Hyperpolarized 13C-MRI is an emerging tool for probing tissue metabolism by measuring 13C-label exchange between intravenously injected hyperpolarized [1–13C]pyruvate and endogenous tissue lactate. Here, we demonstrate that hyperpolarized 13C-MRI can be used to detect early response to neoadjuvant therapy in breast cancer. Seven patients underwent multiparametric 1H-MRI and hyperpolarized 13C-MRI before and 7–11 days after commencing treatment. An increase in the lactate-to-pyruvate ratio of approximately 20% identified three patients who, following 5–6 cycles of treatment, showed pathological complete response. This ratio correlated with gene expression of the pyruvate transporter MCT1 and lactate dehydrogenase A ( LDHA ), the enzyme catalyzing label exchange between pyruvate and lactate. Analysis of approximately 2,000 breast tumors showed that overexpression of LDHA and the hypoxia marker CAIX was associated with reduced relapse-free and overall survival. Hyperpolarized 13C-MRI represents a promising method for monitoring very early treatment response in breast cancer and has demonstrated prognostic potential. Significance: Hyperpolarized carbon-13 MRI allows response assessment in patients with breast cancer after 7–11 days of neoadjuvant chemotherapy and outperformed state-of-the-art and research quantitative proton MRI techniques.

中文翻译：

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用于乳腺癌患者新辅助化疗早期反应评估的超极化碳 13 MRI

超极化 13C-MRI 是一种新兴工具，用于通过测量静脉内注射的超极化 [1–13C] 丙酮酸和内源性组织乳酸之间的 13C 标记交换来探测组织代谢。在这里，我们证明超极化 13C-MRI 可用于检测乳腺癌新辅助治疗的早期反应。7 名患者在开始治疗前和治疗后 7-11 天接受了多参数 1H-MRI 和超极化 13C-MRI。乳酸与丙酮酸的比例增加约 20% 确定了 3 名患者，他们在 5-6 个治疗周期后显示出病理学完全反应。该比率与丙酮酸转运蛋白 MCT1 和乳酸脱氢酶 A (LDHA) 的基因表达相关，LDHA 是催化丙酮酸和乳酸之间标记交换的酶。分析约2，000 个乳腺肿瘤表明，LDHA 和缺氧标志物 CAIX 的过度表达与无复发生存率和总生存率的降低有关。超极化 13C-MRI 代表了一种很有前途的方法，用于监测乳腺癌的早期治疗反应，并已证明具有预后潜力。意义：超极化碳 13 MRI 允许在新辅助化疗 7-11 天后对乳腺癌患者进行反应评估，并且优于最先进的研究定量质子 MRI 技术。