Watching tumours gasp and die with MRI: the promise of hyperpolarised 13C MR spectroscopic imaging.

A better understanding of tumour biology has led to the development of "targeted therapies", in which a drug is designed to disrupt a specific biochemical pathway important for tumour cell survival or proliferation. The introduction of these drugs into the clinic has shown that patients can vary widely in their responses. Molecular imaging is likely to play an increasingly important role in predicting and detecting these responses and thus in guiding treatment in individual patients: so-called "personalised medicine". The aim of this review is to discuss how hyperpolarised (13)C MR spectroscopic imaging might be used for treatment response monitoring. This technique, which increases the sensitivity of detection of injected (13)C-labelled molecules by >10,000-fold, has allowed a new approach to metabolic imaging. The basic principles of the technique and its potential advantages over other imaging methods for detecting early evidence of treatment response will be discussed. Given that the technique is poised to translate to the clinic, I will also speculate on its likely applications.