Hyperpolarized <sup>13</sup>C MRI of Tumor Metabolism Demonstrates Early Metabolic Response to Neoadjuvant Chemotherapy in Breast Cancer
Ramona Woitek, Mary A. McLean, Andrew B. Gill, James T. Grist, Elena Provenzano, Andrew J. Patterson, Stephan Ursprung, Turid Torheim, Fulvio Zaccagna, M. 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 D. Baird, Evis Sala, Martin J. Graves, Fiona J. Gilbert, Jean Abraham, Carlos Caldas, Kevin M. Brindle, Ferdia A. Gallagher
Abstract
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. Keywords: Breast, MR-Spectroscopy, Molecular Imaging-Cancer, Molecular Imaging-Clinical Translation, Neoplasms-Primary, Oncology, Tumor Response Published under a CC BY 4.0 license.