Current methods for hyperpolarized [1-13C]pyruvate MRI human studies.

MRI with hyperpolarized (HP) 13C agents, also known as HP 13C MRI, can measure processes such as localized metabolism that is altered in numerous cancers, liver, heart, kidney diseases, and more. It has been translated into human studies during the past 10 years, with recent rapid growth in studies largely based on increasing availability of HP agent preparation methods suitable for use in humans. This paper aims to capture the current successful practices for HP MRI human studies with [1-13C]pyruvate-by far the most commonly used agent, which sits at a key metabolic junction in glycolysis. The paper is divided into four major topic areas: (1) HP 13C-pyruvate preparation; (2) MRI system setup and calibrations; (3) data acquisition and image reconstruction; and (4) data analysis and quantification. In each area, we identified the key components for a successful study, summarized both published studies and current practices, and discuss evidence gaps, strengths, and limitations. This paper is the output of the "HP 13C MRI Consensus Group" as well as the ISMRM Hyperpolarized Media MR and Hyperpolarized Methods and Equipment study groups. It further aims to provide a comprehensive reference for future consensus, building as the field continues to advance human studies with this metabolic imaging modality.

Filter-exchange spectroscopy is sensitive to gradual cell membrane degradation.

Transmembrane water permeability changes occur after initialization of necrosis and are a mechanism for early detection of cell death. Filter-exchange spectroscopy (FEXSY) is sensitive to transmembrane water permeability and enables its quantification by magnetic resonance via the apparent exchange rate (AXR). In this study, we investigate AXR changes during necrotic cell death. FEXSY measurements of yeast cells in different necrotic stages were performed and compared with established fluorescence cell death markers and pulsed gradient spin echo measurements. Furthermore, the influence of T2 relaxation on AXR was examined in a two-compartment system. The AXR of yeast cells increased slightly after incubation with 20% isopropanol, whereas it peaked sharply after incubation with 25% isopropanol. At this point, almost all the yeast cells were vital but showed compromised membranes. After incubation with 30% isopropanol, AXR measurements showed high variability, at a point corresponding to a majority of the yeast cells being in late-stage necrosis with disrupted cell membranes. Simulations revealed that, for FEXSY measurements in a two-compartment system, a long filter echo time (TEf), compared with the T2 of the slow-diffusing compartment, filters out a fraction of the slow-diffusing compartment signal and leads to overestimation of apparent diffusion coefficient (ADC) and underestimation of AXR. Our results demonstrate that AXR is sensitive to gradual permeabilization of the cell membrane of living cells in different permeabilization stages without exogenous contrast agents. AXR measurements were sensitive to permeability changes induced by relatively low concentrations of isopropanol, at levels for which no measurable effect was detectable by ADC measurements. TEf may act as a signal filter that affects the estimated AXR value of a system consisting of a variety of local diffusivities and a range of T2 that includes T2 values shorter or comparable with the TEf.

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.

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.