Hyperpolarized 13C Pyruvate + Urea Dual Agent MRI Detects Hypoxia-Driven Metabolism Perfusion Mismatch in Patient w/ Aggressive Prostate Cancer

The first-in-human hyperpolarized 1-13Cpyruvate+13C,15N2urea dual-agent MRI demonstrated the safety and feasibility of simultaneous characterization of prostate cancer metabolism and blood flow as a two-minute addition to the standard 1H-multiparametric MRI. Metabolism-perfusion mismatch (i.e. elevated pyruvate-lactate conversion and decreased urea perfusion) in subregions of the high-grade prostate tumor was in agreement with the histopathological and immunochemical markers that reflected lethal phenotypes and their associated hypoxic tumor microenvironment. Correlative analysis of urea and Gadolinium-derived pharmacokinetic parameters found low correlation between the two, which indicates that HP 13C urea’s unique contrast mechanism offers independent information inaccessible through conventional 1H DCE-MRI.