Hyperpolarized 13C-MRI of Tumor Metabolism Demonstrates Early Metabolic Response to Neoadjuvant Chemotherapy in Breast Cancer
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Abstract
Purpose: To compare hyperpolarized carbon-13 (13C)-MRI with dynamic contrast-enhanced MRI (DCE-MRI) for detecting early treatment response in breast cancer.
Materials and Methods: In this institutional review board-approved prospective study, one woman with triple-negative breast cancer (age 49) underwent 13C-MRI following injection of hyperpolarized [1-13C]pyruvate and DCE-MRI at 3 T at baseline and after a single cycle of neoadjuvant therapy. The 13C-lactate/13C-pyruvate ratio derived from hyperpolarized 13C-MRI and the pharmacokinetic parameters Ktrans and 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 demonstrated, catalyzed by the enzyme lactate dehydrogenase. After one cycle of neoadjuvant chemotherapy, a 34% reduction in the 13C-lactate/13C-pyruvate ratio was shown to correctly identify the patient as a responder to therapy, which was subsequently confirmed by a complete pathologic response. However, DCE-MRI showed an increase in the pharmacokinetic parameters Ktrans (132%) and kep (31%), which could be incorrectly interpreted as a poor response to treatment.
Conclusion: Hyperpolarized 13C-MRI successfully identified response in breast cancer after a single cycle of neoadjuvant chemotherapy and may improve response prediction when used in conjunction with multiparametric proton MRI.
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2638-616X
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Engineering and Physical Sciences Research Council (NS/A000023/1)
Cancer Research UK (C37096/A16673)
Wellcome Trust (095962/Z/11/Z)
Cancer Research Uk (None)
Cancer Research UK (C12912/A27150)
Cambridge University Hospitals NHS Foundation Trust (CUH) (3819-1819-07)
Cancer Research UK (C197/A28667)
Cancer Research UK (C19212/A29082)
Medical Research Council (MR/M009041/1)
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
Cancer Research UK (CB4100)
Cancer Research UK (C14303/A17197)
Cancer Research UK (unknown)
Cancer Research Uk (None)
Cancer Research Uk (None)
Cancer Research UK (unknown)
Cancer Research UK (unknown)
Cancer Research UK (unknown)
Cancer Research UK (60098573)
Cancer Research UK (unknown)
Cancer Research UK (9401)
Cancer Research UK (16942)
Cancer Research UK (7325)
Cancer Research UK (16942)
Cancer Research UK (unknown)
Cancer Research UK (unknown)
Cancer Research Uk (None)
Cancer Research UK (unknown)
Cambridge University Hospitals NHS Foundation Trust (CUH) (RG51913)
Cancer Research UK (CB4140)
Cancer Research UK (15580)
Cambridge University Hospitals NHS Foundation Trust (CUH) (unknown)
Department of Health (via National Institute for Health Research (NIHR)) (unknown)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0515-10090)
Cancer Research UK (A27657)
Cambridge University Hospitals NHS Foundation Trust (CUH) (Unknown)
Cancer Research UK (unknown)
Cancer Research UK (C96/A25177)
Cancer Research UK (21491)