Proof-of-Concept Study of Hyperpolarized [1-¹³C]Pyruvate MRI in Participants with Hepatocellular Carcinoma.

Authors

Uffe Kjærgaard, Nikolaj Bøgh, Malene Aastrup, Mattias Hedegaard Kristensen, Nichlas Vous Christensen, Kim Sivesgaard, Steffen Ringgaard, Lotte Bonde Bertelsen, Esben Søvsø Szocska Hansen, Henning Grønbæk, Gerda Elisabeth Villadsen, Christoffer Laustsen

Published in

Radiology. Imaging cancer. Volume 8. Issue 5. Pages e250784.

Abstract

Purpose To assess the feasibility of hyperpolarized [1-¹³C]pyruvate MRI (HP-MRI) as an adjunct to standard CT/MRI-based Liver Imaging Reporting and Data System (LI-RADS) categorization for noninvasive metabolic characterization of hepatocellular carcinoma (HCC). Materials and Methods This prospective, exploratory, single-center study included participants with liver lesions and control participants who underwent HP-MRI between June 2023 and June 2025. Lesions identified on CT and/or MRI scans were categorized according to LI-RADS. HP-MRI metabolic readout included ratios from dynamic ¹³C imaging, such as the lactate-to-pyruvate (L/P) ratio, alanine-to-pyruvate (A/P) ratio, alanine-to-lactate (A/L) ratio, and corresponding tumor-to-background ratios (TBRs). Established HCCs were compared with indeterminate lesions that subsequently progressed to HCC using unpaired t tests and Hedges g. Results Fourteen participants were included (median age, 64 years; IQR, 53-70 years]; 14 [100%] male): 10 participants with lesions on CT/MRI scans and four control participants. A/P and A/L ratios were lower in indeterminate lesions that progressed (n = 4) than established HCCs (n = 5), both in absolute measures and indexed to TBRs (P < .05), whereas there was no evidence of differences in the L/P ratio. In contrast, L/P TBR was higher in indeterminate lesions that progressed than in established HCCs (P = .03). Alanine-indexed TBRs showed large effect sizes, with Hedges g ranging from 2.01 (95% CI: 0.33, 3.70) to 3.02 (95% CI: 0.97, 5.08). One LI-RADS category 3 (LR-3) lesion under surveillance showed no early progression, and progression could not be confirmed for an LR-4 lesion. Conclusion Adjunctive HP-MRI provided complementary lesion-level metabolic information beyond standard CT and/or MRI, and a reduced A/L ratio emerged as a candidate marker of malignant progression. Keywords: Liver, Oncology, Cirrhosis, Hepatocellular Carcinoma Supplemental material is available for this article. Clinical Trials Information System hosted by the European Medicines Agency (EU-CTIS 2024-512490-27-00) © RSNA, 2026.

PMID:
42663532
Bibliographic data and abstract were imported from PubMed on 28 Aug 2026.

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