Hyperpolarized Carbon-13 MRI for Early Response Assessment of Neoadjuvant Chemotherapy in Breast Cancer Patients.

Hyperpolarized 13C-MRI is an emerging tool for probing tissue metabolism by measuring 13C-label exchange between intravenously injected hyperpolarized [1-13C]pyruvate and endogenous tissue lactate. Here, we demonstrate that hyperpolarized 13C-MRI can be used to detect early response to neoadjuvant therapy in breast cancer. Seven patients underwent multiparametric 1H-MRI and hyperpolarized 13C-MRI before and 7-11 days after commencing treatment. An increase in the lactate-to-pyruvate ratio of approximately 20% identified three patients who, following 5-6 cycles of treatment, showed pathological complete response. This ratio correlated with gene expression of the pyruvate transporter MCT1 and lactate dehydrogenase A (LDHA), the enzyme catalyzing label exchange between pyruvate and lactate. Analysis of approximately 2,000 breast tumors showed that overexpression of LDHA and the hypoxia marker CAIX was associated with reduced relapse-free and overall survival. Hyperpolarized 13C-MRI represents a promising method for monitoring very early treatment response in breast cancer and has demonstrated prognostic potential. SIGNIFICANCE: Hyperpolarized carbon-13 MRI allows response assessment in patients with breast cancer after 7-11 days of neoadjuvant chemotherapy and outperformed state-of-the-art and research quantitative proton MRI techniques.

A statistical analysis of the Bloch-Siegert B1 mapping technique.

A number of B1 mapping methods have been introduced. A model to facilitate choice among these methods is valuable, as the performance of each technique is affected by a variety of factors, including acquisition signal-to-noise ratio (SNR). The Bloch-Siegert shift B1 mapping method has recently garnered significant interest. In this paper, we present a statistical model suitable for analysis of the Bloch-Siegert shift method. Unlike previously presented models, the analysis is valid in both low SNR and high SNR regimes. We present a detailed analysis of the performance of the Bloch-Siegert shift B1 mapping method across a broad range of acquisition scenarios, and compare it to two other B1 mapping techniques (the dual angle method and the phase sensitive method). Further validation of the model is presented through both Monte Carlo simulations and experimental results. The simulations and experimental results match the model well, lending confidence to its accuracy. Each technique is found to perform well with high acquisition SNR. However, our results suggest that the dual angle method is not reliable in low SNR environments. Furthermore, the phase sensitive method appears to outperform the Bloch-Siegert shift method in these low-SNR cases, although variations of the Bloch-Siegert method may be possible that improve its performance at low SNR.