Fig. 4

Pyruvate metabolism in a recurrent glioblastoma and treatment-related changes (Patient 2, a and b) and anaplastic oligodendroglioma (Patient 1, c and d). An enhancing mass is located in the right cingulate gyrus (green oval) (a). The hyperpolarized pyruvate map shows high signal corresponding to the cortex/juxtacortical regions and superior sagittal sinus. The volume normalized pyruvate signal in the lesion is 1.3-fold higher than the entire brain. The HP lactate map shows mildly elevated signal corresponding to the lesion, similar to background lactate production by the brain. The volume normalized lactate signal in the lesion is 1.0-fold of the lactate over the entire brain (cortex and white matter) (b). The T2-FLAIR image shows an expansile left frontal mass and contracting right frontal hematoma. The left frontal mass has minimal, patchy enhancement and a small component of elevated plasma volume (green oval) visualized by DCE MRI (c). The HP pyruvate map shows high signal corresponding to the cortex/juxtacortical regions and superior sagittal sinus, but relatively lower signal corresponding to the small hyperperfused component. The HP lactate map shows mildly elevated signal corresponding to the hyperperfused component, similar to background lactate production by the brain (d). Cancer Res. 2018;78(14):3755–3760