180 mm)3 within 6.3 s, enabling to observe metabolism in dynamic acquisitions.

CONCLUSION

After further optimization, the proposed rEPSI method may be useful in applications of HP 13C-tracers where unknown or varying metabolite resonances are expected, and the acquisition of dynamic, volumetric MRSI datasets with an adequate temporal resolution is a challenge.

Simultaneous noninvasive quantification of redox and downstream glycolytic fluxes reveals compartmentalized brain metabolism

Brain metabolism across anatomic regions and cellular compartments plays an integral role in many aspects of neuronal function. Changes in key metabolic pathway fluxes, including oxidative and reductive energy metabolism, have been implicated in a wide range of brain diseases. Given the complex nature of the brain and the need for understanding compartmentalized metabolism noninvasively in vivo, new tools are required. Herein, using hyperpolarized (HP) magnetic resonance imaging coupled with in vivo isotope tracing, we develop a platform to simultaneously probe redox and energy metabolism in the murine brain. By combining HP dehydroascorbate and pyruvate, we are able to visualize increased lactate production in the white matter and increased redox capacity in the deep gray matter. Leveraging positional labeling, we show differences in compartmentalized tricarboxylic acid cycle entry versus downstream flux to glutamate. These findings lay the foundation for clinical translation of the proposed approach to probe brain metabolism.

Rapid lung ventilation MRI using parahydrogen-induced polarization of propane gas

Proton-hyperpolarized contrast agents are attractive because they can be imaged on virtually any clinical MRI scanner, which is typically equipped to scan only protons rather than heteronuclei (i.e., anything besides protons, e.g., 13C, 15N, 129Xe, 23Na, etc.). Even though the lifetime of the proton spin hyperpolarization is only a few seconds, it is sufficient for inhalation and scanning of proton-hyperpolarized gas media. We demonstrate the utility of producing hyperpolarized propane gas via heterogeneous parahydrogen-induced polarization for the purpose of ventilation imaging in an excised rabbit lung model. The magnetization of protons in hyperpolarized propane gas is similar to that of tissue water protons, making it possible to rapidly perform lung ventilation imaging with a 0.35 T clinical MRI scanner. Here, we demonstrate the feasibility of rapid (2 s) lung ventilation MRI in excised rabbit lungs using hyperpolarized propane gas with a 1 × 1 mm2 pixel size using a 50 mm slice thickness, and a 1.7 × 1.7 mm2 pixel size using a 9 mm slice thickness.

Molecular Imaging Biomarkers for Early Cancer Detection: A Systematic Review of Emerging Technologies and Clinical Applications

BACKGROUND

Early cancer detection is crucial for improving patient outcomes. Molecular imaging biomarkers offer the potential for non-invasive, early-stage cancer diagnosis.

OBJECTIVES

To evaluate the effectiveness and accuracy of molecular imaging biomarkers for early cancer detection across various imaging modalities and cancer types.

METHODS

A comprehensive search of PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, and Scopus was performed, covering the period from January 2010 to December 2023. Eligibility criteria included original research articles published in English on molecular imaging biomarkers for early cancer detection in humans. The risk of bias for included studies was evaluated using the QUADAS-2 tool. The findings were synthesized through narrative synthesis, with quantitative analysis conducted where applicable.

RESULTS

In total, 50 studies were included. Positron emission tomography (PET)-based biomarkers showed the highest sensitivity (mean: 89.5%, range: 82-96%) and specificity (mean: 91.2%, range: 85-100%). Novel tracers such as [68Ga]-PSMA for prostate cancer and [18F]-FES for breast cancer demonstrated promising outcomes. Optical imaging techniques showed high specificity in intraoperative settings.

CONCLUSIONS

Molecular imaging biomarkers show significant potential for improving early cancer detection. Integration into clinical practice could lead to earlier interventions and improved outcomes. Further research is needed to address standardization and cost-effectiveness.

Artificial Intelligence for Response Assessment in Neuro Oncology (AI-RANO), part 1: review of current advancements

The development, application, and benchmarking of artificial intelligence (AI) tools to improve diagnosis, prognostication, and therapy in neuro-oncology are increasing at a rapid pace. This Policy Review provides an overview and critical assessment of the work to date in this field, focusing on diagnostic AI models of key genomic markers, predictive AI models of response before and after therapy, and differentiation of true disease progression from treatment-related changes, which is a considerable challenge based on current clinical care in neuro-oncology. Furthermore, promising future directions, including the use of AI for automated response assessment in neuro-oncology, are discussed.

Deep learning corrects artifacts in RASER MRI profiles

A newly developed magnetic resonance imaging (MRI) approach is based on "Radiowave amplification by the stimulated emission of radiation" (RASER). RASER MRI potentially allows for higher resolution, is inherently background-free, and does not require radio-frequency excitation. However, RASER MRI can be "nearly unusable" as heavy distortions from nonlinear effects can occur. In this work, we show that deep learning (DL) reduces such artifacts in RASER images. We trained a two-step DL pipeline on purely synthetic data, which was generated based on a previously published, theoretical model for RASER MRI. A convolutional neural network was trained on 630'000 1D RASER projections, and a U-net on 2D random images. The DL pipeline generalizes well when applied from synthetic to experimental RASER MRI data.

Low-Cost Purpose-Built Ultra-Low-Field NMR Spectrometer

Low-field NMR has emerged as a new analytical technique for the investigation of molecular structure and dynamics. Here, we introduce a highly integrated ultralow-frequency NMR spectrometer designed for the purpose of ultralow-field NMR polarimetry of hyperpolarized contrast media. The device measures 10 cm × 10 cm × 2.0 cm and weighs only 370 g. The spectrometer's aluminum enclosure contains all components, including an RF amplifier. The device has four ports for connecting to a high-impedance RF transmit-receive coil, a trigger input, a USB port for connectivity to a PC computer, and an auxiliary RS-485/24VDC port for system integration with other devices. The NMR spectrometer is configured for a pulse-wait-acquire-recover pulse sequence, and key sequence parameters are readily controlled by a graphical user interface (GUI) of a Windows-based PC computer. The GUI also displays the time-domain and Fourier-transformed NMR signal and allows autosaving of NMR data as a CSV file. Alternatively, the RS485 communication line allows for operating the device with sequence parameter control and data processing directly on the spectrometer board in a fully automated and integrated manner. The NMR spectrometer, equipped with a 250 ksamples/s 17-bit analog-to-digital signal converter, can perform acquisition in the 1-125 kHz frequency range. The utility of the device is demonstrated for NMR polarimetry of hyperpolarized 129Xe gas and [1-13C]pyruvate contrast media (which was compared to the 13C polarimetry using a more established technology of benchtop 13C NMR spectroscopy, and yielded similar results), allowing reproducible quantification of polarization values and relaxation dynamics. The cost of the device components is only ∼$200, offering a low-cost integrated NMR spectrometer that can be deployed as a plug-and-play device for a wide range of applications in hyperpolarized contrast media production─and beyond.

Live magnetic observation of parahydrogen hyperpolarization dynamics

Hyperpolarized nuclear spins in molecules exhibit high magnetization that is unachievable by classical polarization techniques, making them widely used as sensors in physics, chemistry, and medicine. The state of a hyperpolarized material, however, is typically only studied indirectly and with partial destruction of magnetization, due to the nature of conventional detection by resonant-pickup NMR spectroscopy or imaging. Here, we establish atomic magnetometers with sub-pT sensitivity as an alternative modality to detect in real time the complex dynamics of hyperpolarized materials without disturbing or interrupting the magnetogenesis process. As an example of dynamics that are impossible to detect in real time by conventional means, we examine parahydrogen-induced 1H and 13C magnetization during adiabatic eigenbasis transformations at [Formula: see text]T-field avoided crossings. Continuous but nondestructive magnetometry reveals previously unseen spin dynamics, fidelity limits, and magnetization backaction effects. As a second example, we apply magnetometry to observe the chemical-exchange-driven 13C hyperpolarization of [1-13C]-pyruvate-the most important spin tracer for clinical metabolic imaging. The approach can be readily combined with other high-sensitivity magnetometers and is applicable to a broader range of general observation scenarios involving production, transport, and systems interaction of hyperpolarized compounds.

Directly monitoring the dynamic in vivo metabolisms of hyperpolarized 13C-oligopeptides

Peptides play essential roles in biological phenomena, and, thus, there is a growing interest in detecting in vivo dynamics of peptide metabolisms. Dissolution-dynamic nuclear polarization (d-DNP) is a state-of-the-art technology that can markedly enhance the sensitivity of nuclear magnetic resonance (NMR), providing metabolic and physiological information in vivo. However, the hyperpolarized state exponentially decays back to the thermal equilibrium, depending on the spin-lattice relaxation time (T1). Because of the limitation in T1, peptide-based DNP NMR molecular probes applicable in vivo have been limited to amino acids or dipeptides. Here, we report the direct detection of in vivo metabolic conversions of hyperpolarized 13C-oligopeptides. Structure-based T1 relaxation analysis suggests that the C-terminal [1-13C]Gly-d2 residue affords sufficient T1 for biological uses, even in relatively large oligopeptides, and allowed us to develop 13C-β-casomorphin-5 and 13C-glutathione. It was found that the metabolic response and perfusion of the hyperpolarized 13C-glutathione in the mouse kidney were significantly altered in a model of cisplatin-induced acute kidney injury.

Multimodal surface coils for low field MR imaging

Low field MRI is safer and more cost effective than the high field MRI. One of the inherent problems of low field MRI is its low signal-to-noise ratio or sensitivity. In this work, we introduce a multimodal surface coil technique for signal excitation and reception to improve the RF magnetic field (B1) efficiency and potentially improve MR sensitivity. The proposed multimodal surface coil consists of multiple identical resonators that are electromagnetically coupled to form a multimodal resonator. The field distribution of its lowest frequency mode is suitable for MR imaging applications. The prototype multimodal surface coils are built, and the performance is investigated and validated through numerical simulation, standard RF measurements and tests, and comparison with the conventional surface coil at low fields. Our results show that the B1 efficiency of the multimodal surface coil outperforms that of the conventional surface coil which is known to offer the highest B1 efficiency among all coil categories, i.e., volume coil, half-volume coil and surface coil. In addition, in low-field MRI, the required low-frequency coils often use large value capacitance to achieve the low resonant frequency which makes frequency tuning difficult. The proposed multimodal surface coil can be conveniently tuned to the required low frequency for low-field MRI with significantly reduced capacitance value, demonstrating excellent low-frequency operation capability over the conventional surface coil.

Toward Ultra-High-Quality-Factor Wireless Masing Magnetic Resonance Sensing

It has recently been shown that a bolus of hyperpolarized nuclear spins can yield stimulated emission signals similar in nature to maser signals, potentially enabling new ways of sensing hyperpolarized contrast media, including most notably [1-13C]pyruvate that is under evaluation in over 50 clinical trials for metabolic imaging of cancer. The stimulated NMR signal emissions lasting for minutes do not require radio-frequency excitation, offering unprecedented advantages compared to conventional MR sensing. However, creating nuclear spin maser emission is challenging in practice due to stringent fundamental requirements, making practical in vivo applications hardly possible using conventional passive MR detectors. Here, we demonstrate the utility of a wireless NMR maser detector, the quality factor of which was enhanced 22-fold (to 1,670) via parametric pumping. This active-feedback technique breaks the intrinsic fundamental limit of NMR detector circuit quality factor. We show the use of parametric pumping to reduce the threshold requirement for inducing nuclear spin masing at 300 MHz resonance frequency in a preclinical MRI scanner. Indeed, stimulated emission from hyperpolarized protons was obtained under highly unfavorable conditions of low magnetic field homogeneity (T2* of 3 ms). Greater gains of the quality factor of the MR detector (up to 1 million) were also demonstrated.

Enabling SENSE accelerated 2D CSI for hyperpolarized carbon-13 imaging

As hyperpolarized (HP) carbon-13 (13C) metabolic imaging is clinically translated, there is a need for easy-to-implement, fast, and robust imaging techniques. However, achieving high temporal resolution without decreasing spatial and/or spectral resolution, whilst maintaining the usability of the imaging sequence is challenging. Therefore, this study looked to accelerate HP 13C MRI by combining a well-established and robust sequence called two-dimensional Chemical Shift Imaging (2D CSI) with prospective under sampling and SENSitivity Encoding (SENSE) reconstruction. Due to the low natural abundance of 13C, the sensitivity maps cannot be pre-acquired for the reconstruction. As such, the implementation of sodium (23Na) sensitivity maps for SENSE reconstructed 13C CSI was demonstrated in a phantom and in vivo in the pig kidney. Results showed that SENSE reconstruction using 23Na sensitivity maps corrected aliased images with a four-fold acceleration. With high temporal resolution, the kidney spectra produced a detailed metabolic arrival and decay curve, useful for further metabolite kinetic modelling or denoising. Metabolic ratio maps were produced in three pigs demonstrating the technique's ability for repeat metabolic measurements. In cases with unknown metabolite spectra or limited HP MRI specialist knowledge, this robust acceleration method ensures comprehensive capture of metabolic signals, mitigating the risk of missing spectral data.

Design, Synthesis, and Assessment of Tricarboxylic Acid Cycle Probes

Hyperpolarized 13C magnetic resonance spectroscopy can provide unique insights into metabolic activity in vivo. Despite the advantages of this technology, certain metabolic pathways such as the tricarboxylic acid (TCA) cycle are more challenging to examine due to the limitations associated with currently available hyperpolarized 13C probes. In this report, we systematically employ computational analyses, synthetic techniques, and in vitro studies to facilitate the design of new chemical probes for the TCA cycle. This platform allows for the rapid identification of probe scaffolds that are amenable to hyperpolarized 13C experimentation. Using these results, we have developed two 13C-labeled chemical probes, [1,4-13C2]-dipropyl succinate and [1,4-13C2]-diallyl succinate, which are employed in hyperpolarized 13C metabolic studies.

Detecting biomarkers by dynamic nuclear polarization enhanced magnetic resonance

Hyperpolarization stands out as a technique capable of significantly enhancing the sensitivity of nuclear magnetic resonance (NMR) and magnetic resonance imaging (MRI). Dynamic nuclear polarization (DNP), among various hyperpolarization methods, has gained prominence for its efficacy in real-time monitoring of metabolism and physiology. By administering a hyperpolarized substrate through dissolution DNP (dDNP), the biodistribution and metabolic changes of the DNP agent can be visualized spatiotemporally. This approach proves to be a distinctive and invaluable tool for non-invasively studying cellular metabolism in vivo, particularly in animal models. Biomarkers play a pivotal role in influencing the growth and metastasis of tumor cells by closely interacting with them, and accordingly detecting pathological alterations of these biomarkers is crucial for disease diagnosis and therapy. In recent years, a range of hyperpolarized DNP molecular bioresponsive agents utilizing various nuclei, such as 13C, 15N, 31P, 89Y, etc., have been developed. In this context, we explore how these magnetic resonance signals of nuclear spins enhanced by DNP respond to biomarkers, including pH, metal ions, enzymes, or redox processes. This review aims to offer insights into the design principles of responsive DNP agents, target selection, and the mechanisms of action for imaging. Such discussions aim to propel the future development and application of DNP-based biomedical imaging agents.

Coupled stack-up volume RF coils for low-field open MR imaging

Background

Low-field open magnetic resonance imaging (MRI) systems, typically operating at magnetic field strengths below 1 Tesla, has greatly expanded the accessibility of MRI technology to meet a wide range of patient needs. However, the inherent challenges of low-field MRI, such as limited signal-to-noise ratios and limited availability of dedicated radiofrequency (RF) coils, have prompted the need for innovative coil designs that can improve imaging quality and diagnostic capabilities.

Purpose

In response to these challenges, we introduce the coupled stack-up volume coil, a novel RF coil design that addresses the shortcomings of conventional birdcage in the context of low-field open MRI.

Methods

The proposed coupled stack-up volume coil design utilizes a unique architecture that optimizes both transmit/receive efficiency and RF field homogeneity and offers the advantage of a simple design and construction, making it a practical and feasible solution for low-field MRI applications. This paper presents a comprehensive exploration of the theoretical framework, design considerations, and experimental validation of this innovative coil design.

Results

We demonstrate the superior performance of the coupled stack-up volume coil in achieving 47.7% higher transmit/receive efficiency and 68% more uniform magnetic field distribution compared to traditional birdcage coils in electromagnetic simulations. Bench tests results show that the B1 field efficiency of coupled stack-up volume coil is 57.3% higher compared with that of conventional birdcage coil.

Conclusions

The proposed coupled stack-up volume coil outperforms the conventional birdcage coil in terms of B1 efficiency, imaging coverage, and low-frequency operation capability. This design provides a robust and simple solution to low-field MR RF coil design.

Metabolic imaging across scales reveals distinct prostate cancer phenotypes

Hyperpolarised magnetic resonance imaging (HP-13C-MRI) has shown promise as a clinical tool for detecting and characterising prostate cancer. Here we use a range of spatially resolved histological techniques to identify the biological mechanisms underpinning differential [1-13C]lactate labelling between benign and malignant prostate, as well as in tumours containing cribriform and non-cribriform Gleason pattern 4 disease. Here we show that elevated hyperpolarised [1-13C]lactate signal in prostate cancer compared to the benign prostate is primarily driven by increased tumour epithelial cell density and vascularity, rather than differences in epithelial lactate concentration between tumour and normal. We also demonstrate that some tumours of the cribriform subtype may lack [1-13C]lactate labelling, which is explained by lower epithelial lactate dehydrogenase expression, higher mitochondrial pyruvate carrier density, and increased lipid abundance compared to lactate-rich non-cribriform lesions. These findings highlight the potential of combining spatial metabolic imaging tools across scales to identify clinically significant metabolic phenotypes in prostate cancer.

Long-lived enhanced magnetization-A practical metabolic MRI contrast material

Noninvasive tracking of biochemical processes in the body is paramount in diagnostic medicine. Among the leading techniques is spectroscopic magnetic resonance imaging (MRI), which tracks metabolites with an amplified (hyperpolarized) magnetization signal injected into the subject just before scanning. Traditionally, the brief enhanced magnetization period of these agents limited clinical imaging. We propose a solution based on amalgamating two materials-one having diagnostic-metabolic activity and the other characterized by robust magnetization retention. This combination slows the magnetization decay in the diagnostic metabolic probe, which receives continuously replenished magnetization from the companion material. Thus, it extends the magnetization lifetime in some of our measurements to beyond 4 min, with net magnetization enhanced by more than four orders of magnitude. This could allow the metabolic probes to remain magnetized from injection until they reach the targeted organ, improving tissue signatures in clinical imaging. Upon validation, this metabolic MRI technique promises wide-ranging clinical applications, including diagnostic imaging, therapeutic monitoring, and posttreatment surveillance.

Efficient Parahydrogen-Induced 13C Hyperpolarization on a Microfluidic Device

We show the direct production and detection of 13C-hyperpolarized fumarate by parahydrogen-induced polarization (PHIP) in a microfluidic lab-on-a-chip (LoC) device and achieve 8.5% 13C polarization. This is the first demonstration of 13C-hyperpolarization of a metabolite by PHIP in a microfluidic device. LoC technology allows the culture of mammalian cells in a highly controlled environment, providing an important tool for the life sciences. In-situ preparation of hyperpolarized metabolites greatly enhances the ability to quantify metabolic processes in such systems by microfluidic NMR. PHIP of 1H nuclei has been successfully implemented in microfluidic systems, with mass sensitivities in the range of pmol/s. However, metabolic NMR requires high-yield production of hyperpolarized metabolites with longer spin life times than is possible with 1H. This can be achieved by transfer of the polarization onto 13C nuclei, which exhibit much longer T1 relaxation times. We report an improved microfluidic PHIP device, optimized using a finite element model, that enables the direct and efficient production of 13C-hyperpolarized fumarate.

Deuterium Metabolic Imaging Differentiates Glioblastoma Metabolic Subtypes and Detects Early Response to Chemoradiotherapy

Metabolic subtypes of glioblastoma (GBM) have different prognoses and responses to treatment. Deuterium metabolic imaging with 2H-labeled substrates is a potential approach to stratify patients into metabolic subtypes for targeted treatment. In this study, we used 2H magnetic resonance spectroscopy and magnetic resonance spectroscopic imaging (MRSI) measurements of [6,6'-2H2]glucose metabolism to identify metabolic subtypes and their responses to chemoradiotherapy in patient-derived GBM xenografts in vivo. The metabolism of patient-derived cells was first characterized in vitro by measuring the oxygen consumption rate, a marker of mitochondrial tricarboxylic acid cycle activity, as well as the extracellular acidification rate and 2H-labeled lactate production from [6,6'-2H2]glucose, which are markers of glycolytic activity. Two cell lines representative of a glycolytic subtype and two representative of a mitochondrial subtype were identified. 2H magnetic resonance spectroscopy and MRSI measurements showed similar concentrations of 2H-labeled glucose from [6,6'-2H2]glucose in all four tumor models when implanted orthotopically in mice. The glycolytic subtypes showed higher concentrations of 2H-labeled lactate than the mitochondrial subtypes and normal-appearing brain tissue, whereas the mitochondrial subtypes showed more glutamate/glutamine labeling, a surrogate for tricarboxylic acid cycle activity, than the glycolytic subtypes and normal-appearing brain tissue. The response of the tumors to chemoradiation could be detected within 24 hours of treatment completion, with the mitochondrial subtypes showing a decrease in both 2H-labeled glutamate/glutamine and lactate concentrations and glycolytic tumors showing a decrease in 2H-labeled lactate concentration. This technique has the potential to be used clinically for treatment selection and early detection of treatment response.

SIGNIFICANCE

Deuterium magnetic resonance spectroscopic imaging of glucose metabolism has the potential to differentiate between glycolytic and mitochondrial metabolic subtypes in glioblastoma and to evaluate early treatment responses, which could guide patient treatment.

15N Hyperpolarization of Metronidazole Antibiotic in Aqueous Media Using Phase-Separated Signal Amplification by Reversible Exchange with Parahydrogen

Metronidazole is a prospective hyperpolarized MRI contrast agent with potential hypoxia sensing utility for applications in cancer, stroke, neurodegenerative diseases, etc. We demonstrate a pilot procedure for production of ∼30 mM hyperpolarized [15N3]metronidazole in aqueous media by using a phase-separated SABRE-SHEATH hyperpolarization method, with nitrogen-15 polarization exceeding 2.2% on all three 15N sites achieved in less than 2 min. The 15N polarization T1 of ∼12 min is reported for the 15NO2 group at the clinically relevant field of 1.4 T in the aqueous phase, demonstrating a remarkably long lifetime of the hyperpolarized state. The produced aqueous solution of [15N3]metronidazole that contained only ∼100 μM of residual Ir was deemed biocompatible via validation through the MTT colorimetric test for assessing cell metabolic activity using human embryotic kidney HEK293T cells. This low-cost and ultrafast hyperpolarization procedure represents a major advance for the production of a biocompatible HP [15N3]metronidazole (and potentially other hyperpolarized drugs) formulation for MRI sensing applications.

MRI Application and Challenges of Hyperpolarized Carbon-13 Pyruvate in Translational and Clinical Cardiovascular Studies: A Literature Review

Cardiovascular disease shows, or may even be caused by, changes in metabolism. Hyperpolarized magnetic resonance spectroscopy and imaging is a technique that could assess the role of different aspects of metabolism in heart disease, allowing real-time metabolic flux assessment in vivo. In this review, we introduce the main hyperpolarization techniques. Then, we summarize the use of dedicated radiofrequency 13C coils, and report a state of the art of 13C data acquisition. Finally, this review provides an overview of the pre-clinical and clinical studies on cardiac metabolism in the healthy and diseased heart. We furthermore show what advances have been made to translate this technique into the clinic in the near future and what technical challenges still remain, such as exploring other metabolic substrates.

Dual-Tuned Coaxial-Transmission-Line RF Coils for Hyperpolarized 13C and Deuterium 2H Metabolic MRS Imaging at Ultrahigh Fields

OBJECTIVE

Information on the metabolism of tissues in healthy and diseased states plays a significant role in the detection and understanding of tumors, neurodegenerative diseases, diabetes, and other metabolic disorders. Hyperpolarized carbon-13 magnetic resonance imaging (13C-HPMRI) and deuterium metabolic imaging (2H-DMI) are two emerging X-nuclei used as practical imaging tools to investigate tissue metabolism. However due to their low gyromagnetic ratios (ɣ13C = 10.7 MHz/T; ɣ2H = 6.5 MHz/T) and natural abundance, such method required a sophisticated dual-tuned radiofrequency (RF) coil.

METHODS

Here, we report a dual-tuned coaxial transmission line (CTL) RF coil agile for metabolite information operating at 7T with independent tuning capability. The design analysis has demonstrated how both resonant frequencies can be individually controlled by simply varying the constituent of the design parameters.

RESULTS

Numerical results have demonstrated a broadband tuning range capability, covering most of the X-nucleus signal, especially the 13C and 2H spectra at 7T. Furthermore, in order to validate the feasibility of the proposed design, both dual-tuned 1H/13C and 1H/2H CTLs RF coils are fabricated using a semi-flexible RG-405 .086" coaxial cable and bench test results (scattering parameters and magnetic field efficiency/distribution) are successfully obtained.

CONCLUSION

The proposed dual-tuned RF coils reveal highly effective magnetic field obtained from both proton and heteronuclear signal which is crucial for accurate and detailed imaging.

SIGNIFICANCE

The successful development of this new dual-tuned RF coil technique would provide a tangible and efficient tool for ultrahigh field metabolic MR imaging.

Towards a unified picture of polarization transfer - pulsed DNP and chemically equivalent PHIP

Nuclear spin hyperpolarization techniques, such as dynamic nuclear polarization (DNP) and parahydrogen-induced polarization (PHIP), have revolutionized nuclear magnetic resonance and magnetic resonance imaging. In these methods, a readily available source of high spin order, either electron spins in DNP or singlet states in hydrogen for PHIP, is brought into close proximity with nuclear spin targets, enabling efficient transfer of spin order under external quantum control. Despite vast disparities in energy scales and interaction mechanisms between electron spins in DNP and nuclear singlet states in PHIP, a pseudo-spin formalism allows us to establish an intriguing equivalence. As a result, the important low-field polarization transfer regime of PHIP can be mapped onto an analogous system equivalent to pulsed-DNP. This establishes a correspondence between key polarization transfer sequences in PHIP and DNP, facilitating the transfer of sequence development concepts. This promises fresh insights and significant cross-pollination between DNP and PHIP polarization sequence developers.

Distinguishing metabolic signals of liver tumors from surrounding liver cells using hyperpolarized 13 C MRI and gadoxetate

PURPOSE

To use the hepatocyte-specific gadolinium-based contrast agent gadoxetate combined with hyperpolarized (HP) [1-13 C]pyruvate MRI to selectively suppress metabolic signals from normal hepatocytes while preserving the signals arising from tumors.

METHODS

Simulations were performed to determine the expected changes in HP 13 C MR signal in liver and tumor under the influence of gadoxetate. CC531 colon cancer cells were implanted into the livers of five Wag/Rij rats. Liver and tumor metabolism were imaged at 3 T using HP [1-13 C] pyruvate chemical shift imaging before and 15 min after injection of gadoxetate. Area under the curve for pyruvate and lactate were measured from voxels containing at least 75% of normal-appearing liver or tumor.

RESULTS

Numerical simulations predicted a 36% decrease in lactate-to-pyruvate (L/P) ratio in liver and 16% decrease in tumor. In vivo, baseline L/P ratio was 0.44 ± 0.25 in tumors versus 0.21 ± 0.08 in liver (p = 0.09). Following administration of gadoxetate, mean L/P ratio decreased by an average of 0.11 ± 0.06 (p < 0.01) in normal-appearing liver. In tumors, mean L/P ratio post-gadoxetate did not show a statistically significant change from baseline. Compared to baseline levels, the relative decrease in L/P ratio was significantly greater in liver than in tumors (-0.52 ± 0.16 vs. -0.19 ± 0.25, p < 0.05).

CONCLUSIONS

The intracellular hepatobiliary contrast agent showed a greater effect suppressing HP 13 C MRI metabolic signals (through T1 shortening) in normal-appearing liver when compared to tumors. The combined use of HP MRI with selective gadolinium contrast agents may allow more selective imaging in HP 13 C MRI.

Hyperpolarized 13C magnetic resonance imaging in neonatal hypoxic-ischemic encephalopathy: First investigations in a large animal model

Early biomarkers of cerebral damage are essential for accurate prognosis, timely intervention, and evaluation of new treatment modalities in newborn infants with hypoxia and ischemia at birth. Hyperpolarized 13C magnetic resonance imaging (MRI) is a novel method with which to quantify metabolism in vivo with unprecedented sensitivity. We aimed to investigate the applicability of hyperpolarized 13C MRI in a newborn piglet model and whether this method may identify early changes in cerebral metabolism after a standardized hypoxic-ischemic (HI) insult. Six piglets were anesthetized and subjected to a standardized HI insult. Imaging was performed prior to and 2 h after the insult on a 3-T MR scanner. For 13C studies, [1-13C]pyruvate was hyperpolarized in a commercial polarizer. Following intravenous injection, images were acquired using metabolic-specific imaging. HI resulted in a metabolic shift with a decrease in pyruvate to bicarbonate metabolism and an increase in pyruvate to lactate metabolism (lactate/bicarbonate ratio, mean [SD]; 2.28 [0.36] vs. 3.96 [0.91]). This is the first study to show that hyperpolarized 13C MRI can be used in newborn piglets and applied to evaluate early changes in cerebral metabolism after an HI insult.

Hyperpolarized 13 C metabolic imaging of the human abdomen with spatiotemporal denoising

PURPOSE

Improving the quality and maintaining the fidelity of large coverage abdominal hyperpolarized (HP) 13 C MRI studies with a patch based global-local higher-order singular value decomposition (GL-HOVSD) spatiotemporal denoising approach.

METHODS

Denoising performance was first evaluated using the simulated [1-13 C]pyruvate dynamics at different noise levels to determine optimal kglobal and klocal parameters. The GL-HOSVD spatiotemporal denoising method with the optimized parameters was then applied to two HP [1-13 C]pyruvate EPI abdominal human cohorts (n = 7 healthy volunteers and n = 8 pancreatic cancer patients).

RESULTS

The parameterization of kglobal  = 0.2 and klocal  = 0.9 denoises abdominal HP data while retaining image fidelity when evaluated by RMSE. The kPX (conversion rate of pyruvate-to-metabolite, X = lactate or alanine) difference was shown to be <20% with respect to ground-truth metabolic conversion rates when there is adequate SNR (SNRAUC  > 5) for downstream metabolites. In both human cohorts, there was a greater than nine-fold gain in peak [1-13 C]pyruvate, [1-13 C]lactate, and [1-13 C]alanine apparent SNRAUC . The improvement in metabolite SNR enabled a more robust quantification of kPL and kPA . After denoising, we observed a 2.1 ± 0.4 and 4.8 ± 2.5-fold increase in the number of voxels reliably fit across abdominal FOVs for kPL and kPA quantification maps.

CONCLUSION

Spatiotemporal denoising greatly improves visualization of low SNR metabolites particularly [1-13 C]alanine and quantification of [1-13 C]pyruvate metabolism in large FOV HP 13 C MRI studies of the human abdomen.

Simultaneous fMRI and metabolic MRS of hyperpolarized [1-13C]pyruvate during nicotine stimulus in rat

Functional MRI (fMRI) and MRS (fMRS) can be used to noninvasively map cerebral activation and metabolism. Recently, hyperpolarized 13C spectroscopy and metabolic imaging have provided an alternative approach to assess metabolism. In this study, we combined 1H fMRI and hyperpolarized [1-13C]pyruvate MRS to compare cerebral blood oxygenation level-dependent (BOLD) response and real-time cerebral metabolism, as assessed with lactate and bicarbonate labelling, during nicotine stimulation. Simultaneous 1H fMRI (multislice gradient echo echo-planar imaging) and 13C spectroscopic (single slice pulse-acquire) data were collected in urethane-anaesthetized female Sprague-Dawley rats (n = 12) at 9.4 T. Animals received an intravenous (i.v.) injection of either nicotine (stimulus; 88 μg/kg, n = 7, or 300 μg/kg, n = 5) or 0.9% saline (matching volume), followed by hyperpolarized [1-13C]pyruvate injection 60 s later. Three hours later, a second injection was administered: the animals that had previously received saline were injected with nicotine and vice versa, both followed by another hyperpolarized [1-13C]pyruvate i.v. injection 60 s later. The low-dose (88 μg/kg) nicotine injection led to a 12% ± 4% (n = 7, t-test, p ~ 0.0006 (t-value -5.8, degrees of freedom 6), Wilcoxon p ~ 0.0078 (test statistic 0)) increase in BOLD signal. At the same time, an increase in 13C-bicarbonate signal was seen in four out of six animals. Bicarbonate-to-total carbon ratios were 0.010 ± 0.004 and 0.018 ± 0.010 (n = 6, t-test, p ~ 0.03 (t-value -2.3, degrees of freedom 5), Wilcoxon p ~ 0.08 (test statistic 3)) for saline and nicotine experiments, respectively. No increase in the lactate signal was seen; lactate-to-total carbon was 0.16 ± 0.02 after both injections. The high (300 μg/kg) nicotine dose (n = 5) caused highly variable BOLD and metabolic responses, possibly due to the apparent respiratory distress. Simultaneous detection of 1H fMRI and hyperpolarized 13C-MRS is feasible. A comparison of metabolic response between control and stimulated states showed differences in bicarbonate signal, implying that the hyperpolarization technique could offer complimentary information on brain activation.

A continuous flow bioreactor system for high-throughput hyperpolarized metabolic flux analysis

Hyperpolarized carbon-13 labeled compounds are increasingly being used in medical MR imaging (MRI) and MR imaging (MRI) and spectroscopy (MRS) research, due to its ability to monitor tissue and cell metabolism in real-time. Although radiological biomarkers are increasingly being considered as clinical indicators, biopsies are still considered the gold standard for a large variety of indications. Bioreactor systems can play an important role in biopsy examinations because of their ability to provide a physiochemical environment that is conducive for therapeutic response monitoring ex vivo. We demonstrate here a proof-of-concept bioreactor and microcoil receive array setup that allows for ex vivo preservation and metabolic NMR spectroscopy on up to three biopsy samples simultaneously, creating an easy-to-use and robust way to simultaneously run multisample carbon-13 hyperpolarization experiments. Experiments using hyperpolarized [1-13C]pyruvate on ML-1 leukemic cells in the bioreactor setup were performed and the kinetic pyruvate-to-lactate rate constants ( k PL ) extracted. The coefficient of variation of the experimentally found k PL s for five repeated experiments was C V = 35 % . With this statistical power, treatment effects of 30%-40% change in lactate production could be easily differentiable with only a few hyperpolarization dissolutions on this setup. Furthermore, longitudinal experiments showed preservation of ML-1 cells in the bioreactor setup for at least 6 h. Rat brain tissue slices were also seen to be preserved within the bioreactor for at least 1 h. This validation serves as the basis for further optimization and upscaling of the setup, which undoubtedly has huge potential in high-throughput studies with various biomarkers and tissue types.

Multimodal surface coils for low field MR imaging

Low field MRI is safer and more cost effective than the high field MRI. One of the inherent problems of low field MRI is its low signal-to-noise ratio or sensitivity. In this work, we introduce a multimodal surface coil technique for signal excitation and reception to improve the RF magnetic field (B 1 ) efficiency and potentially improve MR sensitivity. The proposed multimodal surface coil consists of multiple identical resonators that are electromagnetically coupled to form a multimodal resonator. The field distribution of its lowest frequency mode is suitable for MR imaging applications. The prototype multimodal surface coils are built, and the performance is investigated and validated through numerical simulation, standard RF measurements and tests, and comparison with the conventional surface coil at low fields. Our results show that the B 1 efficiency of the multimodal surface coil outperforms that of the conventional surface coil which is known to offer the highest B 1 efficiency among all coil categories, i.e., volume coil, half-volume coil and surface coil. In addition, in low-field MRI, the required low-frequency coils often use large value capacitance to achieve the low resonant frequency which makes frequency tuning difficult. The proposed multimodal surface coil can be conveniently tuned to the required low frequency for low-field MRI with significantly reduced capacitance value, demonstrating excellent low-frequency operation capability over the conventional surface coil.

New Horizons in Hyperpolarized 13C MRI

Hyperpolarization techniques significantly enhance the sensitivity of magnetic resonance (MR) and thus present fascinating new directions for research and applications with in vivo MR imaging and spectroscopy (MRI/S). Hyperpolarized 13C MRI/S, in particular, enables real-time non-invasive assessment of metabolic processes and holds great promise for a diverse range of clinical applications spanning fields like oncology, neurology, and cardiology, with a potential for improving early diagnosis of disease, patient stratification, and therapy response assessment. Despite its potential, technical challenges remain for achieving clinical translation. This paper provides an overview of the discussions that took place at the international workshop "New Horizons in Hyperpolarized 13C MRI," in March 2023 at the Bavarian Academy of Sciences and Humanities, Munich, Germany. The workshop covered new developments, as well as future directions, in topics including polarization techniques (particularly focusing on parahydrogen-based methods), novel probes, considerations related to data acquisition and analysis, and emerging clinical applications in oncology and other fields.

Molecular imaging of tumor metabolism: Insight from pyruvate- and glucose-based deuterium MRI studies

Cancer diagnosis by metabolic MRI proposes to follow the fate of glycolytic precursors such as pyruvate or glucose, and their in vivo conversion into lactate. This study compares the 2H MRI outlooks afforded by these metabolites when targeting a pancreatic cancer model. Exogenously injected [3,3',3″-2H3]-pyruvate was visible only briefly; it generated a deuterated lactate signal throughout the body that faded after ~5 min, showing a minor concentration bias at the rims of the tumors. [6,6'-2H2]-glucose by contrast originated a lactate signal that localized clearly within the tumors, persisting for over an hour. Investigations alternating deuterated and nondeuterated glucose injections revealed correlations between the lactate generation and the glucose available at the tumor, evidencing a continuous and avid glucose consumption generating well-localized lactate signatures as driven by the Warburg effect. This is by contrast to the transient and more promiscuous pyruvate-to-lactate transformation, which seemed subject to transporter and kinetics effects. The consequences of these observations within metabolic MRI are briefly discussed.

Repeatability of deuterium metabolic imaging of healthy volunteers at 3 T

BACKGROUND

Magnetic resonance (MR) imaging of deuterated glucose, termed deuterium metabolic imaging (DMI), is emerging as a biomarker of pathway-specific glucose metabolism in tumors. DMI is being studied as a useful marker of treatment response in a scan-rescan scenario. This study aims to evaluate the repeatability of brain DMI.

METHODS

A repeatability study was performed in healthy volunteers from December 2022 to March 2023. The participants consumed 75 g of [6,6'-2H2]glucose. The delivery of 2H-glucose to the brain and its conversion to 2H-glutamine + glutamate, 2H-lactate, and 2H-water DMI was imaged at baseline and at 30, 70, and 120 min. DMI was performed using MR spectroscopic imaging on a 3-T system equipped with a 1H/2H-tuned head coil. Coefficients of variation (CoV) were computed for estimation of repeatability and between-subject variability. In a set of exploratory analyses, the variability effects of region, processing, and normalization were estimated.

RESULTS

Six male participants were recruited, aged 34 ± 6.5 years (mean ± standard deviation). There was 42 ± 2.7 days between sessions. Whole-brain levels of glutamine + glutamate, lactate, and glucose increased to 3.22 ± 0.4 mM, 1.55 ± 0.3 mM, and 3 ± 0.7 mM, respectively. The best signal-to-noise ratio and repeatability was obtained at the 120-min timepoint. Here, the within-subject whole-brain CoVs were -10% for all metabolites, while the between-subject CoVs were -20%.

CONCLUSIONS

DMI of glucose and its downstream metabolites is feasible and repeatable on a clinical 3 T system.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05402566 , registered the 25th of May 2022.

RELEVANCE STATEMENT

Brain deuterium metabolic imaging of healthy volunteers is repeatable and feasible at clinical field strengths, enabling the study of shifts in tumor metabolism associated with treatment response.

KEY POINTS

• Deuterium metabolic imaging is an emerging tumor biomarker with unknown repeatability.  • The repeatability of deuterium metabolic imaging is on par with FDG-PET.  • The study of deuterium metabolic imaging in clinical populations is feasible.