Hyperpolarized carbon 13 MRI in liver diseases: Recent advances and future opportunities

Abstract

Hyperpolarized carbon‐13 magnetic resonance imaging (HP 13C MRI) is a recently translated metabolic imaging technique. With dissolution dynamic nuclear polarization (d‐DNP), more than 10 000‐fold signal enhancement can be readily reached, making it possible to visualize real‐time metabolism and specific substrate‐to‐metabolite conversions in the liver after injecting carbon‐13 labelled probes. Increasing evidence suggests that HP 13C MRI is a potential tool in detecting liver abnormalities, predicting disease progression and monitoring response treatment. In this review, we will introduce the recent progresses of HP 13C MRI in diffuse liver diseases and liver malignancies and discuss its future opportunities from a clinical perspective, hoping to provide a comprehensive overview of this novel technique in liver diseases and highlight its scientific and clinical potential in the field of hepatology.

Enhancing Cancer Diagnosis with Real-Time Feedback: Tumor Metabolism through Hyperpolarized 1-13C Pyruvate MRSI

“…Furthermore, the HP [1- 13 C] pyruvate MRSI study after 2 months of treatment with taxane + platinum chemotherapy showed the efficacy of treatment with a reduced k PL value of 0.015 (s −1 ). This clinical study supports the feasibility of HP [1- 13 C] pyruvate MRSI in future clinical studies of metastatic cancer [ 62 , 63 ].…”

[6,6′‐2H2] fructose as a deuterium metabolic imaging probe in liver cancer

“…In comparison with hyperpolarized 13 C MRI that offers high 13 C signal enhancement of orders of magnitude beyond the Boltzmann polarization and thus allowing to image hyperpolarized 13 C lactate dynamics in vivo, 47 DMI suffers from low signal magnitude, limiting its capability of probing dynamic imaging of 2 H lactate with high spatial resolution. From this point of view, in vivo imaging by hyperpolarized 13 C 48,49 may be superior to DMI for studying glycolysis quantitatively in liver tumors, providing insights into tumorigenesis and malignancy 50 . On the other hand, because of the short window of detection, hyperpolarized 13 C MRI fails to capture downstream metabolites produced from oxidative pathways, that is, H 2 O from the TCA cycle, which is critical in pathological circumstances; however, this is achievable by DMI.…”

“…From this point of view, in vivo imaging by hyperpolarized 13 C 48,49 may be superior to DMI for studying glycolysis quantitatively in liver tumors, providing insights into tumorigenesis and malignancy. 50 On the other hand, because of the short window of detection, hyperpolarized 13 C MRI fails to capture downstream metabolites produced from oxidative pathways, that is, H 2 O from the TCA cycle, which is critical in pathological circumstances; however, this is achievable by DMI. Taken together, future studies would likely benefit from utilizing these complimentary techniques together to more deeply characterize metabolic flux.…”

Hyperpolarized Carbon-13 Magnetic Resonance Imaging: Technical Considerations and Clinical Applications

“…Nevertheless, the liver is a highly metabolic organ, displaying the highest rates of pyruvate-to-lactate and pyruvate-to-alanine conversion among intra-abdominal solid organs [ 46 ]. The use of HP 13 C-MRI to study liver parenchymal diseases, including hepatic steatosis, fibrosis, and malignancies, is presently undergoing thorough investigation [ 58 ].…”