Real time clinical imaging of tumour metabolism using hyperpolarized 13C magnetic resonance spectroscopy.

Hyperpolarization of MR-active nuclei can increase their sensitivity to detection by more than 10,000-fold. The recent development of dissolution Dynamic Nuclear Polarization (DNP) has enabled the spatial distribution of injected hyperpolarized 13C-labelled cell substrates to be imaged in vivo using 13C magnetic resonance spectroscopic imaging (MRSI) as well as the spatial distribution of their metabolites. The technique promises unprecedented insights into human tissue metabolism, where it should allow the detection of disease processes that impact metabolism and the responses of these diseases to treatment. This is a transformational technology with the potential to change the practice of clinical radiology. Since patients with similar tumour types can have markedly different responses to the same therapy, the development of new treatments would benefit from the introduction of imaging methods that allow an early assessment of treatment response in individual patients. We have shown how hyperpolarised 13C-MRSI can be used to detect early evidence of treatment response in preclinical animal models of disease. The purpose of this application is to build on this growing body of preclinical data and the initial results of a phase I/II clinical trial in prostate cancer patients to translate this technology into the clinic.