Hyperpolarized [1-13C]pyruvate to [1-13C]lactate Conversion Rate with mpMRI to Distinguish Pathologically Aggressive Prostate Cancer

Motivation: There is a pressing clinical need to distinguish aggressive from indolent prostate cancer (PCa). Goal(s): This study's objective was to quantify the capability of Hyperpolarized (HP) [1-13C]pyruvate magnetic resonance imaging (MRI) to distinguish aggressive from indolent PCa. Approach: A prospectively enrolled patient cohort underwent 3T multiparametric 1H/HP13C MRI followed by prostatectomy and whole-mount histopathology. Multivariate logistic regression was performed to classify lesions. Results: Statistically significant differences for imaging parameters were observed between low-grade and high-grade PCa. The multivariate model including kPL, ADC, and DCE enhancement slope (ES) predicted aggressive disease with a ROC area under curve = 0.93. Impact: There is a pressing clinical need to distinguish aggressive from indolent prostate cancer (PCa). Hyperpolarized [1-13C]pyruvate magnetic resonance imaging in combination with 1H multiparametric MRI has demonstrated potential to identify aggressive disease with high accuracy.