Quantification of Prostate Cancer Metabolism Using 3D Multiecho bSSFP and Hyperpolarized [1-13C] Pyruvate: Metabolism Differs Between Tumors of the Same Gleason Grade

Background Three-dimensional (3D) multiecho balanced steady-state free precession (ME-bSSFP) has previously been demonstrated in preclinical hyperpolarized (HP) C-13-MRI in vivo experiments, and it may be suitable for clinical metabolic imaging of prostate cancer (PCa). Purpose To validate a signal simulation framework for the use of sequence parameter optimization. To demonstrate the feasibility of ME-bSSFP for HP C-13-MRI in patients. To evaluate the metabolism in PCa measured by ME-bSSFP. Study Type Retrospective single-center cohort study. Phantoms/Population Phantoms containing aqueous solutions of [1-C-13] lactate (2.3 M) and [C-13] urea (8 M). Eight patients (mean age 67 +/- 6 years) with biopsy-confirmed Gleason 3 + 4 (n = 7) and 4 + 3 (n = 1) PCa. Field Strength/Sequences H-1 MRI at 3 T with T-2-weighted turbo spin-echo sequence used for spatial localization and spoiled dual gradient-echo sequence used for B-0-field measurement. ME-bSSFP sequence for C-13 MR spectroscopic imaging with retrospective multipoint IDEAL metabolite separation. Assessment The primary endpoint was the analysis of pyruvate-to-lactate conversion in PCa and healthy prostate regions of interest (ROIs) using model-free area under the curve (AUC) ratios and a one-directional kinetic model (k(P)). The secondary objectives were to investigate the correlation between simulated and experimental ME-bSSFP metabolite signals for HP C-13-MRI parameter optimization. Statistical Tests Pearson correlation coefficients with 95% confidence intervals and paired t-tests. The level of statistical significance was set at P < 0.05. Results Strong correlations between simulated and empirical ME-bSSFP signals were found (r > 0.96). Therefore, the simulation framework was used for sequence optimization. Whole prostate metabolic HP C-13-MRI, observing the conversion of pyruvate into lactate, with a temporal resolution of 6 seconds was demonstrated using ME-bSSFP. Both assessed metrics resulted in significant differences between PCa (mean +/- SD) (AUC = 0.33 +/- 012, k(P) = 0.038 +/- 0.014) and healthy (AUC = 0.15 +/- 0.10, k(P) = 0.011 +/- 0.007) ROIs. Data Conclusion Metabolic HP C-13-MRI in the prostate using ME-bSSFP allows for differentiation between aggressive PCa and healthy tissue. Evidence Level 2 Technical Efficacy Stage 1