Hyperpolarized [1-13C]-pyruvate MRS evaluates immune potential and predicts response to radiotherapy in cervical cancer

EUROPEAN RADIOLOGY EXPERIMENTAL(2024)

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摘要
Background Monitoring pyruvate metabolism in the spleen is important for assessing immune activity and achieving successful radiotherapy for cervical cancer due to the significance of the abscopal effect. We aimed to explore the feasibility of utilizing hyperpolarized (HP) [1-C-13]-pyruvate magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) to evaluate pyruvate metabolism in the human spleen, with the aim of identifying potential candidates for radiotherapy in cervical cancer. Methods This prospective study recruited six female patients with cervical cancer (median age 55 years; range 39-60) evaluated using HP [1-C-13]-pyruvate MRI/MRS at baseline and 2 weeks after radiotherapy. Proton (H-1) diffusion-weighted MRI was performed in parallel to estimate splenic cellularity. The primary outcome was defined as tumor response to radiotherapy. The Student t-test was used for comparing C-13 data between the groups. Results The splenic HP [1-C-13]-lactate-to-total carbon (tC) ratio was 5.6-fold lower in the responders than in the non-responders at baseline (p = 0.009). The splenic [1-C-13]-lactate-to-tC ratio revealed a 1.7-fold increase (p = 0.415) and the splenic [1-C-13]-alanine-to-tC ratio revealed a 1.8-fold increase after radiotherapy (p = 0.482). The blood leukocyte differential count revealed an increased proportion of neutrophils two weeks following treatment, indicating enhanced immune activity (p = 0.013). The splenic apparent diffusion coefficient values between the groups were not significantly different. Conclusions This exploratory study revealed the feasibility of HP [1-C-13]-pyruvate MRS of the spleen for evaluating baseline immune potential, which was associated with clinical outcomes of cervical cancer after radiotherapy.
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关键词
Carbon-13,Magnetic resonance spectroscopy,Radiotherapy,Spleen,Uterine cervical neoplasms
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