Hyperpolarized 13C MRI of Tumor Metabolism Demonstrates Early Metabolic Response to Neoadjuvant Chemotherapy in Breast Cancer

Authors
Ramona Woitek, Mary A. McLean, Andrew B. Gill, James T. Grist, Elena Provenzano, Andrew J. Patterson, Stephan Ursprung, Turid Torheim, Fulvio Zaccagna, Matthew Locke, Marie-Christine Laurent, Sarah Hilborne, Amy Frary, Lucian Beer, Leonardo Rundo, Ilse Patterson, Rhys Slough, Justine Kane, Heather Biggs, Emma Harrison, Titus Lanz, Bristi Basu, Richard Baird, Evis Sala, Martin J. Graves, Fiona J. Gilbert, Jean E. Abraham, Carlos Caldas, Kevin M. Brindle, Ferdia A. Gallagher
Year of publication
2020
Journal name
Radiology: Imaging Cancer
Journal info
Radiology: Imaging Cancer Volume 2: Number 4—2020
E-pub date
Friday, July 31, 2020
Keywords
Hyperpolarized Breast Carbon-13

Purpose: To compare hyperpolarized carbon 13 (13C) MRI with dynamic contrast material–enhanced (DCE) MRI in the detection of
early treatment response in breast cancer.
Materials and Methods: In this institutional review board–approved prospective study, a woman with triple-negative breast cancer (age,
49 years) underwent 13C MRI after injection of hyperpolarized [1–carbon 13 {13C}]-pyruvate and DCE MRI at 3 T at baseline and
after one cycle of neoadjuvant therapy. The 13C-labeled lactate-to-pyruvate ratio derived from hyperpolarized 13C MRI and the pharmacokinetic parameters transfer constant (Ktrans) and washout parameter (kep) derived from DCE MRI were compared before and after
treatment.
Results: Exchange of the 13C label between injected hyperpolarized [1-13C]-pyruvate and the endogenous lactate pool was observed,
catalyzed by the enzyme lactate dehydrogenase. After one cycle of neoadjuvant chemotherapy, a 34% reduction in the 13C-labeled
lactate-to-pyruvate ratio resulted in correct identification of the patient as a responder to therapy, which was subsequently confirmed
via a complete pathologic response. However, DCE MRI showed an increase in mean Ktrans (132%) and mean kep (31%), which could
be incorrectly interpreted as a poor response to treatment.
Conclusion: Hyperpolarized 13C MRI enabled successful identification of breast cancer response after one cycle of neoadjuvant chemotherapy and may improve response prediction when used in conjunction with multiparametric proton MRI.

https://pubs.rsna.org/doi/10.1148/rycan.2020200017

Research Programme
Advanced Cancer Imaging
Breast Cancer