Woitek Ramona, Brindle Kevin M
Research Centre for Medical Image Analysis and AI, Danube Private University, 3500 Krems, Austria.
Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK.
Diagnostics (Basel). 2023 Jul 7;13(13):2311. doi: 10.3390/diagnostics13132311.
One of the hallmarks of cancer is metabolic reprogramming, including high levels of aerobic glycolysis (the Warburg effect). Pyruvate is a product of glucose metabolism, and C-MR imaging of the metabolism of hyperpolarized (HP) [1-C]pyruvate (HP C-MRI) has been shown to be a potentially versatile tool for the clinical evaluation of tumor metabolism. Hyperpolarization of the C nuclear spin can increase the sensitivity of detection by 4-5 orders of magnitude. Therefore, following intravenous injection, the location of hyperpolarized C-labeled pyruvate in the body and its subsequent metabolism can be tracked using C-MRI. Hyperpolarized [C]urea and [1,4-C]fumarate are also likely to translate to the clinic in the near future as tools for imaging tissue perfusion and post-treatment tumor cell death, respectively. For clinical breast imaging, HP C-MRI can be combined with H-MRI to address the need for detailed anatomical imaging combined with improved functional tumor phenotyping and very early identification of patients not responding to standard and novel neoadjuvant treatments. If the technical complexity of the hyperpolarization process and the relatively high associated costs can be reduced, then hyperpolarized C-MRI has the potential to become more widely available for large-scale clinical trials.
癌症的标志之一是代谢重编程，包括高水平的有氧糖酵解（瓦伯格效应）。丙酮酸是葡萄糖代谢的产物，超极化（HP）[1-C]丙酮酸（HP C-MRI）代谢的C-MR成像已被证明是一种用于肿瘤代谢临床评估的潜在通用工具。C核自旋的超极化可将检测灵敏度提高4至5个数量级。因此，静脉注射后，可使用C-MRI追踪超极化C标记丙酮酸在体内的位置及其后续代谢。超极化[C]尿素和[1,4-C]富马酸酯在不久的将来也可能作为分别用于成像组织灌注和治疗后肿瘤细胞死亡的工具应用于临床。对于临床乳腺成像，HP C-MRI可与H-MRI相结合，以满足对详细解剖成像的需求，同时结合改进的功能性肿瘤表型分析以及对标准和新型新辅助治疗无反应患者的极早期识别。如果超极化过程的技术复杂性和相对较高的相关成本能够降低，那么超极化C-MRI有可能更广泛地应用于大规模临床试验。
