Characterization of myocardial infarction by in vivo chemical exchange saturation transfer magnetic resonance imaging using natural D-glucose

Cardiac Magnetic Resonance Imaging (CMRI), the gold standard approach for characterizing myocardial infarction (MI), frequently relies on Late Gadolinium Enhancement (LGE) using gadolinium-based contrast agents (GBCA). Whereas novel GBCAs targeting specific molecules have not yet entered clinical practice, chemical exchange saturation transfer (CEST) MRI shows promise for detecting various endogenous molecules. This study explored the potential of natural D-glucose as a biodegradable MRI contrast agent for imaging MI on day 7 by employing glucose-weighted CEST MRI (glucoCEST). In vivo, the application of cardiac glucoCEST MTR asym (asymmetric magnetization transfer ratio) mapping delineated distinct pre- and post-glucose infusion states in both healthy (n=8) and MI-induced mice (n=6) at 9.4 T. This approach resulted in significant alterations in glucoCEST contrast, effectively identifying MI regions analogous to conventional LGE and immunohistochemical staining. Ex vivo mass spectrometry imaging confirmed elevated 13 C-glucose and gadolinium accumulation in the MI region after exogenous administration, suggesting the potential of glucoCEST MRI for MI detection. Our preclinical study on MI demonstrated that cardiac glucoCEST MRI utilizing natural D-glucose as a biodegradable contrast agent effectively differentiates between MI regions, Remote myocardium (RM), and healthy myocardium. The results were comparable to those obtained using LGE imaging.