{"doi":"10.1016/j.jmro.2024.100165","title":"Dual hyperpolarized [1-13C]pyruvate and [13C]urea magnetic resonance imaging of prostate cancer","abstract":"• Dual-agent hyperpolarized 13 C MRI was used to simultaneously assess tumor metabolism and tissue perfusion in a patient with localized prostate cancer. • Hyperpolarized [1- 13 C]pyruvate MRI was able to detect areas of clinically occult prostate cancer not seen on multiparametric MRI. • The novel addition of hyperpolarized [ 13 C]urea data showed a significant mismatch between intra-tumoral metabolism and tissue perfusion in high grade cancer. Although multiparametric (mp) 1 H magnetic resonance imaging (MRI) is increasingly used to detect and localize prostate cancer (PC), its correlation with tumor grade is limited. Hyperpolarized (HP) carbon-13 ( 13 C) MR is an emerging imaging technique, which can be used to interrogate key biologic processes through in vivo detection of various HP probes. A distinct attribute of HP 13 C MRI is the ability to detect multiple HP probes within a single acquisition. Here we report on the first simultaneous dual HP [1- 13 C]pyruvate and [ 13 C]urea MRI with correlations to histopathologic findings in a patient with localized PC scheduled for radical prostatectomy. Paired HP 13 C and standard mp 1 H MRI were performed in a patient with biopsy-proven Gleason score 4 + 3 = 7 adenocarcinoma of the prostate scheduled for radical prostatectomy through a first-in-human pilot study of dual-agent HP MRI (NCT02526368). HP 13 C MRI was performed using a clinical 3T scanner with 13 C transmit-and-receive capabilities. Dynamic series of HP 13 C pyruvate, lactate and urea imaging were acquired following intravenous (IV) injection of co-hyperpolarized [ 13 C]urea (25 mM) and [1– 13 C]pyruvate (125 mM). The [1- 13 C]pyruvate-to-[1- 13 C]lactate conversion rate (k PL ) was calculated using an inputless two-site exchange model; AUC urea was the [ 13 C]urea signal summed over time. Following radical prostatectomy, whole-mount prostate histopathological slides were prepared and reviewed by an experienced genitourinary pathologist. Following informed consent, the patient underwent paired mp 1 H MRI and dual-agent HP MRI. mp 1 H MRI revealed a 1.2 cm lesion in the left apical posterior zone. Dual-agent HP MRI identified a focus of increased [1- 13 C]pyruvate-to-[1- 13 C]lactate conversion rate (k PL ) extending from the left apical posterior peripheral zone to the right gland. A corresponding area of abnormal tissue perfusion (AUC urea ) was seen in the left gland. Metabolism-perfusion mismatch (with several foci of increased k PL /AUC urea ) was observed throughout the tumor. Tumor extension to the right midgland was confirmed at the time of radical prostatectomy and staining for lactate dehydrogenase-A was increased throughout the tumor relative to surrounding benign prostatic tissue. This first-in-human radiopathologic study demonstrates the feasibility of dual-agent HP MRI in PC patients. Simultaneous assessment of tumor metabolism and perfusion was able to detect occult disease as well as to show a significant mismatch between intra-tumoral metabolism and tissue perfusion in high-grade PC. Prospective validation of these findings is warranted.","journal":"Journal of Magnetic Resonance Open","year":2024,"id":443244,"datarank":0.32958368660043297,"base_score":2.1972245773362196,"endowment":2.1972245773362196,"self_citation_contribution":0.32958368660043297,"citation_network_contribution":0.0,"self_endowment_contribution":0.32958368660043297,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":8,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9523,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1186025,"name":"Hao Nguyen","orcid":"0000-0001-6742-1748","position":1,"is_corresponding":false},{"id":460831,"name":"Hsin‐Yu Chen","orcid":"0000-0002-2765-1685","position":2,"is_corresponding":false},{"id":884982,"name":"Xiaoxi Liu","orcid":"0000-0003-0657-8922","position":3,"is_corresponding":false},{"id":488323,"name":"Hecong Qin","orcid":"0000-0003-2618-8366","position":4,"is_corresponding":false},{"id":627614,"name":"Bradley A. Stohr","orcid":"0000-0002-5836-2624","position":5,"is_corresponding":false},{"id":489438,"name":"Romelyn Delos Santos","orcid":null,"position":6,"is_corresponding":false},{"id":535118,"name":"Michael A. Ohliger","orcid":"0000-0001-6878-8189","position":7,"is_corresponding":false},{"id":1257846,"name":"Zhen Jane Wang","orcid":null,"position":8,"is_corresponding":false},{"id":345505,"name":"Robert Bok","orcid":"0000-0003-1737-9056","position":9,"is_corresponding":false},{"id":345502,"name":"Jeremy W. Gordon","orcid":"0000-0003-2760-4886","position":10,"is_corresponding":false},{"id":916039,"name":"Peder E.Z. Larson","orcid":null,"position":11,"is_corresponding":false},{"id":704075,"name":"Mary Frost","orcid":null,"position":12,"is_corresponding":false},{"id":704076,"name":"Kimberly Okamoto","orcid":null,"position":13,"is_corresponding":false},{"id":475479,"name":"Daniel Gebrezgiabhier","orcid":"0000-0002-8118-3931","position":14,"is_corresponding":false},{"id":260283,"name":"Matthew R. Cooperberg","orcid":"0000-0003-4339-6685","position":15,"is_corresponding":false},{"id":345507,"name":"Daniel B. Vigneron","orcid":"0000-0001-5795-8699","position":16,"is_corresponding":false},{"id":460832,"name":"John Kurhanewicz","orcid":"0000-0002-3544-5339","position":17,"is_corresponding":false},{"id":36081,"name":"Rahul Aggarwal","orcid":"0000-0001-7003-7982","position":18,"is_corresponding":false},{"id":701059,"name":"Ivan de Kouchkovsky","orcid":"0000-0002-3092-3565","position":0,"is_corresponding":true}],"reference_count":25,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:01:24.471942Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}