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Frijia F, Flori A, Giovannetti G, Barison A, Menichetti L, Santarelli MF, Positano V. MRI Application and Challenges of Hyperpolarized Carbon-13 Pyruvate in Translational and Clinical Cardiovascular Studies: A Literature Review. Diagnostics (Basel) 2024; 14:1035. [PMID: 38786333 PMCID: PMC11120300 DOI: 10.3390/diagnostics14101035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/06/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Cardiovascular disease shows, or may even be caused by, changes in metabolism. Hyperpolarized magnetic resonance spectroscopy and imaging is a technique that could assess the role of different aspects of metabolism in heart disease, allowing real-time metabolic flux assessment in vivo. In this review, we introduce the main hyperpolarization techniques. Then, we summarize the use of dedicated radiofrequency 13C coils, and report a state of the art of 13C data acquisition. Finally, this review provides an overview of the pre-clinical and clinical studies on cardiac metabolism in the healthy and diseased heart. We furthermore show what advances have been made to translate this technique into the clinic in the near future and what technical challenges still remain, such as exploring other metabolic substrates.
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Affiliation(s)
- Francesca Frijia
- Bioengineering Unit, Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (A.F.); (V.P.)
| | - Alessandra Flori
- Bioengineering Unit, Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (A.F.); (V.P.)
| | - Giulio Giovannetti
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (G.G.); (L.M.); (M.F.S.)
| | - Andrea Barison
- Cardiology and Cardiovascular Medicine Unit, Fondazione Toscana G. Monasterio, 56124 Pisa, Italy;
| | - Luca Menichetti
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (G.G.); (L.M.); (M.F.S.)
| | - Maria Filomena Santarelli
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (G.G.); (L.M.); (M.F.S.)
| | - Vincenzo Positano
- Bioengineering Unit, Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (A.F.); (V.P.)
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Shaul D, Azar A, Sapir G, Uppala S, Nardi-Schreiber A, Gamliel A, Sosna J, Gomori JM, Katz-Brull R. Correlation between lactate dehydrogenase/pyruvate dehydrogenase activities ratio and tissue pH in the perfused mouse heart: A potential noninvasive indicator of cardiac pH provided by hyperpolarized magnetic resonance. NMR IN BIOMEDICINE 2021; 34:e4444. [PMID: 33258527 DOI: 10.1002/nbm.4444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 10/05/2020] [Accepted: 10/24/2020] [Indexed: 06/12/2023]
Abstract
Cardiovascular diseases account for more than 30% of all deaths worldwide and many could be ameliorated with early diagnosis. Current cardiac imaging modalities can assess blood flow, heart anatomy and mechanical function. However, for early diagnosis and improved treatment, further functional biomarkers are needed. One such functional biomarker could be the myocardium pH. Although tissue pH is already determinable via MR techniques, and has been since the early 1990s, it remains elusive to use practically. The objective of this study was to explore the possibility to evaluate cardiac pH noninvasively, using in-cell enzymatic rates of hyperpolarized [1-13 C]pyruvate metabolism (ie, moles of product produced per unit time) determined directly in real time using magnetic resonance spectroscopy in a perfused mouse heart model. As a gold standard for tissue pH we used 31 P spectroscopy and the chemical shift of the inorganic phosphate (Pi) signal. The nonhomogenous pH distribution of the perfused heart was analyzed using a multi-parametric analysis of this signal, thus taking into account the heterogeneous nature of this characteristic. As opposed to the signal ratio of hyperpolarized [13 C]bicarbonate to [13 CO2 ], which has shown correlation to pH in other studies, we investigated here the ratio of two intracellular enzymatic rates: lactate dehydrogenase (LDH) and pyruvate dehydrogenase (PDH), by way of determining the production rates of [1-13 C]lactate and [13 C]bicarbonate, respectively. The enzyme activities determined here are intracellular, while the pH determined using the Pi signal may contain an extracellular component, which could not be ruled out. Nevertheless, we report a strong correlation between the tissue pH and the LDH/PDH activities ratio. This work may pave the way for using the LDH/PDH activities ratio as an indicator of cardiac intracellular pH in vivo, in an MRI examination.
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Affiliation(s)
- David Shaul
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Assad Azar
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Gal Sapir
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Sivaranjan Uppala
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Atara Nardi-Schreiber
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Ayelet Gamliel
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - J Moshe Gomori
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Rachel Katz-Brull
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
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Sánchez-Heredia JD, Olin RB, McLean MA, Laustsen C, Hansen AE, Hanson LG, Ardenkjær-Larsen JH. Multi-site benchmarking of clinical 13C RF coils at 3T. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2020; 318:106798. [PMID: 32755748 PMCID: PMC7501735 DOI: 10.1016/j.jmr.2020.106798] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/17/2020] [Accepted: 07/23/2020] [Indexed: 05/06/2023]
Abstract
A quality assurance protocol for RF coils is proposed, which can be used for volume (Tx/Rx) and surface (Rx) coils. Following this protocol, a benchmarking of seven coils (from three different MR sites) dedicated to 13C MRI at 3T is reported. Coil performance is particularly important for 3T MRI at the 13C frequency, since the coil-to-sample noise ratio is typically high. The coils are evaluated experimentally using the proposed protocol based on MR spectroscopic imaging performed with two different phantoms: one head-shaped, and one with cylindrical shape and nearly twice the volume of the first one. To achieve an unbiased SNR comparison of volume and array coils, coil combination was done using sensitivity profiles extracted from the data. SNR, noise correlation matrices and example g-factor maps are reported. For globally calibrated, equal excitation angles, the measured SNR shows large differences for the volume coils of up to 115% at the phantom center for a head phantom. The arrays show lower differences in superficial SNR. The sample surface depth at which the volume coils outperform the arrays is estimated to 7 cm, and SNR furthest away from the coil surface is 28% lower for the best array compared to the best volume coil. A broad set of coils for 13C at 3T have been benchmarked. The results reported, and the method used to benchmark them, should guide the 13C community to choose the most suitable coil for a given experiment.
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Affiliation(s)
| | - Rie B Olin
- Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Mary A McLean
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Christoffer Laustsen
- MR Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Adam E Hansen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars G Hanson
- Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark
| | - Jan Henrik Ardenkjær-Larsen
- Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark; GE Healthcare, Brøndby, Denmark.
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Ardenkjaer-Larsen JH. Hyperpolarized MR - What's up Doc? JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2019; 306:124-127. [PMID: 31307893 DOI: 10.1016/j.jmr.2019.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 07/04/2019] [Accepted: 07/08/2019] [Indexed: 06/10/2023]
Abstract
Hyperpolarized MR by dissolution Dynamic Nuclear Polarization (dDNP) appeared on the scene in 2003. Since then, it has been translated to the clinic and several sites are now conducting human studies. This has happened at record pace despite all its complexities. The method has reached a pivotal point, and the coming years will be critical in realizing its full potential. Though the field has been characterized by strong collaboration between academia, government and industry, the key message of this perspective paper is that accelerated consensus building is of the essence in fulfilling the original vision for the method and ensuring widespread adoption. The challenge is to gain acceptance among clinicians based on strong indications and clear evidence. The future appears bright; initial clinical data looks promising and the scope for improvement is significant.
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Affiliation(s)
- Jan H Ardenkjaer-Larsen
- Technical University of Denmark, Department of Health Technology, Denmark; GE Healthcare, Denmark.
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