Advanced Hyperpolarized 13C Metabolic Imaging Protocol for Patients with Gliomas: A Comprehensive Multimodal MRI Approach.

This study aimed to implement a multimodal H/HP-C imaging protocol to augment the serial monitoring of patients with glioma, while simultaneously pursuing methods for improving the robustness of HP-C metabolic data. A total of 100 H/HP [1-C]-pyruvate MR examinations (104 HP-C datasets) were acquired from 42 patients according to the comprehensive multimodal glioma imaging protocol. Serial data coverage, accuracy of frequency reference, and acquisition delay were evaluated using a mixed-effects model to account for multiple exams per patient. Serial atlas-based HP-C MRI demonstrated consistency in volumetric coverage measured by inter-exam dice coefficients (0.977 ± 0.008, mean ± SD; four patients/11 exams). The atlas-derived prescription provided significantly improved data quality compared to manually prescribed acquisitions ( = 26/78; = 0.04). The water-based method for referencing [1-C]-pyruvate center frequency significantly reduced off-resonance excitation relative to the coil-embedded [C]-urea phantom (4.1 ± 3.7 Hz vs. 9.9 ± 10.7 Hz; = 0.0007). Significantly improved capture of tracer inflow was achieved with the 2-s versus 5-s HP-C MRI acquisition delay ( = 0.007). This study demonstrated the implementation of a comprehensive multimodal H/HP-C MR protocol emphasizing the monitoring of steady-state/dynamic metabolism in patients with glioma.