aiming to do with this work is change
clinical practice, but we are a long way
from that right now. We are just taking
the ;rst steps in that direction.”
1. Ardenkjaer-Larsen JH, Fridlund B, Gram A, et al. Increase in
signal-to-noise ratio of > 10,000 times in liquid-state NMR.
Proc Natl Acad Sci U S A 2003;100( 18):10158-10163.
2. Rider OJ, Tyler DJ. Clinical Implications of Cardiac
Hyperpolarized Magnetic Resonance Imaging. Journal
of Cardiovascular Magnetic Resonance 2013, 15:93.
3. Rodrigues TB, Serrao EM, Kennedy BWC, Hu D-E, Kettunen
MI, Brindle KM. Magnetic resonance imaging of tumor
glycolysis using hyperpolarized C-13-labeled glucose.
Nat Med 2014; 20(1):93-97.
4. Serrao EM, Kettunen MI, Rodrigues TB, et al. MRI with
hyperpolarised [1-13C] pyruvate detects advanced pancreatic
preneoplasia prior to invasive disease in a mouse model.
5. Nelson SJ, Kurhanewicz J, Vigneron DB, et al. Metabolic
Imaging of Patients with Prostate Cancer Using
Hyperpolarized [1-13C]Pyruvate. Sci Transl Med
6. Cunningham CH, Lau JY, Chen AP, et al. Hyperpolarized 13C
Metabolic MRI of the Human Heart: Initial Experience.
Circulation Research, Sept 2016. Published ahead of print.
7. Hyperpolarized C- 13 pyruvate and other hyperpolarized
C- 13 substrates may only be used for human applications
under an approved research study (IND or equivalent). MR
data collection (including images and/or spectra) involving
hyperpolarized C13 compounds may require investigational
MR coils and MR system software.
for therapy monitoring in humans with
lymphoma, glioblastoma, breast, and
ovarian cancers. They have imaged one
patient and expect to image several
more in the next few months.
The challenge with 13C, he explains, is
the short lifetime of the polarization,
and therefore fast imaging sequences
must be employed to address this. “The
polarization is very short-lived, only a
20-30 second half-life, so we only have
2-3 minutes to get everything done—
from injecting the labeled material into
the patient, have it travel through the
blood stream to the target, and then
collect the imaging data very quickly,”
Professor Brindle says.
However, there is an enormous
bene;t: “The gain in sensitivity using
hyperpolarized 13C is huge. We are
talking about a 10,000-fold gain and
that, in any scienti;c technique, is
clearly a paradigm-shifting event. It
allows you to see things that you would
never have seen before.”
Cambridge is using spiral EPI-based
acquisitions and spatial spectral pulses
for selective excitations of individual
resonances. One of the key advantages
is that spectra have relatively few
signals and that is important when
rapidly acquiring a series of images.
“The key question now is what useful
clinical information can we get, and
that’s where we are at. I have no doubt,
based on the pre-clinical studies and
the ;rst published human clinical
trial, that we can image this signal in
patients. We have some idea of what
we can do with the technique, and now
we are looking to test that in the clinic.
“We are at the beginning of this journey,”
Professor Brindle adds. “What we are
Dr. Charles Cunningham, PhD, is a Senior Scientist of Physical Sciences at Sunnybrook Research Institute in Toronto, and an Associate Professor in the
Department of Medical Biophysics at the University of Toronto. He received his PhD in medical biophysics from the University of Toronto.
Sunnybrook Research Institute (SRI) is a fully a;liated research and teaching hospital with the University of Toronto. Research spans three Toronto-based
campuses: Sunnybrook Health Sciences Centre, Holland Musculoskeletal Centre and St. John’s Rehab. Total research funding for 2014/2015 was $96.6 million.
Kevin M. Brindle, FMedSci, is a Professor in the Department of Biochemistry and Cancer Research UK Cambridge Institute at the University of Cambridge.
The primary aim of his laboratory is to develop clinically applicable imaging methods that can be used to detect early tumor responses to treatment. Through
a partnership with GE Healthcare, his team is developing nuclear spin hyperpolarization as a novel tool for molecular imaging.
The University of Cambridge is a collegiate public research university in Cambridge, England. Founded in 1209, Cambridge is the second-oldest university
in the English-speaking world and the world’s fourth-oldest surviving university.
Damian Tyler, PhD, is an Associate Professor of Physiological Metabolism at the University of Oxford. He earned his MSci in Medical Physics and his doctorate
from the University of Nottingham. He is a British Heart Foundation Senior Research Fellow and a Tutorial Fellow in Medicine at Somerville College. He’s also an
associate member of the Cardiac Metabolism Research Group (CMRG) and leads the Oxford Metabolic Imaging Group.
Oxford University Medical School is the medical school of the University of Oxford. It is a component of the Medical Sciences Division, and teaching is carried
out in its various constituent departments. The Medical School was ranked 1st in the world by the 2016 Times Higher Education rankings of Universities for
Pre-Clinical, Clinical and Health Studies.
“The beauty of hyperpolarized 13C is that it can directly measure metabolism, and only cells that are alive can
metabolize, so we can potentially better stratify if
patients should be revascularized.„